If a hip labral tear causes significant hip pain and symptoms do not improve with medical treatment or therapeutic injections, NYU Langone doctors may recommend surgery to repair or reconstruct the labrum and fix any underlying structural abnormality that may have caused the labral tear.
For instance, our doctors may surgically reshape the bones in the hip joint so that they fit smoothly together in addition to repairing the labrum. This can improve the hip joint’s function and relieve pain caused by the friction between these bones. Because this friction can also cause progressive damage to the joint’s cartilage and lead to the development of hip osteoarthritis, surgery can help to ensure long-term hip joint health.
Orthopedic surgeons at NYU Langone may recommend one of several surgical techniques to repair a hip labral tear. You and your doctor can discuss which technique is most appropriate for you. Many factors are considered, including your age, the extent of the structural abnormality in the hip joint, the presence of cartilage damage in the hip joint, and whether you’ve had previous hip surgery. These procedures are performed using general anesthesia.
In hip arthroscopy, a surgeon accesses the hip joint through very small incisions, minimizing damage to nearby muscle and other soft tissue. Hip arthroscopy is almost always an outpatient procedure, meaning you can expect to return home on the day of surgery. Our doctors use this minimally invasive technique to repair a torn labrum whenever possible. Most people in good health are candidates for arthroscopic surgery.
To perform arthroscopy in the hip, a surgeon makes several small incisions in the skin above the hip. He or she then inserts a pencil-sized instrument called an arthroscope into one of these incisions to position it in the joint. The arthroscope has a light and a camera lens at its tip. Live images of the inside of the hip are broadcast on a monitor, allowing the doctor to accurately navigate the joint.
After the arthroscope is positioned correctly, the surgeon uses instruments that are inserted through a second small incision to reattach the torn labrum to the acetabulum, the bowl-shaped socket in the pelvis. He or she accomplishes this by implanting small plastic or metal “anchors” into the rim of the joint socket. Sterile thread is looped through these anchors and around the labrum, securing the labrum firmly in the correct position. The repaired labrum restores the seal around the hip joint, improving joint function.
NYU Langone surgeons may also reshape the bones of the joint during arthroscopy, using a small metal tool to shave down any bone growths or irregularities. This may be necessary, for instance, if the labral tear is caused by unusual contact with the bones of the joint, a condition called hip impingement syndrome. After the procedure is complete, the incisions are closed with dissolvable stitches.
Arthroscopic surgery is almost always an outpatient procedure, and you can expect to go home within hours of surgery. Most people are able to walk with crutches almost immediately after the procedure. Our pain management specialists ensure you have the medication you need to remain comfortable during recovery.
Doctors recommend using crutches for two to three weeks, and your surgeon schedules a follow-up appointment for two weeks after surgery to remove stitches and confirm that the incision wounds are healing normally. Your surgeon also examines your hip and asks you to rotate your leg gently in different directions to assess its range of motion after surgery.
Our doctors recommend starting physical therapy in the days after surgery. Physical therapy helps you to rebuild muscle strength, flexibility, and range of motion in the hip.
If your doctor determines that you have a torn labrum and structural changes in the hip joint that affect areas of the femoral head or acetabulum—the “ball-and-socket” that make up the hip joint—that cannot be accessed using an arthroscopic procedure, he or she may recommend a surgical hip dislocation. This procedure has the advantage of giving surgeons open access to the entire hip joint, making repairs easier.
A surgeon makes an incision at the side of the hip and moves aside a small part of the upper femur, or thigh bone, so that he or she can better access the hip joint. The surgeon puts the bone fragment back into place after the joint is repaired.
Using various instruments, the surgeon reattaches the torn labrum to the socket using plastic or metal anchors that are implanted into the rim. Sterile thread is then looped around the detached labrum and through the anchors, firmly securing the labrum into place. The surgeon may also reshape the femoral head and acetabulum during surgery, using a small metal tool to shave down irregularities in the bones.
Finally, the surgeon uses two or three metal screws to secure the femur bone fragment back into place. The incision is closed with stitches or staples.
After the anesthesia wears off, you may feel pain at the site of the incision. This is normal, and NYU Langone pain management specialists immediately work with you to make sure you are comfortable while your body heals.
As soon as you feel capable, NYU Langone physical therapists help you to stand and walk. They may provide crutches or a walker to help you avoid putting weight on the hip. Getting out of bed and standing or taking a few steps is important to retain strength in your muscles and joints and to avoid complications, such as deep vein thrombosis, a clot that obstructs blood flow, from occurring as a result of inactivity. Our doctors recommend starting physical therapy during the first week of recovery to rebuild muscle strength, flexibility, and range of motion.
Most people leave the hospital after one to three days and return to have the stitches removed and for a follow-up examination about two weeks later. Crutches are required for approximately six weeks, and over-the-counter or prescription pain medication may be recommended to relieve pain at the site of the incision and in the hip while the tissue heals.
If the existing labrum is in such poor condition that it cannot properly protect the hip joint, doctors may recommend a labral reconstruction. This procedure may be performed during arthroscopic surgery or during surgical hip dislocation.
Doctors first trim away the damaged parts of the labrum and then attach healthy tissue onto the rim of the acetabulum. This tissue may be obtained from another part of your body—often from the hip—or from a tissue bank that provides donor tissue. Doctors then implant small anchors into the rim of the acetabulum and use sterile thread to connect the anchors to the healthy tissue. This ensures that the labrum stays in place and provides a tight seal for the hip joint.
Over time, the implanted tissue grows into the labrum and surrounding tissue, helping to restore function in the hip.
Recovery from labral reconstruction varies, depending on factors such as whether surgery was arthroscopic or open, the extent of the damage to the labrum, and whether other surgical procedures—for example, reshaping the bones in the joint—were performed at the same time. Our doctors and rehabilitation specialists tailor a postoperative care plan to your needs and goals.
In periacetabular osteotomy, your surgeon repositions the acetabulum in order to provide a better fit for the femoral head. If the acetabulum is too shallow, the “ball” of the femoral head can’t fit snugly into the hip joint, causing instability and dysfunction. This misalignment is common in people with hip dysplasia.
The surgeon first makes an incision on the front of the hip to access the joint. He or she then makes several cuts in the pelvic bone, separating the socket-shaped acetabulum from the rest of the pelvic bone. The acetabulum is rotated, so that it matches the alignment of the femoral head, and then attached to the pelvis in this new position with metal screws. The incision is closed with stitches or staples.
After surgery, you may remain in the hospital for three to four days while the bone begins to heal. During this time, our pain management specialists ensure that you recover comfortably and have the medications you need. In addition, NYU Langone physical therapists visit you and help you to stand and walk using crutches or a walker.
Your doctor schedules a follow-up appointment for two weeks after surgery to remove stitches or staples. Crutches are required for at least six additional weeks. Our doctors recommend starting physical therapy during the first week of recovery to rebuild muscle strength, flexibility, and range of motion.
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