Many different non-operative modalities should be tried first. These include anti-inflammatory medications, physical therapy, weight loss and walking assistance devices. There are operative alternatives to hip replacement in patients with certain causes of hip disease. Femoral osteotomies are usually done in children before the age of four and pelvic osteotomies are usually performed after the age of four. Patients with avascular necrosis may undergo either core decompression, bone grafting or osteotomy depending on the severity of the osteonecrosis.
Core decompression involves drilling holes in the femoral neck in order to get it to heal faster.
Osteotomies are performed to realign the femoral head and take the stress off the involved area. Bone grafting is performed to improve the blood supply to the femoral head. In the past, total hip replacements have been performed with cement. Results of these procedures have had relatively good outcomes. Success rates are very promising in the short term.