Hip Labral Tears
Overview
The hip is a ball-and-socket joint composed of the acetabulum (socket) and femoral head (ball). The labrum is a soft tissue gasket that is located at the edge of the socket. A normal hip joint has a delicate balance between normal range of motion and good stability. This balance comes from the depth of the socket, the shape of the ball, the soft tissue restrains surrounding the joint, and the muscles crossing the joint. Hip Impingement, or more specifically femeroacetabular impingement, refers to an imbalance in the shape of the femoral head and/or the depth of the acetabulum, which can create a conflict between these two structures. It is also possible for the hip to be more shallow than normal, a term called hip dysplasia.
Causes
The labrum is susceptible to damage from repetitive use and from traumatic events. The most common type of labral tear is from repetitive abrasion from hip impingement when it is pinched between the femoral neck and the acetabulum. This creates separation of the soft tissue labrum from its bony attachment and may create pain. Some people who have hip dysplasia (a shallow hip socket) are more susceptible to labral tears due to the increased stress on the labrum, which provides stability to the hip.
Symptoms
Individuals who suffer from hip labral tears may notice pain within the hip joint with specific activities when they place their hips in certain positions. The most common location of hip pain is in the front of the hip near the groin crease. Some patient will also have pain that radiates into the buttocks. Typically, deeper hip flexion, sitting for long times, and more vigorous sporting activities cause pain. It may be a dull ache at rest. Painful hip labral tears are almost always associated with an underlying bony abnormality such as hip impingement or hip dysplasia.
Diagnosis
A standard set of X-rays will measure specific parameters of the femoral head and acetabulum to determine if there is impingement or dysplasia. An MRI will show if there is also a labral tear. An ultrasound guided hip injection can verify that the pain is coming from inside the hip joint.
Treatment
Hip labral tears are relatively common, even in asymptomatic active individuals. When associated with cartilage degeneration (hip arthritis), the treatment is aimed at the underlying cartilage degeneration. When the hip joint is otherwise well preserved we will narrow our focus on the labral tear.
Physical Therapy
Strengthening the muscles around the hip and learning appropriate movement patterns can be effective in reducing pain from hip impingement. We always recommend a course of activity modification, home exercises, and as needed anti-inflammatory utilization as first line treatment.
Injections
An ultrasound-guided injection into the hip joint can help temporarily relieve symptoms from a hip labral tear. Cortisone and PRP can alleviate symptoms for a number of months, but typically is only a temporary measure. I oftentimes will also recommend a diagnostic injection of a numbing agent into the hip joint to make sure all of the pain you are experiencing is coming from the labral tear. Injections do not have the ability to heal a tear.
surgical management
When conservative measures are not relieving the pain in your hip you may be indicated for a surgical procedure. In general, hip arthroscopy is only indicated in patients who have preserved cartilage within the joint. Once the cartilage starts to wear out it may be too late to preserve the hip joint and a hip replacement might be a better solution.
Arthroscopic Treatment of Impingement. Most cases of impingement can be managed surgically with an arthroscopy, in a minimally invasive nature. I look inside of the hip using a special camera, and fix any labral tears at the same time. The area of impingement (CAM and/or Pincer) is then removed with a special burr under X-ray guidance. The idea is to restore a normal contour of the femoral head and neck and to leave a normal socket. Patients are made partial weight bearing for 4 weeks after surgery and can progress to running as early as 3 months post operatively.
Arthroscopic Hip Labral Repair. Labral tears most always occur in conjunction with hip impingement. Most tears are amenable to a repair, where special devices called suture anchors are placed at the edge of the socket and high-strength sutures are used to secure the labrum to the bony attachment. Hip arthroscopy is done on an outpatient basis with patients going home the same day. Patients will use crutches for 4-6 weeks after surgery.
Hip Labral Reconstruction. In cases where there is not enough labral tissue to recreate its normal function we sometimes will perform a reconstruction procedure. The goal of the reconstruction is to make a new labrum inside the hip joint. A piece of cadaver tissue is anchored around the socket to recreate the labrum.
Hip Arthroscopy in Salem, Oregon
Dr. Daniel Elkin is a leading Orthopedic Surgeon performing hip arthroscopy in the Willamette Valley. He specializes in minimally invasive techniques for a faster recovery after your labral repair and impingement procedure. He uses a post-free hip distraction system to minimize pain and traction related complications.