Hip Labral Tear | Anatomy and Symptoms
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The labrum of the hip is a cartilage ring around the acetabulum, which is the socket of the hip joint situated in the pelvis. The femoral head is the round ball at the end of the thigh bone that sits in the socket. The labrum deepens the hip socket and therefore has a significant role in keeping the femoral head in place while allowing for a large range of movement at the hip. A tear to the hip labrum can occur from an acute injury or from chronic wear, usually associated with some specific shapes of the hip. For example, the femoral head can be more oval than round, called a Cam lesion, or the socket can be too deep, a Pincer lesion. These are very common, and most people are unaware if they have either of these hip shapes, but these are associated with an increased risk of hip impingement pain and labral tears.
If the tear is large, complex or in a position that is likely to continue to cause problems for the individual, then surgery may be offered to repair the tear. Most labral hip tear surgery will be done arthroscopically (keyhole surgery). Hip arthroscopy labral tear surgery causes less damage to the surrounding tissue and has a faster rate of recovery than open surgery. Loose and damaged parts of the labrum may be removed, or areas may be sown together. In some cases, tissues from other parts of the body can be used if there are exposed areas from the removed labrum. In cases caused by hip impingement linked to the shape of the femoral head or acetabulum, these may be surgically altered, such as by shaving the head of the femur in order to make it more spherical to fit the acetabular socket better.
Arthroscopic hip labral tear surgery is a very successful surgery, with studies showing a success rate of between 80-90%. Meaning 10-20% of people still being in pain or having physical limitations after surgery or require further surgery. Some factors are associated with better outcomes, such as younger patients, specifically those under 40 years old doing better than older patients. Arthritis identified or confirmed during surgery was predictive of worse surgical outcomes (McCormick et al, 2012).
Many people who have hip labral tear surgery can return to their previous sporting levels with the correct post-operative rehabilitation.
Recovery from arthroscopic surgery for labral tear repair of the hip is typically around 4 months, and up to 9 months for full recovery, including the return to high-impact sports. The time needed to recover from hip labral tear surgery will depend on the surgical technique, the damage in the hip, as well as the individual’s age, health, strength and fitness. Most cases are sent home on the same day as surgery. Physical therapy should be started on the day of surgery with mobility of the hip. Movement can help the blood circulation of the leg, which is helpful for recovery and can also reduce the risk of blood clots, which are a risk following surgery. Physical therapy can then start to build your strength as well as direct you in terms of what activities you should be doing in different phases of your recovery, improving your recovery rate. For example, using a static bike early in your recovery (often from 2 weeks) can be helpful, but your physical therapist may advise that you have an upright trunk and limit the resistance you use, to protect the surgical site.
Hip labral tear surgery will require time off work for recovery. Many people can return to work within two weeks. However, if the individual’s job is more physical in nature, they may need more time off.
If surgery has been performed arthroscopically, the scars from hip labral tear surgery will be very small. There are usually 3 or 4 incisions made around the hip, each about 1cm in length. These can fade very quickly following surgery. If open surgery is necessary, this will involve a larger incision to the front or side of the hip and thigh. The scar is usually 8-12cm in length, but it may be longer.
– Pain relief
– Increased range of movement
– Reduce the risk of further injury
– 80-90% success rate
– Low-risk surgical procedure
– Recovery time
– Cost of surgery and post-op care
– Surgery can be unsuccessful
– Risk of further tear if protocol is not followed
– General surgical risks: blood clots, infection, nerve damage
Depending on the specifics of the injury, age and health of the joint, as well as the age of the patient and their physical demands for their hip, hip replacement surgery may be recommended over labral tear repair surgery. If there is significant arthritic wear and tear to the joint surfaces along with a labral tear, this can be a good option to provide pain relief. However, this surgery comes with limitations. Repetitive high-load activities can wear the prosthetic joint faster, so surgeons and physical therapists usually advise against lots of running, heavy weight lifting and competitive sports.
This is an interesting Hip Labral Tear Surgery Recovery Blog, written by Courtenay McFadden, about her personal journey. She is a 2x USA World Championship team member in Cyclocross and multiple top 5 finisher at Cyclocross Nationals and Pan American Championships and went through hip labral tear surgery twice.
This is not medical advice. We recommend a consultation with a medical professional such as James McCormack. He offers Online Physiotherapy Appointments.