The Reality of Hip Labrum Tear Surgery Results

by Chris Centeno, MD /

The hip joint is a ball-and-socket structure, and when a bone spur develops on either the ball or the socket, this is called a femoroacetabular impingement (FAI), or a hip impingement. With an impingement, the concept is that you have a misshapen ball or socket that is somehow damaging or creating tears in the labrum, a fibrous rim around the lip of the hip socket designed to add stability by helping to keep the femur securely within that socket. Surgeons like to go in and surgically reshape all of this, cut off the bone spurs and cut out or rebuild the torn pieces of the labrum, but is this a good idea? Let’s step outside of the surgeon’s world for a moment and take a look at the reality of hip labrum tear surgery results.

You might think that because these surgeries are so common and because your surgeon is recommending them, we must have lots of research that supports them. You would be wrong! What we actually do have is quite a bit of research that sheds some light on the reality of these surgeries and the lack of evidence to support them. I’ve shared many of these studies on this blog over the years, and now we have another study to discuss-one that reviews all of the prior research.

18 Studies on Surgery for Hip Impingement Reviewed

This recent study from April of this year was published in the prestigious journal Osteoarthritis and Cartilage. The authors reviewed 18 different studies on hip impingement surgery, and these were the best available studies they could find in this particular area. First worth mentioning is that the authors noted that most of the studies had a high risk of bias, meaning the surgeon performing the study wanted to see his or her hypothesis work. There isn’t any way to remove this bias; it’s just there. Is that automatically a bad thing? Depends on where you sit.

The authors concluded the following: “Although evidence supports improvement in symptoms after surgery in FAI, no studies have compared surgical and non-surgical treatment. Therefore no conclusion regarding the relative efficacy of one approach over the other can be made. Surgery improves the alpha angle but whether this alters the risk of development or progression of hip OA is unknown.” The authors went on to conclude, “This review highlights the lack of evidence for use of surgery in FAI.” What this means is that we don’t know if this type of surgery is going to reduce your likelihood of getting arthritis, even though, in my direct experience, that’s what many of my patients have been told. Given that the reduction in the likelihood of getting arthritis and needing a hip replacement is a huge motivator for the procedure, not knowing if this will really happen is troubling.

So maybe you’re saying, This is all fine and good, Dr. Centeno, but my hip really hurts, so I think I’ll go ahead and take my chances with the surgery. Why not? Well, there are a slew of why nots to consider, so grab a shovel, and let’s dig through a few.

The “Why Nots” of Hip Impingement and Hip Labrum Tear Surgery 

Certainly, in some extreme cases, surgery may be the only option; however, in my experience, this isn’t the majority. I have covered many reasons and studies over the years (a few links follow) that should clearly answer this question for the majority: Why would you skip hip impingement surgery and what do hip labrum tear surgery results actually look like?

  1. Hip labrum tear surgery results are poorer when the patient has hip arthritis, even if the arthritis is very minimal. This study also concluded that, in addition, arthritis worsened in 6 in 10 patients despite the surgery.
  2. Hip labrum tears seen on MRI may not be the cause of hip pain and, in fact, may just be incidental findings due to normal wear and tear. Labrum tears are also common in patients without pain, so having a labrum tear on MRI and having hip pain doesn’t automatically mean that it’s the tear that causing your pain. Many other things cause hip pain, most of these problems are not inside the hip joint.
  3. A recenet study showed that hip impingement surgery to remove bone spurs is really no better than doing nothing at all. The hip-socket bone spur is a good example. One study concluded that the bone spur isn’t causing the arthritis, but may actually be forming to protect the joint from arthritis. So if these spurs are leading to less arthritis, doing nothing may be the better option.
  4. Removing bone spurs that form as a result of instability may remove the one thing keeping the joint stable. When the hip joint becomes unstable, bone spurs form to stabilize the joint. So what happens when we saw off the bone spurs? Instability returns! And the joint now has the added stress of having to deal with the trauma of surgery.
  5. Physical therapy exercises may be able to help you fix your hip impingement and avoid surgery. The tilt of your pelvis can impact hip impingement. Tilting your pelvis forward results in more impingement and tilting it backward results in less impingement, according to one study.

The upshot? Why do we continue to saw off bone spurs, which protect our joint and provide stability, and cut out labrum tears that are part of normal wear and tear? Especially when none of this may even be the cause of hip pain? Now that you know the reality of hip impingement and hip labrum tear surgery results, you have a choice to make. Do you step back into that surgeon’s office or walk away? I know what I would do.

Category: Hip, Latest News, Videos

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18 thoughts on “The Reality of Hip Labrum Tear Surgery Results

  1. Eliz Patten

    This is very good info. explained simply to a persons understanding of this information.

    1. Regenexx Team Post author

      Thanks Eliz, that was the hope!

  2. Walt Rosendale

    I’m about to seek a surgeons advice on 9/1. I have a weakness in rt hip and occasionally the leg gives out and I lose balance but regain it quickly and there is a continual discomfort- I found the article interesting and gave me food for thought-will try phys ther first but it will be interesting to see what surg says-am 77 yrs old and have some recent x-rays to show him- he might want more like m r i

    1. Regenexx Team Post author

      Walt,
      An MRI would be important, but an exam to establish whether or not the hip is the source of the symptoms is essential as sometimes these situations can actually be low back problems. Here is a list of Physicians trained to do that type of exam: http://www.regenexx.com/find-a-physician/

  3. Roger Knox

    I certainly wish I could have these options discussed with my late mother and father. My mother had both hips replaced, with a reduction of pain and additional mobility for a period of a few years. Unfortunately, she had back issues such as spinal stenosis which worsened after the hip replacements and greatly restricted her mobility late in her life.

    My very active 91 y/o father had a undiagnosed hip injury and spinal stenosis which caused him substantial pain in his last year of life. The large doses of pain meds and lack of surgical options created a domino effect that led to his death. I felt like I was always chasing adequate treatment for him. Whatever my difficulties with services and health care in general for my father, I would most welcome a non-surgical option. I have a painful shoulder injury—undiagnosed for now—that I hope I may have the option to treat non-surgically in the future. Once many insurance companies cover these options, I feel these treatments will be ubiquitous.

    1. Regenexx Team Post author

      Roger,
      The bird’s eye, rather than wide angle lens used in medicine these days so often misses the actual problem, and creates new ones. So sorry to hear how that affected both your parents! Knowledge is power. Hope we can help at some point: http://www.regenexx.com/the-regenexx-procedures/shoulder-surgery-alternative/

  4. George Crisafulli

    My right hip joint hurts when I walk. An orthopedist told me it is burn spurs. What should I do next?

    1. Regenexx Team Post author

      George,

      The Doctor was likely talking about bone spurs which are the result of instability. Treating the cause of the instability in your hip, rather than removing the bone spurs which will only re-form because the instability hasn’t been addressed, is the best option. Please see: http://www.regenexx.com/blog/removing-hip-bone-spurs-hip-impingement-no-better-nothing/ and http://www.regenexx.com/the-regenexx-procedures/hip-surgery/ If you’d like to be evaluated for a patelet or stem cell injection procedure to address the problem without surgery, please submit the Candidate form.

      1. Barbara Hopkins/Knipper

        Have recent mri + have had 6 prolo therapys that greatly reduced the pain. Still feels like a nerve is being pinched inside the sockrt+ extream bone on bone sounds! I had radiation and cemo for anal cancer in 2013..now clear. Am I still a good candidate for hip regenexx?

        1. Regenexx Team Post author

          Barbara,
          In order to answer that question you’d need to submit the candidate form so we can take a look at your MRI’s, take a full medical history, etc. Your past cancer is not a issue, https://regenexx.com/blog/can-you-place-stem-cells-at-cancer-sites/. Please see: http://www.regenexx.com/blog/new-research-knee-and-hip-oa-are-different/

  5. Allison

    I had hip labrum repair with some shaving, but no arthritis my ortho said. I had a full recovery without incident but I have to credit a lot of swimming for the excellent results as well as a prp injection at the time of surgery.

    1. Regenexx Team Post author

      Allison,
      Great news! PRP is a great addition to surgery, but often is not enough to surmount the trauma of the surgery itself. For that reason using PRP or stem cells to address the problem directly by injection is a better use their regenerative potential. Consider yourself lucky!

  6. BMX Mom

    Thank you for this article. My 15 year old son, who is a BMX racer and a powerlifter, has chronic hip pain after suffering two femur breaks. He does have FAI with a torn labrum, and we are doing all that we can to keep him out of surgery– PT, chiropractor, massage therapy, acupuncture, etc. So far the best results have been from the chiropractor and massage therapist, who seem to be on the same page. Our orthopedist recommends surgery, which that is the last thing we want, however, there is a concern that the hardware in his leg could be contributing to the impingement. I’d love to hear from someone who has faced something similar after a femur break.

    1. Regenexx Team Post author

      BMX Mom,
      What type of hardware?

  7. Janie

    What about my suitation? Any advice or suggestion is greatly appreciated.

    I am a Registered Nurse x 27 years, working as charge nurse at local hospital labor and delivery, and a normal week for me was that I stood, sometimes without a break, up to and over 12hrs 3-4 times a week. Very active person, healthy, no hip, leg, back problems at all, Until Nov 18th, when I was rear ended by a big rig, and pushed into and up under vehicle in front of me, causing 2 left hip labrum tears, unable to bear any weight on left leg, bumbness, and gof awful left groin pain, 3 protruding pushed out disc in my lower back, left shoulder pain, and weakness, numbness, whiplash left knee menscius tears, left femoral neck fracture. All caused by my SUV crumpling on my left side. And I cannot work, and been off work since then, 7 months, cause I cannot walk, have to use crutches, basically bed bound, with no quality of life anymore, since accident.

    My labrum tears are from a trauma, not a gradual aging process, even though they are common at age 50. I was healthy and active, instantly, reduced to bedbound.

    What other options are there for me? 7 month MRI now shows arthritis, bone spurs, that I didn’t have 6 mo ago when they diagnosis labrum tears x 2. But I still cannot walk to my mailbox and back without pain. I cannot even go to the grocery store anymore, or even live alone. This is not a life, I’m willing to accept for next 20-30 years, caged in my own home.

    What othe options do I have so I can go back to the way I was, except surgery?

    1. Regenexx Team Post author

      Janie,
      Sadly, this is not uncommon for car accidents as the amount of force involved is transferred along. Each of the issues mentioned are things we treat regularly individually, but given the magnitude of issues, this would likely require the Cultured procedure only done in Grand Cayman so that we would have more stem cells to work with. If you’d like to see if you’d be a good Candidate, please submit the candidate form to the right of the Blog. Please see: https://regenexx.com/blog/car-crash-upper-back-injury/ and https://regenexx.com/blog/continuing-advance-orthopedic-regen-med-msc-augmented-prp/

  8. Julie Ebeling

    I will be getting the Regenexx procedure in February for my hip. I have a Labrum tear and a bone spur. If you don’t remove the bone spur, is it possible that it caused the labrum tear and could happen again if not removed. Would hate to have my labrum repaired by platelets only to have it tear again because of the bone spur.

    1. Regenexx Team Post author

      Julie,
      It’s a logical question. Most bone spurs form to stabilize an unstable joint, and removing a functional bone spur leaves the joint less stable. It’s unlikely that the bone spur caused the labral tear, and more likely that the labral tear caused the need for the bone spur. If you have have questions about your particular case, please contact the Doctor scheduled to do the procedure, as they would know the particulars of your case.

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
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