Hip Labral Tear Treatment

What is the treatment of hip labral tear?
Depending on the severity of the pain and the stage of the disease the physician may prescribe injections and physical therapy.  Usually combining both provides the best clinical results. To control the pain the physicians may prescribe medications.

Surgical operation remains to be the last reserve for treatment where the physician sees no other choice. Surgical operation for hip labral tear (acetabular labral tear ) is called hip arthroscopy.
As a summary treatments of hip labral tears ( acetabular labral tears ) are:

1. Changing your life style and physical activities: This may prevent any further injuries. If your job requires you to sit for a long time; try to take little breaks every 20-25 minutes. Take a short walk. Changing positions and taking regular breaks are necessary. Improving your posture is necessary.  Improper posture when sitting, walking or running can put pressure on your labrum. You should keep yourself away from activities that take the hip through extreme or full ranges of motion.  Commit yourself to maintain your hip strength.

2. Pharmacotherapy: This is being employed to manage the pain caused by labral tear. Pain medications are being prescribed by the physicians. NSAIDs and acetaminophen are the alternative choices of therapy for control the pain. Glucosamines and condroitins are also being used as part of the pharmacologic therapy.

3. Physical Therapy:  Every hip labral patients should exercise.  This is a must to have step for the patient suffering hip labral tear. Dynamic lomber stabilization exercises and lower extremity strength training are most common exercises to help to strengthen the hip and increase the stability. Thus by making the regular exercises the patient may reduce the hip labral tear related symptoms. The exercises should be done under the supervision of a qualified  physiotherapist. He/she should provide you a good physical therapy program focusing on hip strengthening.

4. Injections: The most commonly used injections are corticosteroids. Corticosteroids are used to control the pain and inflammation. Hyaluronic Acid  is also being used as an injection for the treatment of hip labral tear.

5. Arthroscopic Surgery: Although it is the last reserve for a hip labral tear patient; if the symptoms go longer than one month without any improvement or the patient’s health status get worsen hip arthroscopy takes place as a surgical operation.  In this case the hip labral tear may be surgically treated with debridement which means trimming, removal or repair and reattachment.
There are 2 main surgical options:

1. Arthroscopy
2. Open labral surgery

Although each patient is different, recovery period may take 2-3 months. In some patients this may take up to 6 months with restricted activities. Your surgeon will provide proper guidance for this period together with a physiotherapist.  After a short period on crutches, the patient performs an exercise program under the supervision of mentioned physicians.
However keep in mind that even a repaired labrum may re-tear. Discuss the pros and cons of the surgery with your physician.

In medical practice, hip arthroscopy is frequently applied to outpatients.  General anesthesia is being employed. However this does not require a hospital stay.  Patients may return to sports after three months with the guidance of their physicians.

Non operative management of hip labral tears include:
1. Injections
2. Physical Therapy

What is the labrum?

The hip is a ball and socket joint.
The ball is formed of the top end of the thigh bone or femur. The labrum is a fibrocartilaginous structure on the rim of the acetabulum in continuity with the articular cartilage of the acetabulum. We know that the socket is formed of the pelvis bones and it is being also described as acetabulum.

What is the function of the labrum?

The labrum has a critical function that is responsible from hip stability. Labrum maintains the hip stability through deepening the acetabulum socket. Additionally it secures a seal of the hip joint.

What are the treatment options of labral tear?

Each patient is different. Thus the clinical episodes and experiences may alter from patient to patient. So does the treatment. While some patients may be treated by non operative treatments; other may need hip arthroscopy.

Non operative treatments include;

• Physical therapy
• Activity modification
• Medications
  o Anti-inflammatory drugs
  o Viscosupplement injections ( Synvisc, Hyalgan and others.. )

Operative treatments:

Hip arthroscopy:

It is a successful diagnostic and therapeutic tool for patients with hip labral tear (acetabular labral tear ) . If the patients still experience the symptoms despite the non operative treatments; physicans may decide to proceed with hip arthroscopy. With the help of hip arthroscopy, patient’s labrum may be repaired together with the other problems that are linked with hip joint.

What are the long term consequences of a labral tear?

Today it still remains as a question mark.  Opinion leaders in this field think that there is a strong link between arthritis in the hip and hip labral tears. However there is no solid evidence behind this thought. Current clinical data does not show such an interrelation between two disorders.

What is hip arthroscopy?

Hip arthroscopy is diagnostic and therapeutic tool that is being performed by a certificated surgeon where the surgeon uses an equipment which has a camera and through the little incisions it enables physicians to visualize the inside of a joint.
Hip arthroscopy uses similar instruments to knee arthroscopy. It is being clinically observed that patients who have hip arthroscopy generally return to their active life very quickly.

The benefits of hip arthroscopy includes:
• Enabling physicians for a better diagnosis
• Comprehensive assessment of the hip joint
• Supporting patients for a better treatment
• Providing a less painful procedure comparing to traditional surgery
• Accelerates the recovery period of the patients

What are the main risks of hip arthroscopy?

Hip arthroscopy is generally a safe operation without major complications.
However few complications may exist including:
• Infection: This is true for every surgical operation.
• Deep Venous Thrombosis
• Femoral neck fracture
• AVN of the femoral head
• Heterotopic ossification (abnormal bone formation in soft tissues)
• Nerve injury
• Nonunion
• Scarring/Adhesions

What is the minimally invasive treatment of labral tears?

Today we can say that arthroscopy is corner stone therapy for patients with hip labral tears (acetabular labral tears). This diagnostic and therapeutic tool enables the physician to observe and analyze the joint by simply inserting a micro camera. Thus the surgeon easily evaluates the injuries of the labrum and the joint. When there is a necessity, physician can use specific instruments that may be inserted into the arthroscope.  Whether the condition is mild to moderate or moderate to severe; this techniques is being applied for most cases of hip labral tears. During the operation the damaged part of the labrum is being eliminated.

It involves any flaps of cartilage which restrict the joint to mobilize.
After having a simple labral surgery, physicians recommend a physical therapy to increase and regain the strength and range of joint motion. Recovery period may change from patient to patient. Especially full  recovery period for  people who make sports like tennis may take up to 6 months.

What is the conservative care for Labral Tears?

Today we know that labrum has a rich blood supply. Thus it is being asserted that particular labral tears are healing on their own. Part of the general patient population may get benefit from the physical therapy ( in cases where tear is linked with impingement that the rotator cuff rubs on the labrum). If patient does not respond to the physical therapy  surgery may be considered.