• Hip Labrum Tears / Hip Arthroscopy

      “A-Rod” isn’t the only one with hip pain. Many athletes, dancers, weekend warriors and non-athletes can suffer with pain in the hip from a tear of the labrum.  The labrum is a ring of cartilage circling the hip socket and aids in stability and reducing the stresses across the hip joint. Interestingly, women have a higher incidence of labrum tears than men.

      Mechanisms of Labrum Injury

      • Trauma: Such as a violent twisting or pivoting maneuver or a hip dislocation.
      • Repetitive overuse: Repetitive twisting or pivoting maneuvers such as golf, dancing, or hockey without a specific injury event.
      • Ligamentous laxity: Some people have very loose ligaments and this can lead to increased stresses and tears of the labrum.
      • Developmental Dysplasia of the Hip (DDH): The hip joint is a ball & socket joint. Some people have a shallow socket that doesn’t cover enough of the ball. This puts excessive stresses on the labrum and leads to tears.
      • Femoro-Acetabular Impingement (FAI): In some people the femoral head neck junction (the ball) or the hip socket develop in such a way that they impinge on each other in an abnormal fashion which leads to labrum tears.

      (A) Normal hip. (B) CAM impingement. (C) Pincer impingement. (D) CAM + Pincer impingement.

      Symptoms:

      • Groin pain
      • Clicking or snapping sensation in the hip
      • Pain with pivoting, twisting, squatting
      • Pain with sitting for extended periods of time

      Evaluation by the Physician

      • Review of the patient’s symptoms and activities.
      • Physical examination: There are several specific maneuvers the physician will perform to the hip to help determine if a labrum tear is the cause of the patient’s hip pain.
      • Diagnostic injection: Occasionally the physician will send the patient to get an injection (anesthetic and sometimes with steroid) into the hip joint under ultrasound or fluoroscopic imaging. If the pain resolves even for a few hours this indicates that the pain is emanating from the joint (i.e. labrum tear).

      Imaging

      • X-rays are helpful in evaluating Femoro-Acetabular Impingement (FAI), DDH and ruling out arthritis.
      • MRI is useful in identifying labrum tears, cartilage defects, Femoro-Acetabular Impingement (FAI) and ruling out arthritis. Often a dye is injected (arthrogram) to the hip joint at the time of the MRI.  This improves the accuracy of the MRI identifying labrum tears.

      This is an MRI showing a patient with a labrum tear and impingement problem. The arrow is pointing to the labrum tear. The white line represents the tear, the labrum is to the left of the line and the acetabulum is to the right of the line. In a normal hip, without a tear, there would be no white line. The arrowheads are pointing to the bony protuberance (CAM defect) on the femoral head which is causing impingement.

      Non-operative Treatment

      • Activity modification: Patients are advised to avoid activities requiring pivoting, twisting, and squatting. Patients can be educated by a physical therapist how to perform activities without aggravating the hip.
      • Physical therapy: Although therapeutic exercises will not heal a labrum tear they can improve the overall mechanics of the hip. This can lead to improved function and decreased pain.
      • Medication: Antiinflammatory medications (NSAIDS) can help relieve pain and inflammation. Patients with GI or cardiac disease need to consult a physician prior to taking these types of medications.

      Surgery

      There is a limited ability for the hip labrum to heal without surgical intervention. Recent advances in arthroscopic surgical techniques now allow specially trained orthopedic surgeons (Dr. Edmond Cleeman & Dr. Mark Klion) to repair labrum tears through 2 or 3 small portals around the hip. These procedures are performed in an ambulatory setting (patient goes home the same day).

      • Repairing the labrum: The torn labrum is reattached to the acetabular rim (socket).  Sutures are arthroscopically placed around the torn labrum and fixed to the acetabular rim with implants called anchors. These anchors are non-metallic.
      • Addressing Impingement: Bony impingement issues (FAI) can also be corrected arthroscopically.  The bony protuberances are reshaped using high-speed arthroscopic burrs.

      Post Surgery Care:

      • Partial weight bearing with crutches for 2-4 weeks
      • Occasionally a brace is used for 2 weeks
      • Ice is applied to the surgical area.
      • Pain medication
      • Physical therapy
      • Recovery can take 3-4 months before patients are ready to return to sports