Profesionales médicos

May 14, 2026

Adolescent athletes have a higher incidence of symptomatic femoroacetabular impingement (FAI), hip dysplasia and avulsion fractures compared with the general pediatric population. Although activity modification remains an effective first line intervention for managing hip pain and functional impairment, it can be devastating for young athletes.

Surgical hip preservation offers an alternative. It can serve as a pathway to alleviate pain and preserve the native joint. It allows athletes to return to sports while delaying, or possibly even preventing, progression to painful arthritis and the future need for a total hip arthroplasty. Historically, concerns about open growth plates and the limited adoption of minimally invasive approaches posed challenges. But advances in pediatric hip preservation surgery are changing what's possible.

Pediatric orthopedic surgeons at Mayo Clinic Children's are leveraging advanced technology, refined surgical techniques and evolving minimally invasive strategies to address those challenges and expand hip preservation options.

Candidates for hip preservation

Hip preservation may benefit adolescent athletes with persistent hip pain despite conservative management, particularly those with FAI, dysplasia, or cartilage lesions and open growth plates. Early referral is important for athletes seeking pain relief, functional improvement and return to sport while preserving the native joint.

"The goal of hip preservation surgery for adolescent athletes is to delay arthroplasty while improving pain and function, enabling timely return to activity and high-level performance," says Emmanouil Grigoriou, M.D., a pediatric orthopedic surgeon specializing in hip preservation at Mayo Clinic Children's in Rochester, Minnesota. "Advances in surgical techniques and perioperative planning are transforming our ability to achieve that goal."

Addressing hip preservation challenges with advanced surgical techniques

Using innovative and minimally invasive techniques, pediatric orthopedic surgeons have overcome long-standing challenges in four hip preservation surgeries:

1. Hip arthroscopy

   FAI is a predominant hip injury in young athletes. While there have been concerns about performing hip arthroscopy in younger patients with open growth plates, surgeons are now treating young athletes with FAI safely with this procedure.

   "Precise surgical techniques enable us to safely distract the hip during hip arthroscopy," Dr. Grigoriou says. Advanced surgical techniques such as "venting" the joint or tractionless hip arthroscopy can be used for very young patients to avoid any disruption to the growth plate.

   Another concern associated with hip arthroscopy for FAI is bone regrowth after shaving the bone and reshaping the femur. Preventing bone regrowth or the formation of additional mature bone can be achieved through specific surgical techniques at the time of surgery. High doses of anti-inflammatory medication also may be administered postoperatively to prevent the growth of bone in the soft tissues, a condition known as heterotopic ossification.

2. Periacetabular osteotomy

   Periacetabular osteotomy (PAO) treats hip dysplasia by repositioning the acetabulum to improve femoral head coverage and durability of the hip joint. Because the triradiate cartilage does not fuse until a child is approximately 14 or 15 years old, orthopedic surgeons have historically waited until that closure to perform a PAO.

   "That historical guideline subjected patients to years of pain while waiting for them to become more skeletally mature," Dr. Grigoriou says. "Now we can perform the PAO and do it safely, even in younger patients with an open triradiate cartilage as early as 9 or 10 years old."

   Cutting through the triradiate cartilage prematurely closes the growth plate and halts further development of the acetabulum. However, research suggests that the impact is minor, with only minimal changes in acetabular development.

3. Surgical hip dislocation with osteochondral allograft transplantation

   Both osteochondritis dissecans (OCD) of the hip and avascular necrosis (AVN) of the femoral head are generally considered rare in the pediatric population. However, cases have been reported in adolescent athletes, typically those involved in high-impact, high-intensity sports, after repetitive stress on the joint or following traumatic injury, such as hip fracture or dislocation.

   The most significant concerns associated with traditional surgical approaches for OCD or AVN involve the ability to preserve the growth plate, blood supply and hip stability. All are critical for preserving the open femoral head growth plate and allowing for continued hip development.

   Surgical hip dislocation enables direct visualization of the femoral head without compromising blood supply. Replacing damaged cartilage and bone in the femoral head with a fresh donor osteochondral plug replaces the damaged cartilage, prevents collapse and restores joint mechanics, while allowing the growth plate to remain functional.

   "After coring out either the AVN or OCD lesions, we template the exact size and fill that defect by transplanting a custom-fit fresh-frozen cadaver bone and cartilage plug," Dr. Grigoriou says. "The surgical technique must be carefully planned to find the perfect graft match and meticulously executed to avoid injury to the growth plate and the blood supply to the femoral head."

4. Minimally invasive avulsion surgery

   Most avulsion fractures can be managed nonoperatively. But for young athletes, prolonged healing time may negatively affect their mental health and athletic development.

   The challenge has been that avulsion surgery is traditionally an invasive, open surgery involving a large incision. Considering surgical risks and recovery time, open avulsion surgery provides limited benefit for athletes.

   "The paradigm has shifted," Dr. Grigoriou says. "Now we can address avulsion fractures through a small percutaneous incision using intraoperative navigation. This minimally invasive approach enables us to fix acutely more, but not all, avulsion injuries than we would in the past. Shortened recovery time enables athletes an earlier return to their sport."

The role of advanced preoperative planning technology

Pediatric hip preservation requires precise and individualized surgical planning, especially in patients with open growth plates. Advanced technology plays a critical role in optimizing outcomes.

Key perioperative planning tools include:

• 3D anatomic modeling: Custom-built models of patient-specific anatomy created by Mayo Clinic's 3D Anatomic Modeling Laboratories provide presurgical visualization of complex hip preservation surgery. Printed models enable surgeons to fine-tune cuts prior to surgery. Watch this video to see a real-life use case for 3D anatomic modeling.
• Patient-specific cutting guides: Preoperative templating enables necessary corrections to be made on the computer prior to surgery. During surgery, cutting guides offer precise execution without the need for imaging. This limits radiation exposure.

Importance of lifelong follow-up after pediatric hip preservation

Pediatric patients are closely followed in the weeks and months after hip preservation surgery. Postoperative care involves multidisciplinary coordination among orthopedic surgeons, physical therapists and sports medicine physicians.

After initial recovery and return to sports, follow-up intervals gradually extend but continue for life. Transitioning to Mayo Clinic's Young Hip Clinic ensures continuity from pediatric to adult orthopedic care.

"Even though our hip preservation patients may do great after the surgery, there is still a potential risk of developing arthritis later in life," Dr. Grigoriou says. "Continued monitoring helps us identify signs of early arthritis and be proactive in treating these."

"With modern, contemporary techniques, our hope is that the vast majority of preserved hips in adolescents will do excellent long term," Dr. Grigoriou says. "Hip preservation surgery can improve a young patient's pain so they can be active and enjoy the years ahead of them. The secondary benefit is delaying and potentially preventing the need for hip replacement."

For more information

3D Anatomic Modeling Laboratories. Mayo Clinic.

Young Hip Clinic. Mayo Clinic.

Refer a patient to Mayo Clinic.