Ask the Expert: Dr. Struan Coleman, Orthopedic Surgeon, Answers Your Questions on Hip Arthroscopy

by Dr. Struan Coleman
Dr. Struan Coleman, Orthopedic Surgeon

Q1. Will a hip arthroscopy fix a labral tear or will it eventually re-tear?

Hip arthroscopy is a minimally invasive surgical procedure used to treat a number of conditions of the hip joint, including labral tears, loose bodies, cartilage damage and bony impingement.  A torn labrum can usually be repaired with suture anchors during hip arthroscopy.  Once the labrum has been repaired and all bony impingement has been corrected there is a very small chance that the labrum will re-tear.  However, if the labrum is repaired without removing the bony impingement there is a high likelihood that the labrum will tear again.

Q2. In someone with FAI (femoro-acetabular impingement) (both cam and pincer), what is typically the maximum degree of femoral retroversion for which arthroscopic surgery can still be effective, rather than needing a femoral osteotomy to correct the retroversion?

Prior to recommending a patient for hip arthroscopy, many patients will likely undergo a CT scan of the hip to look for dysplasia.  Dysplasia is defined as an abnormal relationship between the femoral head (ball) and the acetabulum (socket).  Typically, dysplasia manifests as an under-coverage of the femoral head, either caused by a shallow acetabulum or a version abnormality in which the acetabulum is anteverted or retroverted. Dysplasia is a developmental condition and puts the patient with dysplasia at a higher risk of developing hip arthritis at a younger age.  When the hip dysplasia is severe, the patient is of an appropriate age and the cartilage in the hip is preserved, we may recommend an osteotomy (cutting of the bone) in order to correct the mismatch between the acetabulum and the femoral head.  The goal of an osteotomy is to prevent arthritis of the joint from occurring.  Hip arthroscopy, prior to or following an osteotomy, is peformed specifically to treat a torn labrum or to remove excess bone.

Q3. What are some complications that can occur with a hip arthroscopy?

There have been a number of complications reported following hip arthroscopy, including superficial wound infection, nerve injury and hip dislocation. Fortunately these complications are extremely rare.

Q4. How can a hip arthroscopy treat arthritis in the hips?

Hip arthroscopy is not indicated in the setting of advanced arthritis of the hip joint. One of the potential outcomes following hip arthroscopy, although rare, is that the patient goes on to develop arthritis requiring a hip replacement.  This arthritis is not a result of the arthroscopy, but rather occurs despite the arthroscopy and implies poor patient selection by the surgeon.  However, arthroscopy of the hip can be used to treat patients with focal cartilage loss in the joint.  During arthroscopy, a microfracture procedure is used on focal cartilage loss to stimulate the growth of a cartilage-like membrane.  Focal cartilage loss can occur in the setting of both cam and pincer impingement of the hip or as a result of a hip dislocation.

Q5. How long are the recovery and rehabilitation time following a hip arthroscopy for a labral tear?

In our practice, patients are on crutches with protected weight bearing for 1 to 2 weeks following hip arthroscopy.  Patients undergoing a microfracture procedure are on crutches for a longer period, sometimes as long as 6 weeks.  Patients can return to work and to normal activities of daily living quite quickly following arthroscopy of the hip; however, time to return to sports is usually 3 to 6 months and can in some cases take up to a full year.  A detailed rehabilitation program under the supervision of an experienced PT or ATC is critical to a favorable outcome following hip arthroscopy.  The rehabilitation program can last up to 3 months.

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The information provided in this blog by HSS and our affiliated physicians is for general informational and educational purposes, and should not be considered medical advice for any individual problem you may have. This information is not a substitute for the professional judgment of a qualified health care provider who is familiar with the unique facts about your condition and medical history. You should always consult your health care provider prior to starting any new treatment, or terminating or changing any ongoing treatment. Every post on this blog is the opinion of the author and may not reflect the official position of HSS. Please contact us if we can be helpful in answering any questions or to arrange for a visit or consult.

Comments

Sharon Blanton says:

How do you find a Dr.? I went to an Orthopedic Surgeon and he stated that there are a handful of Dr.’s that do this and he wants to do PT and injections for Piriformis and if that doesn’t work and he thinks the pain is from the tear. He will find me a Dr. I did have an MRI and there is a tear. I’ve had pain for 5 months. Any advice? I was thinking of a second option.

HSS on the Move says:

Hi Sharon, thanks for reaching out. If you are interested in care at HSS, please call our Physician Referral Service at 877-606-1555. They can assist you.

Michelle P says:

Hello. I have had arthroscopic surgery for labral tears in both hips with debridement of the tear rather than a repair (left-Nov 2008 & right-March 2013 both at Cleveland Clinic). I think I have re-torn my left labrum and am having the exact same symptoms but no injury. I did however have a total knee replacement of my left knee late June 2013 and have been doing quite a lot of therapy and now exercising on my own in pool and exercise bike a lot. I have 2 questions: Is is possible to re-tear the labrum and if so would surgical treatment be same 2nd time around? 2nd question: How would I be diagnosed since I am no longer able to have an MRI? Thank you.

HSS on the Move says:

Hi Michelle, thank you for reaching out. Dr. Anil Ranawat, Orthopedic Surgeon, says: “It is possible to re-tear the labrum, either acutely with a specific injury, or in a chronic, degenerative nature. It is likely that since your repair was over 5 years ago, you may have some degeneration of your labrum and some cartilage wear as well, which causes arthritis. This can present similar symptoms of a labral tear. While you can do a revision hip arthroscopy, if there is too much arthritis, it is likely more beneficial to do a hip replacement if the pain becomes bad enough. If you are basing the idea that you cannot have an MRI on the fact you had a recent knee replacement, this is not true. Most orthopedic implants today are MRI compatible, and having a knee replacement would not inhibit your ability to have an MRI, which would be the ideal test to evaluate the labrum and your cartilage. An x-ray, however, is a quick and easy test that can also evaluate cartilage wear and arthritis, though it is not quite as sensitive as an MRI. To help reduce your symptoms, you may want to modify some of your exercises, such as avoiding activities with high flexion and rotation of your hip.” It is best to consult with your treating physician. If you are interested in care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

Roberta says:

Hello,
I have had pain in left hip and in lower back and the left iliac . For the past 4 years. I just found out that I have a tear in left hip and a lot oh arthritis in lower back. The orthopedic surgeon tells me that we have to find someone to do the surgery.
I”m 1 and a half hours from Kanas City . Is their a surgeon you can refer me to?????

HSS on the Move says:

Hi Roberta, thank you for reaching out. We have sent your question to Westley Holiday, Coast to Coast (C2C) Program Coordinator. He should be contacting you shortly.

R says:

Hi there, I had a labrel tear repair last April and have to have a revision on it, next week. Is it safe to have the revision so soon (tear had got bigger) and is there anything that I should be extra caucious of post operation?

HSS on the Move says:

Hello, thank you for reaching out. Dr. Struan Coleman, Orthopedic Surgeon, says: “A revision labral repair one year after surgery is not unheard of, but sugests an undertreated bony deformity that has caused a re-tear of the labrum. Make sure that your surgeon has performed all the studies recommended in the literature prior to revision surgery, including a CT scan to look at the 3D morphology of your hip.” It is best to consult with your treating physician for a better diagnosis. If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

Ellen says:

Hello, I had a hip labral tear repair done in November 2013 with FAI with combination of lesions. I am four months post-op, but I fell on the side which was repaired. I have had severe pain prior to surgery. The tear was 35 years old as it was misdiagnosed for years. Is it possible when I fell on the side which was repaired – could I have dislodged the anchors (I have five) or tore it somewhere else within the labrum? My tear was 9 a.m. – 3 p.m. What should I expect when I return to my doctor? Thanks.

HSS on the Move says:

Hi Ellen, thank you for reaching out. For more information on labral tears of the hip, please visit http://www.hss.edu/condition-list_labral-tears-hip.asp. It is best for you to consult with your treating physician so they can better advise. If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

Christine Rossidis says:

I developed severe pain in my hips bilaterally 2 years ago running. In the past 2 years I was treated with rest, PT and acupuncture for pyriformis in combination with steroid injections. I am still in severe pain with the inability to sit for > 20 minutes and have terrible pain after doing tredmill walking or yoga. I recently went back to the original orthopedic who sent me for a pelvic PRI, which stated nondiplaced bilateral labral tears r>l. I s this an indication for surgery?

HSS on the Move says:

Hi Christine, thank you for reaching out. Dr. Struan Coleman, Orthopedic Surgeon, says: “Based on the information given, you should be evaluated and can be a possible candidate for hip surgery.” It is best to consult with your treating physician so they can further advise. If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

Jordan says:

I initially tore my labrum some time in November of 2012. I remember a pop in my hip with a lot of pain after I stepped down off a curb. I continued running on it but it eventually got bad enough that I went to the medics. After months of seeing them I finally got an MRI then eventually an MRA, and finally in August of 2013 I had surgery. I have since deployed despite some continued pain even after rehab that my surgeon thought might be caused by tightness of my iliopsoas tendon. I quit doing most physical activities as they were making my hip hurt. It goes numb when I sit certain ways or raise it above a certain angle. About a week ago, it popped again during pt and the pain is now worse, about on par to how it felt before surgery. I’ve been limping since. Is it possible I tore it again?

HSS on the Move says:

Hi Jordan, thank you for reaching out. Dr. Struan Coleman, Orthopedic Surgeon, says: “It sounds like you need to be reevaluated by a hip specialist. A hip can make a popping sound and be painful for a number of different reasons. A popping sound does not necessarily mean that you have re-torn your labrum. In addition, numbness may indicate that your back may be involved.” If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

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