HIP LABRAL TEAR

A hip labral tear is an injury to the hip (acetabular) labrum, a fibrocartilaginous ring which attaches to the acetabular (socket) bony rim and encloses the femoral head beyond it’s equator.  It deepens the socket cavity, increasing the stability and strength of the hip joint. It continues across the inferior acetabular notch as the transverse acetabular ligament.

Causes

A hip labral tear may result from a traumatic injury (e.g. motor vehicle accident or significant fall) or from participating in sports, such as football, soccer, basketball, tennis, and even golf. These sports are characterized by requiring sudden changes of direction or twisting/torsional movements under load that can damage the labrum. Over time the repetitive nature of these stresses and weight bearing activities can result in tearing of the hip labrum, and even secondary damage to the adjacent acetabular (socket) rim joint surface cartilage.  Labral tears are also commonly seen in older patients with degenerative arthritic changes in the hip.

Symptoms

Many patients have a hip labral tear and are completely asymptomatic.  Others experience discomfort or pain in the hip or groin area, episodes of a catch or locking sensation in the hip, or restricted hip range of motion.

Diagnosis

Following a thorough history and physical examination, A/Prof Woodgate will order certain tests to determine or confirm the cause of your hip pain, and these may include:

• X-rays – These help to exclude other possible conditions that may be causing the symptoms, such as fractures or structural abnormalities.
• Magnetic resonance imaging (MRI) – This has become almost the gold standard for evaluation of labral tears, and with higher quality machines, no contrast injection into the joint is necessary.  These scans can also demonstrate other pathology in and around the hip joint.
• Injection of local anaesthetic (with or without steroid – This is occasionally used to confirm that the hip is the primary source of symptoms – if the injection almost completely relieves pain, even for a short period, the source of pain is likely inside the hip joint.

Treatment

Treatment options for hip labral tears will vary and need to be individualized, depending on the severity of the condition.  Minor tears may settle within a few weeks of conservative (non-surgical) management.

Conservative Treatment:

• Activity modification
• Medications – Anti-inflammatory medications may be helpful in reducing inflammation and pain associated with hip labral tears.  
• Intra-articular steroid injections – Occasionally used to alleviate pain (as well as being diagnostic due to the local anaesthetic injected at the same time).
• Physical therapy – Helps to improve hip strength, range of motion and stability. 

Surgery:

Surgery is indicated for hip labral tears that fail to respond to conservative measures. This usually involves hip arthroscopy.

Hip arthroscopy is a surgical procedure usually performed under general anaesthetic.   A/Prof Woodgate will make 2 or 3 small incisions over the outer and front regions of the hip joint area.  The arthroscope is inserted into the hip through one of these incisions, and is connected to a camera for viewing on a monitor.   Sterile fluid is pumped into the joint to maintain a clear view, and to dilate the joint allowing room for insertion of instruments.  Specifically-designed tools are used to remove (or repair) damaged areas of the labrum, cartilage or other structures.  At the completion of the procedure, the arthroscope and all instruments are removed from the hip joint.  The joint is injected with local anaesthetic and steroid to help settle any post-operative procedure inflammation, and the small surgical incisions are infiltrated with local anaesthetic.  The wounds are closed with sutures, and a pressure dressing is applied.

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(Left) Your surgeon inserts the arthroscope through a small incision about the size of a buttonhole. (Right) Other instruments are inserted to treat the problem.

Post-Surgery Care:

Most patients will stay overnight in hospital and receive peri-operative antibiotic prophylaxis to prevent infection.  Instructions on discharge the following morning will be directed towards wound care management (including timing for suture removal, analgesia for pain management, activities to avoid or modify, and a graduated exercise programme to restore strength and mobility.  Arrangements for subsequent follow-up review will be confirmed.  Of course, following discharge, if any issues develop or are of concern, it is imperative that you contact A/Prof Woodgate as soon as possible.