Friday, April 12, 2024

Labral Tear In Hip Surgery

Types Of Hip Labral Tears

Fixing a hip labral tear without surgery – Katie’s story

A hip labral tear can occur anywhere along the labrum. Doctors sometimes describe labral tears as anterior or posterior, depending on which part of the joint is affected:

  • Anterior hip labral tears: The most common type of hip labral tear. These tears occur on the front of the hip joint.
  • Posterior hip labral tears: These tears occur on the back of the hip joint.

How Is An Acetabular Labral Tear Diagnosed

Acetabular labral tears can be hard to diagnose. Studies show that, on average, people with labral tears of the hip go more than 2 years before getting a correct diagnosis.

Your doctor will give you a thorough evaluation, examining the hip, and getting you to flex and rotate your leg. You may need an MRI or other imaging tests to look for the tear. However, even with these tests, diagnosis is often difficult.

A more invasive way of diagnosing an acetabular labral tear is an arthroscopy, in which small incisions are made and a tool with a tiny camera is slipped into the hip to look at the labrum.

What Is Unique About Yale Medicine’s Approach To Hip Labral Tears

The providers in the Yale hip preservation program are experts in arthroscopic treatment of labrum tears, says Dr. Jimenez. They are on the cutting edge of treatment utilizing the most advanced techniques in labral preservation and treatment. They are also often use biologic injections such as PRP or stem cells to help augment their labral repairs and offer the best outcomes for their patients.

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Prolotherapy For Hip Labrum Tears

In our own research, Prolotherapy for hip labral tears was curative in 54% of the patients and overall relieved 80-85% of their pain, which in our experience will end up much better than surgical procedures, because the hip is now stable.

Prolotherapy is an injection technique utilizing simple sugar or dextrose.

Are There Different Types Of Hip Labral Tear

Hip Arthroscopy Doctor

There are two types of hip labral tear: one occurs at the front of the hip and another at the back of the hip. The two types are usually caused by different motions.

  • Anterior labral tears are the most common type of hip labral tear. This type of hip tear occurs at the front of the hip and is typically caused by repetitive pivoting and twisting.
  • Posterior labral tears occur at the back of the hip. This type of hip tear is less common and is caused by traumatic injuries that strain the back of the hip joint.

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What Are The Risk Factors For A Hip Labral Tear

  • Gender: Hip labral tears are more common in girls than boys, most likely because girls have higher rates of hip dysplasia.
  • High-impact sports: Sports that typically involve tackling, falling, or collisions increase an athletes risk of a tear in the labrum.
  • Rotating sports: Sports that require repeated twisting and rotation of the hip bone inside the socket, such as golf and softball, also increase an athletes risk of a labral hip tear.

What Causes A Hip Labral Tear

Hip labral tears can be caused by many things, including the following:

  • Structural ailments: Conditions that cause abnormal hip movement can also lead to hip labral tears. In femoroacetabular impingement , the femoral head doesnt fit into the socket properly. This imperfect fit can cause long-lasting groin pain and movement limitations. This is the most common cause of labral tears. FAI can affect people at any age. Without treatment, it can result in osteoarthritis in some patients.
  • Injury: Trauma to the hip can lead to a hip labral tear. This can happen to people who play certain sports that have repetitive and high-impact movements, such as ice hockey, football, soccer and golf.
  • Degenerative health conditions: Osteoarthritis is a chronic wearing down of the cartilage between the joints. As cartilage slowly erodes over time, it becomes more prone to tearing. Older age and excessive weight can increase a persons risk for developing osteoarthritis. People with osteoarthritis commonly have pain and stiffness in more than one joint .

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Diagnosis Of A Hip Labral Tear

Your doctor will order certain tests to determine the cause of your hip pain.

X-rays of the hip allow your physician to rule out other possible conditions such as fractures or structural abnormalities.

Magnetic resonance imaging may also be used to evaluate the labrum. An injection of contrast material into the hip joint space at the time of the MRI can help show the labral tears much clearer.

Injection of local anesthetic into the joint space is sometimes performed to confirm the location of the pain. If the injection completely relieves your pain, it is likely that the cause of the problem is located inside the hip joint.

How Is A Hip Labral Tear Diagnosed

What to Expect from Hip Arthroscopy Labral Tear Repair Surgery / FAI

To diagnose a hip labral tear, the doctor will do a physical examination. During the exam, the doctor may ask you to move your leg or walk around. How well you can move, and any pain you feel while moving, can help the doctor with the diagnosis.

Imaging tests can also help doctors diagnose a hip labral tear. The doctor may order the following imaging tests:

  • X-rays: X-rays can alert doctors to problems with the hip bones, such as femoroacetabular impingement, or osteoarthritis, that may contribute to a labral tear and a painful hip.
  • Magnetic Resonance Imaging : This test shows more details in soft tissues. An MRI can show where a labral tear is, and how severe it is.

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Causes And Risk Factors

Hip labral tears can be caused by degenerative or traumatic factors. Typically, tears in the labrum are caused by sports or other activities that involve the hip, such as soccer, ballet, football, ice hockey, or golf. Labral tears can also be associated with other conditions of the hip such as hip dysplasia or hip impingement.

Diagnosing A Labral Tear

Your doctor can do a physical exam to check your hips range of motion and determine where the pain is occurring, but you might need to have other tests done to be sure that the pain is being caused by a labral tear.

  • Diagnostic injectionYour doctor can inject an anesthetic into your joint to help diagnose the cause of your hip pain. If your pain is completely gone after receiving the injection, it confirms that a problem in your joint is the source of the pain. If you still feel pain after the injection, it could mean that something else is causing it.
  • X-rayAn X-ray can help your doctor get a better look at the bones in your joint. He or she will check the X-ray images for conditions that might be causing your hip pain, like FAI or dysplasia.
  • MRI scanAn MRI scan provides more detailed images of tissues in and around your hip joint. This will help your doctor determine the location and severity of the tear. An MRI can show labral tears even if you dont have any symptoms.
  • ArthroscopyAn arthroscopy is a surgical procedure that can be used both to diagnose and to treat certain hip conditions, including labral tears. Your doctor will insert a small camera into your joint to look for damage.

After determining what is causing your symptoms, your specialist will make a recommendation for treatment.

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Labral Tears After Age 40

There has also been controversy regarding the treatment of patients over the age of 40 who have labral tears. These patients must be approached very cautiously when considering hip arthroscopy.

While there are some situations where middle-aged people can find good pain relief with arthroscopic hip surgery, many do not have improvements with this type of surgery.

Studies have shown that people over the age of 40 have a higher rate of progressive arthritis of the hip joint, and the labral tear is likely an early sign of arthritis in the hip. Almost 20% of these patients ultimately end up having hip replacement surgery within a year and a half of undergoing arthroscopic hip surgery.

As is the case with many emerging surgical procedures, hip arthroscopy included, orthopedic surgeons are continually improving the understanding of which patients are most likely to benefit, and which are not, from surgical intervention.

It is clear that not every individual who has a hip labral tear needs arthroscopic hip surgery. In fact, nonsurgical treatment in many cases may be just as effective, and sometimes even more effective, than surgical intervention. Working to define which patients are most likely to benefit is an ongoing process.

It is clear that in almost all situations nonsurgical treatment should be attempted first and patients over the age of 40 should be considered very cautiously for a surgical treatment.

In This Video Ross Hauser Md Discusses Hip Labrum Surgery And Non

Hip Labral Tear

Summary points:

  • Caring Medical published research demonstrated that 2 out of the 3 patients in our study came to us after they had already been recommended for hip labrum surgery. We were able to successfully help them without surgery.
  • While many people do benefit from this surgery, we see many people for whom surgery was not a good long-term option.
  • The challenges with stapling or tacking the labrum are that the labrum tissue is designed to be resilient and flexible
  • In some patients, because of the severity of the tear, we would recommend Prolotherapy and PRP treatments. .

These are usually not the people we see in our office, we see the people whose conservative care mentioned above did not help them get back to work or the game.

Alice had a hip labral tear. After months of visiting the chiropractor with limited results, Alice had an MRI that revealed a hip labral tear. She was able to avoid surgery with Prolotherapy treatments. The significance of her tear required 7 Prolotherapy treatments. Results of Prolotherapy treatments vary among patients. Prolotherapy will not be effective for everyone.

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Growth And Healing Factors In Prp This Is What Makes Prp Work

A paper in the journal Clinical Cases in Mineral and Bone Metabolism describes the growth, healing, and repair factors found in platelet-rich plasma. These are the healing factors and what they do:

  • VEGF is the major regulator of vasculogenesis and angiogenesis and plays an important role in tissue regeneration. It does so by creating new highways of blood vessels for the healing factors to get to the site of the injury.
  • Transforming Growth Factor including TGF-b1 stimulates chondrocyte and decreases catabolic activity . There is also research to suggest that TGF-bi stimulates stem cell activity in the injured area.
  • So the concept is here. These healing growth factors in your blood are taken and spun, to separate out a platelet-rich plasma solution filled with these healing and growth factors, and then the solution is injected into your knee.

    Another Study: Concerns About Hip Labrum Mri And Surgical Recommendation

    If the above research was not enough, listen to what doctors at the David Geffen School of Medicine at UCLA wrote in the medical journal Skeletal Radiology. This should concern patients over the age of 50 who had an MRI or MRA for suspected hip labral tears and were recommended for surgery.

    • Arthroscopy for acetabular labral tears has minimal impact on pain and function in older patients, especially in the setting of concomitant osteoarthritis. Still, many physicians seek this diagnosis with magnetic resonance arthrography . . .

    Basically, the surgeons wanted to do hip labrum surgery, and are seeking an MRA , to justify the surgery.

    The radiologists of this study said this:

    • Given the high frequency of labral pathology and the questionable efficacy of an arthroscopic surgical intervention in older patients, MR arthrography should be primarily for those with minimal arthritis on radiograph and potential to benefit from surgery. If further imaging beyond radiographs is necessary for these patients, standard MRI may be a more appropriate imaging tool.

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    There Had Been Previous Concerns About Offering Hip Arthroscopic Surgery To Older Patients

    This is not exactly new information. There had been previous concerns about offering hip arthroscopic surgery to older patients. In 2017 doctors at the Department of Orthopaedic Surgery, School of Medicine, Kitasato University in Japan wrote in the Journal of Orthopaedic Surgery and Research about the high conversion to total hip replacement, but, selecting the right patients for hip arthroscopy could reduce the high conversation rate.

    In this study, the doctors investigated the clinical outcomes of arthroscopic surgery for the treatment of labrum tear and/or osteoarthritis in patients over 50 years of age. Overall, although the clinical outcomes generally improved, they contained cases in which conversion to total hip replacement occurred at a constant rate. One paper reported that patients aged 50 years or older could have hip arthroscopy if they were carefully screened as the results of this study did not see more conversations to hip replacement. However, nearly 35% of the successful hip arthroscopic procedures showed

    Lets turn to two other surgical studies:

    What Is A Labral Tear Of The Hip

    How to Fix a Hip Labral Tear Without Surgery

    A labral tear of the hip is an injury to the labrum a ring of cartilage on the socket part of the hip joint. Your hip joint is a ball-and-socket joint, composed of the ball, which is the top of your femur and a socket, which is part of your pelvis . The labrum helps keep the bones of the hip joint aligned and in place as you move. It also helps keep the joint fluid inside the joint to ensure frictionless motion.

    The extent of hip labral tears can vary. Sometimes, hip labrum can have mini tears or fray at the edges. This usually happens due to a gradual wear on the labrum. In other cases, a section of hip labrum can separate, or tear away, from the socket bone. These types of hip labrum injuries are usually due to trauma.

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    What Happens During Hip Labral Tear Surgery

    There are three main surgical procedures your orthopedic surgeon may perform during hip labral tear surgery. These are:

  • Debridement: the surgeon will trim and smooth frayed hip labral edges to remove the painful, damaged, and loose soft tissue.
  • Labral Repair: the surgeon will reattach the torn labrum to the hip socket joint.
  • General Repairs: the surgeon will repair any other damage they might discover, like bone abnormalities that need shape correction, wear and tear damage, and some labral reconstruction.
  • What Is Femoroacetabular Impingement

    FAI is a condition affecting the hip joint and is characterized by abnormal contact between the femoral head and the rim of the acetabulum leading to damage to the articular cartilage in the acetabulum, or to the labrum of the hip, or both. The labrum is a ring of cartilage that surrounds the acetabulum. Damage to the labrum and/or articular cartilage will likely cause pain. An abnormality in the shape of the femoral head or acetabulum, or both, may cause FAI. Activities that involve recurrent hip motion can increase the frequency of this abnormal contact.

    FAI can affect all age groups from the early teens to throughout adult life, and is being increasingly recognized as one of the predisposing factors for osteoarthritis of the hip. While hip arthroscopy may reduce the chance of developing osteoarthritis, it does not eliminate it. Arthroscopic hip surgery can be used to reshape the socket and/or the femoral head to prevent femoral acetabular impingement and aims to decrease the risk of developing osteoarthritis, as well relieving current painful symptoms.

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    Higher Success Rate Is One Of The Main Pros Of Hip Labral Tear Surgery

    The arthroscopic hip surgery success rate is around 85 to 90%. The operation is intended to help your hip function properly again, although it’s most successful at reducing pain. Hip labral tear surgery is often successful in treating the condition. In most cases, people experience a significant reduction in pain and an improved range of motion after surgery.

    Hip Labral Tear Causes

    Acetabular Labral Tear

    Hip labral tears can happen to anyone. Hip labrum can tear suddenly, as a result of an impact, or gradually. Causes typically include:

    • Repetitive hip motions and hip overuse
    • Traumatic hip injuries
    • Regular wear and tear of the hip
    • Deformities of the hip joint, such as hip dysplasia and abnormal bone shape that leads to hip impingement, can increase stress on the labrum.
    • Degenerative conditions such as osteoarthritis. The relationship between osteoarthritis and hip labral tears goes both ways: The erosion of cartilage caused by arthritis can contribute to a labral tear, and a labral tear can make you more likely to develop arthritis years later.

    Causes of hip labral tears may vary depending on the location of the tear. Anterior hip labral tears are usually caused by repetitive movements common in sports such as ballet, golf, football or hockey. Posterior hip labral tears are usually caused by traumatic injuries such as falls, accidents or high-impact sports injuries.

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    Imaging And Diagnostic Studies

    A series of standard radiographs are critical as part of the initial assessment to evaluate the patient for osteoarthritis, femoroacetabular impingement , and hip dysplasia. The imaging modality most commonly used to confirm a labral tear is an MRI or MR-Arthrogram . Multiple studies have demonstrated the superior accuracy of MR-arthrography as compared with standard magnetic resonance imaging for the diagnosis of labral tear. Intra-articular gadolinium has been shown to improve the sensitivity of diagnosing labral pathology. However, recent advances in standard magnetic resonance imaging, including the use of 3-Tesla magnets, has improved the accuracy in diagnosing acetabular labral tears with standard non-contrast MRIs.

    In cases where the diagnosis of a labral tear is equivocal or in which a tear has been diagnosed by MRI but it is uncertain whether the patients symptoms are related to the tear, an intra-articular injection of local anaesthetic combined with corticosteroid can be a useful diagnostic tool. If the patients symptoms improve with this injection, it can be assumed that the intra-articular pathology is responsible for the patients pain and symptoms.

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