Two top hip specialists cover hip anatomy, arthritis vs. non-arthritic pain, labral tears, hip arthroscopy, hip replacement, resurfacing, the direct anterior approach, and robotic surgery.
The hip is lined with cartilage which helps with gliding. If you're a baseball player, soccer player, or just running, a lot of power comes from the hip—it links the core to the lower extremities.
A healthy hip is one that doesn't hurt. You need strong musculature around it. If you have a pain generator in your hip—whether arthritis or other pathology—it affects how you walk and exercise, starting a chain of events that impacts your performance.
Important: Many people say "hip pain" but actually point to their lower back or buttock—that's often a low back issue, not a hip problem.
Dr. Pauyo: "I like to think about arthritic vs. non-arthritic pain. If someone has arthritis, they need to see Dr. Rodriguez. For me, it's everything that's not arthritis."
Dr. Rodriguez (arthroplasty): Hip replacement for end-stage arthritis
Dr. Pauyo (preservation): Slowing or preventing arthritis onset
When symptoms aren't clear, we use diagnostic injections of lidocaine (anesthetic) directly into the hip joint. Think of it like the dentist freezing your gums.
Key point: X-rays and MRIs tell you what you have, but treatment decisions are based on what symptoms you're experiencing. Having arthritis on imaging that doesn't hurt doesn't mean surgery.
A relatively new procedure (evolved over 20-25 years) where we use traction to access the hip and create space to look inside. We can address:
The labrum is the O-ring around the hip socket. When torn, the hip loses 10-20% of its stability. This creates pain and dysfunction.
Repair vs. debridement: Dr. Pauyo does 0% labral debridement. Studies show repair outcomes are far better because debridement doesn't restore stability—only repair reattaches the labrum to the socket.
More than 90% of hip arthroscopies involve combined procedures with bony work. Often there's extra bone on the femur or socket that causes impingement and tears the labrum.
We remove what's causing the symptom (tear) AND the offending factor (extra bone) to prevent further damage.
Results start declining after age 40 due to presence of arthritis. Dr. Pauyo operates on patients over 40, but pays very close attention to ensure no arthritis.
Caution: A generation of aggressive hip arthroscopy 5-10 years ago led to rapid degeneration in some patients—older patients with arthritis who were scoped when they shouldn't have been.
Dr. Pauyo: "I want to be transparent—no one can say that if I do hip arthroscopy I will prevent you from having arthritis."
There's an association between labral tears, cam lesions, and arthritis over time. Some data suggests we can delay it. But to prove prevention would require unethical studies where we don't treat patients who need treatment.
Dr. Rodriguez: "If we look at all surgical procedures—gallbladder, brain surgery, eye surgery—number one for restoring quality of life, longevity, and efficacy is cataract surgery. Number two is hip replacement."
It's called the Operation of the Century because it's life-changing for patients.
Old thinking: 7-10 years, only do it when you're in a wheelchair
Current reality: 20-25 years expected, often lasting longer
Every time we've predicted lifespan, we've been wrong—they last longer than expected. And revision surgery (redo) is safe and effective with modern techniques.
Dr. Rodriguez: "The idea of being 'too young' based on what the surgeon decides is the wrong answer."
If you're in your 50s with pain and ready for surgery, grinding it out for 2-4 more years doesn't change future outcomes. That patient should understand they may need another surgery, but why suffer for years?
Pain affects sleep, mood, marriage, exercise—many areas of life. Some patients say they'd rather die than continue with the pain.
Anesthesia: Low-dose spinal, no narcotics (less nausea), worn off within an hour
Blood loss: Tranexamic acid reduced transfusion rates from 40% to less than 1%
Walking: Same day, 3-5 hours post-surgery
80% recovered: By 6 weeks
Cane/walker: 2-4 weeks typically
Dr. Rodriguez: "The minute you wake up, you will have less pain than you have right now. You'll feel like you have a bruise on your thigh, but that deep gnawing sharp pain will literally be gone."
Dr. Rodriguez on Robotics: "Navigation has made me a better surgeon. I can put things where I want to put them. We're trying to put prostheses that last 20-30 years—you want to be accurate to the millimeter and degree."
ROSA Hip enables more accurate reaming, easier cup impaction, and intraoperative AI-assisted templating.
For patients with disease in both hips, bilateral surgery in one session is safe with the anterior approach. Tranexamic acid has mitigated blood loss concerns.
The benefit: Instead of recovering from one hip and making your "good side" the operated one, you get a new lease on life for both.
Instead of putting a stem into the femur, you put a cap on top. It's like a mixture between arthroplasty and joint preservation—resurfacing the top of the femur.
Benefits:
Metal-on-metal resurfacing was associated with metal ion issues in 2010-2012. The main culprit was actually metal-metal hip replacements (trunion corrosion), not true resurfacing.
Long-term monitoring hasn't linked elevated ions to cancer or major issues, but the perception has caused resurfacing to fall out of favor. Ceramic-on-ceramic resurfacing is now emerging.
Young patients with arthritis where you want something that could last 30-40 years. Dr. Rodriguez shares an example of a 16-year-old with post-traumatic arthritis (skeletal mature) who received resurfacing.
Important: You still need arthritis for resurfacing—it's not appropriate for labral tears or FAI without arthritis.
Old thinking: Cement was vilified
Reality: The problem was the plastic, not cement
Cement is excellent for weak bones (prevents fractures). In Europe, it's used more often. In North America, it's making a comeback. Typically used for patients 75-80+ or those with poor bone quality (e.g., on prednisone).
Ballet: While many dancers come with tears, they're often naturally selected for hip range/flexibility. Many have undercoverage (dysplasia) which leads to arthritis. Their issues are often overuse and weak muscles that can be addressed with physiotherapy.
Before surgery: Muscle bulk and mass is the #1 predictor of post-surgical outcomes. The more you work on soft tissues ahead of time, the better.
Dr. Pauyo on prevention: A lot more emphasis should be put on prevention. Their A2 Sports Medicine lab in Montreal uses 12-camera AI motion analysis to identify muscle imbalances.
Different providers serve different purposes: physiotherapists, athletic trainers, strength coaches, kinesiologists—all have different skill sets helpful at different stages.
Book a consultation with Dr. Pauyo (arthroscopy/preservation) or Dr. Rodriguez (replacement) to explore your options. Virtual appointments available across Canada.
