How Successful Is Hip Labral Tear Surgery Really?
On this page:
- What is the hip labrum?
- What is a hip labrum tear?
- What is FAI?
- Can physical therapy help FAI?
- Can a hip labral tear heal itself?
- Will a cortisone shot help a torn hip labrum?
- What’s the hip labral tear surgery success rate?
What is the hip labral tear surgery success rate? What is the recovery time for labral hip tear surgery? Can a labral tear in the hip heal itself? What happens if a labral tear goes untreated? Will a cortisone shot help a torn hip labrum? Let’s dig in.
What Is the Hip Labrum?
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Before we can get into the hip labral tear surgery success rate, I need to provide some background. The hip joint is a deep ball and socket. Labrum is a Latin word that means “lip” hence the labrum is the lip around the socket of the hip joint.
This is a fibrocartilaginous (read tough fibrous tissue) rim. Unlike the labrum in the shallow shoulder joint which provides more of a stability function, the labrum in the deeper hip socket provides less of that function.
What Is a Hip Labrum Tear?
The hip labrum can get torn with wear and tear or trauma (1). While these can often be easily seen on MRI, we have to be careful when thinking about a labral tear as a common source of pain. Why? Research has shown that lots of people without hip pain have labral tears (2-4).
In fact, in one study, 69% of patients without hip pain had labral tears! Hence, if you develop hip pain and a later MRI shows a labral tear, you need to be very cautious about linking that labral tear to your pain.
If you have an MRI CD or link and want to see what’s on the images, watch my video below:
What Is FAI?
FAI stands for femooacetebular impingement which is the most common reason hips get arthroscopic surgery. This means that either bone spurs develop on the socket (pincer) or on the bottom of the ball (cam). A bone spur is just an area where the bone has grown bigger and not necessarily anything that is the cause of pain.
To see how the pincer type develops, check out my video below:
Again, we need to be really careful about thinking of these bone spurs as causing pain. For example, in one study, the pincer type was shown to be protecting the joint from further arthritic breakdown and not hurting the joint (13). In another study, more than 90% of healthy young adults without hip pain had one or more hip MRI findings of FAI (14).
Can Physical Therapy Help FAI?
Physical therapy can help FAI. For example, in one small study, hip and trunk stabilization exercises helped reduce pain and improve function (8). The focus should be strengthening the core muscles that control spine and hip stability.
Can a Hip Labral Tear Heal Itself?
The hip labrum can only heal itself in the very young (5). However, as discussed above, hip labral tears that don’t cause pain are very common. Hence, having a hip labral tear may not be as important as many surgeons claim. Meaning, you likely have many people you know who have no hip pain and who would have a labral tear if we were to perform an MRI on their hip.
Will a Cortisone Shot Help a Torn Hip Labrum?
Steroid shots like cortisone (aka corticosteroids) can help reduce inflammation, but they can also be very toxic to orthopedic tissues like cartilage (6).
For example, we have research that now shows that cortisone injected into a joint will increase the loss of normal cartilage in that joint. In addition, a 2014 study demonstrated that a cortisone shot given to treat hip pain in patients who had a labral tear was of limited benefit (7).
What’s the Hip Labral Tear Surgery Success Rate?
In one of the largest high-level studies to date comparing hip arthroscopy to physical therapy, there was no difference between the outcomes of the two groups (11). Meaning, surgery didn’t beat PT. In another study, patients with labral tears and FAI did better with the surgery than just physical therapy alone.
However, in another study where many research investigations were summarized, while patients reported earlier pain improvements with surgery, there were indications that the patients who had surgery did worse on residual hip pain and function in the long run (10). We also know that if the patient has any arthritis, the outcomes with hip surgery for labral tears or FAI are worse (12).
To summarize, the research on hip labral tear surgery success rates isn’t convincing at this point that surgery is definitely better than just physical therapy. Also, note that the gold standard research for this procedure would be a randomized controlled trial versus a faked procedure (sham). That research doesn’t yet exist.
The upshot? We really don’t have solid evidence that supports a robust hip labral tear surgery success rate. Hopefully, more research will add more clarity here. This is one of the reasons that as a physician, I generally don’t send these patients for this procedure.
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References
(1) Naraghi A, White LM. MRI of Labral and Chondral Lesions of the Hip. AJR Am J Roentgenol. 2015;205(3):479-490. doi:10.2214/AJR.14.12581
(2) Kumar D, Wyatt CR, Lee S, et al. Association of cartilage defects, and other MRI findings with pain and function in individuals with mild-moderate radiographic hip osteoarthritis and controls. Osteoarthritis Cartilage. 2013;21(11):1685-1692. doi:10.1016/j.joca.2013.08.009
(3) Duthon VB, Charbonnier C, Kolo FC, et al. Correlation of clinical and magnetic resonance imaging findings in hips of elite female ballet dancers. Arthroscopy. 2013;29(3):411-419. doi:10.1016/j.arthro.2012.10.012
(4) Register B, Pennock AT, Ho CP, Strickland CD, Lawand A, Philippon MJ. Prevalence of abnormal hip findings in asymptomatic participants: a prospective, blinded study. Am J Sports Med. 2012;40(12):2720-2724. doi:10.1177/0363546512462124
(5) Clement RC, Carpenter DP, Cuomo AV. Spontaneous Healing of a Bucket-Handle Posterior Labral Detachment After Hip Dislocation in a Five-Year-Old Child: A Case Report. JBJS Case Connect. 2018;8(2):e28. doi:10.2106/JBJS.CC.17.00133
(6) McAlindon TE, LaValley MP, Harvey WF, et al. Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial. JAMA. 2017;317(19):1967-1975. doi:10.1001/jama.2017.5283
(7) Krych AJ, Griffith TB, Hudgens JL, Kuzma SA, Sierra RJ, Levy BA. Limited therapeutic benefits of intra-articular cortisone injection for patients with femoro-acetabular impingement and labral tear. Knee Surg Sports Traumatol Arthrosc. 2014;22(4):750-755. doi:10.1007/s00167-014-2862-3
(8) Aoyama M, Ohnishi Y, Utsunomiya H, et al. A Prospective, Randomized, Controlled Trial Comparing Conservative Treatment With Trunk Stabilization Exercise to Standard Hip Muscle Exercise for Treating Femoroacetabular Impingement: A Pilot Study. Clin J Sport Med. 2019;29(4):267-275. doi:10.1097/JSM.0000000000000516
(9) Palmer AJR, Ayyar Gupta V, Fernquest S, et al. Arthroscopic hip surgery compared with physiotherapy and activity modification for the treatment of symptomatic femoroacetabular impingement: multicentre randomised controlled trial [published correction appears in BMJ. 2021 Jan 18;372:m3715]. BMJ. 2019;364:l185. Published 2019 Feb 7. doi:10.1136/bmj.l185
(10) Kierkegaard S, Langeskov-Christensen M, Lund B, et al. Pain, activities of daily living and sport function at different time points after hip arthroscopy in patients with femoroacetabular impingement: a systematic review with meta-analysis. Br J Sports Med. 2017;51(7):572-579. doi:10.1136/bjsports-2016-096618
(11) Mansell NS, Rhon DI, Meyer J, Slevin JM, Marchant BG. Arthroscopic Surgery or Physical Therapy for Patients With Femoroacetabular Impingement Syndrome: A Randomized Controlled Trial With 2-Year Follow-up. Am J Sports Med. 2018;46(6):1306-1314. doi:10.1177/0363546517751912
(12) Krych AJ, King AH, Berardelli RL, Sousa PL, Levy BA. Is Subchondral Acetabular Edema or Cystic Change on MRI a Contraindication for Hip Arthroscopy in Patients With Femoroacetabular Impingement?. Am J Sports Med. 2016;44(2):454-459. doi:10.1177/0363546515612448
(13) Agricola R, Heijboer MP, Roze RH, et al. Pincer deformity does not lead to osteoarthritis of the hip whereas acetabular dysplasia does: acetabular coverage and development of osteoarthritis in a nationwide prospective cohort study (CHECK). Osteoarthritis Cartilage. 2013;21(10):1514-1521. doi:10.1016/j.joca.2013.07.004
(14) Laborie LB, Lehmann TG, Engesæter IØ, Eastwood DM, Engesæter LB, Rosendahl K. Prevalence of radiographic findings thought to be associated with femoroacetabular impingement in a population-based cohort of 2081 healthy young adults. Radiology. 2011;260(2):494-502. doi:10.1148/radiol.11102354
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