Hip Labral Tears

Labral Tear

A hip labral tear is an injury to the labrum, the cartilage that surrounds the outer rim of your hip joint socket. The hip joint is a ball and socket joint in which the head of the femur is the ball and the pelvic acetabulum forms the socket. The labrum helps to deepen the socket and provide stability to the joint. It also helps regulate fluid within the hip joint and that enhances smooth movements of the joint. When the labrum is torn, it can cause pain.

Causes

A tear in the labrum of the hip can result from traumatic injury, such as a motor vehicle accident or from participating in sports such as football, soccer, basketball, and snow skiing. These sports are associated with sudden changes of direction and twisting movements that can cause pain in the hip.  Repetitive movements and weight bearing activities over time can lead to joint wear and tear that can  ultimately result in a hip labral tear. Degenerative changes to the hip joint in older patients can also lead to a labral tear.

Symptoms

Many patients with a hip labral tear do not have symptoms, and may not require treatment.  However, some patients may experience pain in the hip or groin area, a catching or locking sensation in the hip joint, or significant restriction in hip movement. 

Diagnosis 

Dr. Dumont specializes in hip injuries, and will perform a thorough assessment to determine the cause of your pain and propose appropriate treatment options. The evaluation will include a discussion about the history of your hip symptoms, and the characteristics of your pain. Certain imaging studies will also be valuable in the diagnostic process.

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

Magnetic resonance imaging (MRI) 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 sometimes show the labral tears more clearly.   

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 (as opposed to the muscles and structures outside of the joint).

Treatment Options

Treatment for a hip labral tear will vary depending on the severity of the symptoms, and the associated bony conditions of the hip.   Patients with hip arthritis can often have associated degenerative labral tears, WHICH DO NOT REQUIRE

Conservative treatments include:

  • Medications: Anti-inflammatory medications can be helpful in relieving pain and reducing inflammation associated with labral tears.  Analgesic and cortisone injections to alleviate the pain associated with a hip labral tear may sometimes be useful.
  • Physical therapy: Physical therapy that helps to improve hip range of motion, and strength is also recommended.

Certain cases may require arthroscopic surgery to repair the torn portion of the labrum.

Surgery

Hip arthroscopy is minimally invasive surgery that uses small incisions to access the hip joint, evaluate for existing structural damage or abnormality, and correct damaged structures.  Although hip arthroscopy is performed through small incisions, substantial corrective procedures are often undertaken that often require considerable periods of recovery.

The arthroscope is a small, fiber-optic instrument consisting of a lens, light source, and high definition video camera. The camera projects an image of the inside of the joint onto a large screen monitor allowing the surgeon to look for any damage, assess the type of injury, and repair the problem.

Hip arthroscopy is performed under general anesthesia.  Traction is required to gradually separate the ball from the socket to allow the instruments to carefully enter the joint.

The surgery usually requires 2 to 4 small incisions about 1 cm in length around the hip joint.  The number if incisions may vary based on the type of work that is required.  Through one of the incisions an arthroscope is inserted. Along with it, a sterile solution is pumped into the joint to expand the joint area and allow clear visualization of the structures in the hip.

The larger image on the television monitor allows visualization of the joint to determine the extent of damage so that it can be surgically treated.  Surgical instruments will be inserted through other small incisions to treat the problem.

After the surgery, the incisions are closed and covered with a bandage.  Hip arthroscopy can result in swelling of the hip area and thigh after surgery, but this typically improves within a few days.

Post - Operative Care

Following the surgery, you will be given instructions on caring for your incisions, activities to avoid and exercises to perform for a smooth recovery and a successful outcome.  Physical therapy will be initiated to restore your strength and mobility.  Pain medication is also utilized to

Risks and Complications

As with any surgery, there are potential risks and complications involved. It is very important that you are informed of these risks before you decide to proceed with arthroscopic hip surgery. Possible risks and complications include:

  • Infection at the surgical incision site or in the joint space.
  • Nerve damage which may cause numbness, tingling, pain, and weakness.
  • Excess bleeding into the joint, a condition called hemarthrosis.
  • Blood clots may form inside the deep veins of the legs which can travel to the lungs (pulmonary embolism).
  • Bone formation in the muscles and soft tissues around the hip (heterotopic ossification).
  • Cartilage injury during surgery.
  • Persistent hip pain after your surgery.

  • American Orthopaedic Society for Sports Medicine
  • The Arthroscopy Association of North America
  •  American Academy of Orthopaedic Surgeons
  • International Society for Hip Arthroscopy