surgery for hip labrum
As a doctor who sees patients with labral tears, there’s allot of confusion among patients about what’s injured when they hear the word “labrum”. Think about the labrum as the lip around the socket where the ball of the femur bone (hip bone) inserts. I’ve seen a number of patients get surgery for a torn labrum in the hip, some with good results, some not so good. Why? One of the issues appears to be the very large amounts of traction that need to be pulled on the hip to get the arthroscope into the hip. This can cause the major nerve of the leg to loose the ability to transmit signals as well as extreme stretching of critical hip ligaments. The second reason likely has more to do with the same reason meniscus surgeries have recently come under fire, removing parts and pieces of a joint as part of what we medical types call “debridement” may sometimes cause more problems than it solves. For example, this removeal of important structural tissue from the hip may cause a retear of the hip labrum. How can a torn hip labrum cause problems in the first place? Realize that the labrum is one of the things that helps the hip bone (femur) stay in it’s socket. So a tear may cause small amounts of extrra motion, especially with movement out to the side (as in figure skaters, horse back riding, and gymnastics). So if the repair of the torn labrum in the hip can actually help the lip of the hip socket (labrum) mend without adding additional trauma, then the surgery will be sucessful. However, if it’s just a “cut out the bad part” type surgery, then it may make the problem worse. Is there a better way without surgery and pulling 80-100 pounds of traction? Yes, we’ve had good success with injecting the patient’s own stem cells into the tear in the labrum, which helps provide new tissue and heal the tear. This procedure can be done through an injection, without the need for surgery and as a result, with much quicker recovery and less down time.
Joint Preservation Blog 
Hi Doc,
Interesting information you have on your site, particularily in reference to the hip labrum. I was intrigued by the title of your blog as well, “Joint Preservation,” as this is and has been the focus of my hip experience to date.
As a hip patient who has already undergone 6 hip surgeries on the same hip in the last few years…yet with recurrent, continued issues…I currently have no anterior labrum left after repeat debridements (in addition to other things, as listed under “hip surgeries I’ve had” on my blog).
I mention this because I wonder if there is any particular chance of regrowth of an absent labrum?
I am also somewhat familiar with information regarding some orthopedists who are now utilizing other soft tissues as labrum ‘replacements’, such as using part of the tensor fascia lata. Do you have any comment on these procedures?
Also, in regards to cartilage delamination in the hip secondary to dysplasias and femoroacetabular impingements, some orthopedists offer microfracture to generate stem cells to promote new, but different, cartilage growth. Are you involved with this procedure at all?
Thanks for your answers in advance. Feel free to email me directly at superhipchick72@yahoo.com. My blog on FAI, DDH, PAO, and mroe from a patient’s perspective can be located at http://congenitallychallenged.wordpress.com/
Comment by superhipchick — January 13, 2009 @ 2:46 pm
If the labrum is gone, then regeneration using our current technology is likely difficult. Using TFL to rebuild might help, but I’d be cautious about the amount of traction that needs to be pulled to get that done, as this can cause issues. The other concern is that there may be another cause of your hip pain or at least other things that are a part of the picture. We see patients with low back and SI joint problems that go undiagnosed, yet these things are really causing hip pain. So I would make sure all of these things are investigated if you’re in a situation where your pain continues to return despite multiple surgeries. We are keeping track of a micro fracture plus mesenchymal stem cell study currently underway and the early data would suggest that adding the cells produces better cartilage than microfracture alone.
Comment by Chris Centeno MD — January 13, 2009 @ 4:34 pm
I had a recent MRI which revealed a labrum tear, and inflamed tendon, and an old fracture (healed) of my left hip. My pain though doesnt make sense to my doctor. I dont hurt in the groin area, but rather more on the side and going towards the left gludias maximus. They treated me for bursitis with 2 shots over a month and physical therapy. It didnt help relieve the pain. I also had a radiologist give me a steroid / numbing shot directly into the socket which relieved the side hip pain but only for 2 weeks. The doc is now talking traction / arthoscopis surgery but didnt sound too optimistic that it would help with the side pain. Im suffering and unsure what to do. Im a young athletic 40 that rides a stationary bike 5 times a week (60 min) and works out with weights. Im not ready to retire to the couch and live on painkillers
Comment by Jesse Andrews — May 7, 2009 @ 3:47 pm
Jesse,
It sounds like you may want to find a physician who can first identify the site of pain. The low back, SI joint, muscles, and ligaments can all cause the pain you’re describing. The doctor should be able to numb up these areas on x-ray to see if it eliminates your pain. Once that’s done, you’ll know where the pain is coming from and figure out how best to treat.
Comment by Chris Centeno MD — May 7, 2009 @ 4:05 pm
Ive been to 3 orthopedic doctors since July 2008. Two of them said it was simply bursitis and gave me injections. Neither injection helped.
I also have been seeing my internal medicine family doctor frequently. He has sent me to physical therapy numerous times where im treated with ice, stretching, accupuncture, and Iono something (steroid on a bandaid with a small device that pushes it into the tissue).
Finally my family doc sent me to the Hip specialist in Boise Idaho who said that my tear cant be causing side hip pain but there was a way to see for sure. He had a radiologist inject a numbing agent plus steroid into the hip socket. The thinking was that if my side and butt pain went away then somehow the labrum tear was causing that pain. The shot in fact did take away the side pain and butt pain. Although it only lasted two weeks.
The hip doc is now saying “lets go in and clean up the tear and hope that fixes the side pain for you”
Frankly Im at a loss on what to do. Ice and advil dont help much but surgery with traction doesnt sound like its a sure bet to help me.
Ive literally seen all the docs in my small town area plus the specialist in Boise and am out of options for opinions.
Comment by Jesse Andrews — May 7, 2009 @ 5:10 pm
Sounds like they may diagnosed it as coming from someplace inside the hip. Options we would consider in our patients would be injecting SynVisc into the hip under x-ray, prolotherapy, or a stem cell transplant. The surgery is a big deal, in that they pull large amounts of traction which causes the nerve in the thigh to loose it’s conduction during the surgery. In addition, “clean up” type surgeries in the knee have not been shown to be better than placebo.
Comment by Chris Centeno MD — May 7, 2009 @ 5:51 pm
The history is consistent with someone who would need an MRI as the next step. However, I would caution that an MRI alone doesn’t make the diagnosis, as the medical literature is chock full of studies where MRI findings are not associated with pain. In our practice, to make the diagnosis, we would inject numbing medicine into the hip under x-ray to make sure we could eliminate the pain before we trusted that the MRI was showing something that could be creating the pain. Other sources of hip pain include the low back and SI joint, just to name a few.
Comment by Chris Centeno MD — May 8, 2009 @ 12:58 pm