Hip Labral Tear

A hip labral tear is an injury to the labrum, the cartilage that surrounds the outside 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 acts as a cushion and enables smooth movements of the joint.

Causes

A tear in the labrum of the hip can result from traumatic injury, such as a motor vehicle accident or sports such as football, soccer, basketball or 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, which 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 show any symptoms. 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

Your doctor will order certain tests to determine the cause of your hip pain.

X-rays of the hip allow your physician 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 help show the labral tears much clearer.

Injection of local anaesthetic 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 at that point.

Treatment options

Treatment for a hip labral tear will vary depending on the severity of the condition. People with a minor labral tear recover within a few weeks with the help of non-surgical treatments.

Conservative treatments include:

• Medications: Anti-inflammatory medications can be helpful in relieving pain and reducing inflammation associated with labral tears. Your doctor may also recommend cortisone injections to alleviate the pain associated with a hip labral tear.
• Physiotherapy: Physiotherapy that helps to improve hip range-of-motion, strength, and stability are also recommended.

However, severe cases may require arthroscopic surgery to remove or repair the torn portion of the labrum.

Surgery

Hip arthroscopy, also referred to as keyhole surgery or minimally invasive surgery, is a surgical procedure in which an arthroscope, a narrow tube with a tiny camera on the end, is used to assess and repair damage to the hip.

The surgery is performed under general, spinal or local anaesthesia.

Your surgeon will make 2 or 3 small incisions around the hip joint area. The arthroscope is inserted into the hip joint through one of the incisions to view the labral tear. The camera attached to the arthroscope displays the image of the joint on the monitor. A sterile solution will be pumped into the joint to get a clear view and room to work. Through the other incisions, specially designed instruments are inserted. Your surgeon repairs the torn tissue by sewing it back together or removes the torn piece all together, depending upon the cause and extent of the tear. After the completion of the procedure, the arthroscope and instruments are removed, and the incisions are closed.

Postoperative care

Following the surgery, you will be given instructions on caring for your incisions, activities to avoid and exercises to perform for a fast recovery and a successful outcome. Physiotherapy will be recommended by your doctor to restore your strength and mobility. Your doctor will also prescribe pain medications to keep you comfortable.

Risks and complications

Possible risks and complications specific to arthroscopic hip surgery include:

• Infection
• Deep vein thrombosis (DVT)
• Blood vessel or nerve damage
• Haemarthrosis (bleeding inside the joint)
• Failure to relieve pain