The labrum, which surrounds the acetabulum, can be partially damaged or torn. This is usually associated with FAI, but not always so. It can also occur with hip dysplasia (a shallow hip socket), after an injury or trauma, or even from over-use. With hip arthroscopy, the labrum can be either repaired, or in some cases debrided (remove the damaged tissue only). Occasionally a labrum can also be reconstructed with a graft. MRI and/or CT scans usually, but not always, reveal a hip labral tear.
The hip labrum is strong fibrocartilaginous tissue that forms a rim at the socket of the hip joint. It acts as a shock absorber, lubricates the joint and distributes pressure equally. It deepens the socket increasing the stability of the joint and limiting movements of the head of the femur. Trauma, repetitive movements, or structural abnormalities like hip impingement, femoroacetabular impingement (FAI), or dysplasia can cause damage to the labrum or a labrum tear.
During hip arthroscopy, the hip labrum tear is repaired with sutures and suture anchors. A reconstruction of a torn hip is performed if the labrum tissue is damaged beyond repair. Labrum repair and labrum reconstruction may be performed through arthroscopic surgery, a minimally invasive surgery performed through a few small incisions.
The hip labrum is reconstructed either with tissue from a cadaver (allograft) or with tissue from the patient’s own body (autograft). Labral repair and labrum reconstruction can relieve pain associated with hip labrum tears and improves the stability of the hip joint by restoring the suction seal function of the labrum.
During the procedure, a slender illuminated tube with a camera called an arthroscope is inserted through a small incision and small surgical instruments are inserted through one or more similar incisions. Magnified images from the camera are relayed to a monitor which your surgeon uses to guide the instruments. Any damaged or inflamed tissue is first debrided from the hip joint. The labrum is then inspected, and then your surgeon will either recommend hip labrum repair or labrum reconstruction as necessary. This minimally invasive surgery takes about 1-2 hours to complete.
To control pain, your doctor will administer a local anesthetic injection at the end of the procedure. You will also receive a prescription for pain medications. Application of ice is recommended for pain and swelling. Following the procedure, you are advised to use crutches for 2 weeks for safety and stability, although weight bearing is allowed as tolerated. You should avoid hyperextending or hyperflexing the hip or any movement that causes hip pain. Mild range of motion exercises such as stationary bike riding is recommended from the day following surgery to prevent stiffness. A hip brace is recommended for use at night to hold the hip in a safe position. You should follow up with your doctor within a week and will then begin a physical therapy program to improve strength and flexibility of the hip joint. Thanks to the surgery for hip being minimally invasive a full recovery usually takes about 12 weeks.
Since the early 20th century, when hip arthroscopy was regarded as being almost impossible to undertake, the procedure has developed in leaps and bounds. Presently there are many reasons why hip arthroscopy may be recommended. Perhaps the two most common current indications for hip arthroscopy include the presence of symptomatic FAI or an acetabular labral tear or both.
FAI (or hip impingement) is a condition affecting the hip joint and is characterized by abnormal contact between the femoral head (hip ball) and the rim of the acetabulum (hip socket) leading to damage to the articular cartilage (lining) 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.
Hip dysplasia, or a shallow acetabulum (socket), can increase the stress on the acetabular cartilage and labrum with regular or increased activities. With a shallow socket, some of the force that would normally be placed on the socket is transferred to the labrum, which can lead to a labral tear. In cases of mild or borderline dysplasia, repairing the labrum can relieve the painful symptoms within the hip with arthroscopy. However, it does not deepen the socket. A shallow socket can increase the risk of developing osteoarthritis in the hip. The goal of a hip arthroscopy would be relieving the current painful symptoms in the hip. It will not eliminate the risk of developing arthritis. In cases of advanced dysplasia, larger reconstructive surgeries (like a periacetabular osteotomy or PAO) is an option to increase the coverage.
Hip dysplasia and hip impingement are opposite ends of a spectrum (over-coverage versus under-coverage). Please check with me if you are unsure about your underlying diagnosis.
Hip surgery is the last option when all conservative management fails. However, other treatments are available. These vary from no treatment, just living with the condition, to physical therapy exercises, medication or injections.
Stem cells are used in regenerative medicine to repair diseased or damaged tissues. While stem cell or PRP injections may not heal your hip on their own, there is emerging evidence that it can be used to augment and strengthen your surgical repair.
These treatments can be done during your surgery. Unfortunately, they are currently not covered by insurance. Please contact us if you would like more information or would like to include this with your surgery.
