Hip Labral Tear? Causes of Pain After Hip Arthroscopy

By Chris Centeno, MD /

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pain after hip arthroscopy

The animated GIF above may drive you a bit nutty if you watch it long enough, but it’s crucial nonetheless. Arthroscopic hip surgery to treat a labral tear is frequently billed as a minimally invasive procedure, but from the damage we’ve seen created by the tools used to perform the surgery, I don’t know if that’s true. This is another one, in our ever-expanding collection of MRIs, that shows tissue damage caused by the surgery, which led to pain after hip arthroscopy. So let’s explore today why a patient would still be in pain despite this procedure. It’s also helpful to educate you through the lens of a patient’s experience and what I found this week on an examination.

Hip Arthroscopy Rates Have Exploded in the Past Decade

In the last decade, hip arthroscopy rates have exploded, making it the fastest growing type of orthopedic surgery. On the surface, this seems like a good thing as before arthroscopy most hip conditions couldn’t be operated on without more invasive open hip surgery or replacement. However, when we dig beneath the surface, we discover there are many problems with hip arthroscopy, including not only poor results but also the fact that many are just simply unnecessary.

A hip arthroscopy involves making an incision through the skin and into the body and inserting a scope into the hip joint to visualize the structures. Once the scope is inserted, portals, or access tunnels, are then created through the body and into the joint, so the surgeon can insert the surgical tools needed to complete the procedure. Through these portals, the surgeon performs the repair as he or she visualizes it through the scope. Tears in the labrum and hip impingement are the two most common conditions treated using hip arthroscopy.

The hip is a ball-and-socket joint, and the lip around the socket where the ball of the femur inserts is called the labrum. The labrum can experience tears or degeneration. A hip impingement can occur when any of the bones of the joint somehow become misshapen or even when the patient is born with an oddly shaped hip. In addition to the lack of high-level research showing the effectiveness of hip arthroscopy, there are a number of reasons why hip arthroscopy may be unnecessary or even cause further complications, including the following:

The Portal Syndrome

In the last section, I mentioned the portals, those tunnels created through the patient’s skin, tissues, and muscles during hip arthroscopy to insert surgical tools and instruments to access the joint. These portals in and of themselves can cause chronic pain and other problems, and I’ve seen this in enough patients that I created a term for it: “portal syndrome.”

The idea is that those portals used for arthroscopy equipment should heal up quickly; however, sometimes this isn’t the case, and instead a gaping tunnel through the tissue remains. Understandably, portal syndrome, this unhealed tissue, can be the source of chronic and ongoing pain. Add this to the poor results for some patients and constant pain in the hip joint itself following arthroscopy, and it’s easy to see why patients should be cautious about making this surgical decision.

What Other Things Can Cause Hip Pain if Not the Hip?

I’ve mentioned the idea of “MRI hysteria” before. This happens when doctors find an abnormality on a patient’s MRI and assume it is the cause of the patient’s pain. To the patient, this makes sense. The patient’s hip hurts, and the MRI shows a tear in the labrum—problem solved, let’s operate. But it’s just not that simple. In fact, there is a great deal of scientific evidence that there is no association between hip pain and labral tears that show up on an MRI.

Consider this for a minute. Research shows that patients can have labral tears and have NO pain, and it also indicates that patients who have hip pain have no more labral tears than those with no pain. So if labral tears are not associated with hip pain, how is operating on the labrum going to address the patient’s hip pain? And if it isn’t the tear in the labrum seen on MRI causing the hip pain, what else could it be?

We see many patients after hip arthroscopies still complaining of pain. The reason is that the pain was never coming from their hip joint but from somewhere else. Click on this link to view my “Common Causes of Chronic Hip Pain” infographic. Let’s review a few of these:

My Patient’s Pain after Hip Arthroscopy Story

This patient is an ex-figure skater who noted sharp hip pain after a sudden movement a few years back. She had an MRI showing a labral tear and then was told she needed hip arthroscopy to help the damage. The recovery was awful, taking 6–7 months in PT to feel halfway normal. After the surgery, she had more pain than before, so she sought out our care.

The first interesting thing I found on this patient’s exam is that she also has severe SI joint instability on the same side as her labral tear. This is likely from many falls on her backside as a figure skater. This diagnosis was completely missed as the operating surgeon never considered or looked at her low back. So right off the bat, most of her hip pain could very well be originating from that SI joint problem.

However, what’s on her MRI is fascinating, so much so that I’ve created an animated GIF of the issue above. I used this form of media because the area of interest shows up on about 10 different slices, making it impractical to show on static images. Realize that the picture above is a cross section looking down at the hip, which appears as the circular structure. The yellow arrow points to the problem. The white stuff is MRI contrast injected into the joint. What does the animated GIF show?

Note the normal dark-appearing muscle in cross section just to the right of the yellow arrow and above the circular hip bone. Also note that the arrow points to an area of white in that dark muscle. What is this? It’s MRI contrast that has leaked from the joint into the tears in the muscle. In fact, parts of this white area mirror pathways that the surgical tools took to enter the hip. These injuries to her psoas muscle have never healed, as it’s been years since her surgical procedure. Also, the entire undersurface of the psoas muscle is damaged as a result of the hip arthroscopy. This is similar to the portal syndrome I have outlined above. Given that the psoas is a key stabilizer of the hip and spine and is involved in flexing your hip or needs to relax for you to straighten up, it’s not surprising she now has more severe chronic hip pain. I’ll treat this issue this week using a same-day stem cell injection by precisley injecting these into her hip as well as this damaged muscle.

The upshot? There’s nothing “minimally invasive” about hip arthroscopy surgery. The tools and devices used to get into the joint can cause severe and permanent injury to the ligaments, muscles, and fascia around the joint. We’ve seen it many times in many patients. So do yourself a favor: avoid hip arthroscopy where possible and stick with precise injections instead! We don’t leave gaping holes in our patients when we inject them…

Category: Hip, Latest News

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17 thoughts on “Hip Labral Tear? Causes of Pain After Hip Arthroscopy

  1. Ellen holmes

    To find out if I am a good candidate for stem cell therapy to heal hip joint as per an X-ray that reported significant hip degeneration on both sides, do you have to see an MRI?

    Thank you,
    Ellen Holmes

    1. Regenexx Team Post author

      Ellen,
      Yes, as there is more, and different, information on a MRI.

  2. Jade Jeffrey

    Hi, I have found this article so interesting. I had hip arthroscopy May 2016 and I am still in chronic pain. I ended up having bone shaved off my femur and hip socket for cam and pincer impingement, labrum tidied up after it was graded 3 out of 4 for severity. I also had IT band shaved from hip to knee and Hip bursa removed. Hospital didn’t tell me the op was more invasive than expected and I should work to a 16 week recovery. I went back to work after 5 weeks (my job involves lot of walking across cobbles too!) I really wish I never had this procedure done I am in just as much pain and significantly worse off since. everyone tells me I’m in a bad position as I keep overdoing it but I’m not I’m trying to live my life and I can’t! I also now feel like the hospital have washed their hands with me and I don’t know where to go for help?! I’m also only 28, who was very active. the thought of being in chronic pain rest of my life scares me!

    1. Regenexx Team Post author

      Jade,
      So sorry to hear all that! Did your Doctor do an extensive low back exam before proceeding with surgery? Don’t know if there is anything we can do, but if you’d like us to take a look, please submit the Candidate form: http://www.regenexx.com/the-regenexx-procedures/hip-surgery/

  3. Amy McPherson

    I myself have had a hip arthroscopy done. I had an MRI, which showed a labral tear. He went in to fix it, recovery was horrible because I am a very active person. It has been two years since surgery & I am still in severe pain. My pain is at it’s very worse, if I am stooping to sweep, mop, etc. When I hurt, I hurt terribly in my back & buttock as well. I have seen my doc on my follow up visit & he thinks another surgery to remove scar tissue is in order. I haven’t seen him since do to the fact that I am scared to have another sx that doesn’t work. I don’t understand how removing scar tissue will not create more. Can you give me your opinion? I am not sure where to go from here. Thanks

    1. Regenexx Team Post author

      Amy,
      It likely will. It is the “arthroscopic clean it up paradigm”. Please see: http://www.regenexx.com/side-effects-of-hip-labrum-surgery/ If you’d like to see if we could help, please submit the Candidate form.

      1. Amy McPherson

        THANK YOU FOR YOUR TIME. 🙂

  4. Ashley

    I had bilateral hip tears and surgery. Both were 1 year apart. My recovery was not horrible it was actually fairly quick. But now I have hip pain and I am scared that a hip replacement is my last resort. I’m 30 and very active. I have 3 kids and I can never sit still. Dr is saying it is bursitis in both hips and has done cortisone injections which were no help. I am not sure what to do next. But I need to figure it out because not being able to walk or walk with a limp is not going to work.

    1. Regenexx Team Post author

      Ashley,
      Cortisone injections escalate the situation as they are lethal to the local stem cells, breakdown cartilage and can damage tendons. Please see: http://www.regenexx.com/steroid-injection-risks/ As covered in the blog, there are many possibilities that can be causing post-arthroscopy pain, but also pre-arthroscopy pain, as labral tears are generally not associated with pain. If you’d like us to weigh in, please submit the Candidate form so you can upload your MRI’s and medical history and speak to one of our Physicians about your case, or if you are local to one of our locations you can schedule an exam. Please see: http://www.regenexx.com/find-a-physician/ and http://www.regenexx.com/the-regenexx-procedures/hip-surgery/

  5. Chris

    I had a right hip arthroscopic surgery in June for a right labral tear, and they also told me I have a left labral tear as well. I am skeptical about doing labral repair surgery on the left hip next month since my right leg almost feels worse than before the surgery. I have been diagnosed with pelvic instabilty/hypermobility and arthritis so I am not sure if the labral surgeries even help that issue. I am considering stem cells. Should I have stem cell injections for both hips even though they just did the right labral repair surgery?

    1. Regenexx Team Post author

      Chris,
      Unfortunately, labral repair surgery generally causes more instability, so it would be unlikely to help. It’s also unfortunately not uncommon to be in worse pain ater the surgery. We treat Labral tears and instability regularly, you’d need to go through the Candidacy process or have an exam for us to advise in your particular case and to see if you would be a good Candidate for a Regenexx procedure. If you’d like to do that, please submit the Candidate form to the right of the Blog. Please see: https://regenexx.com/blog/hip-labrum-stem-cell-procedure/ and https://regenexx.com/blog/hip-labrum-tear-surgery-results/ and https://regenexx.com/blog/side-effects-of-hip-labrum-surgery/

  6. Kaitlin Pakkala

    I had hip arthroscopy in August 2014 and I am still in chronic pain. I ended up having the bone shaved off my femur and hip socket for cam and pincer impingement, and my labrum tidied up When I first got the surgery done I was in less pain and it felt great, know 3 years later I can barely walk. I went and got a second MRI done and they said everything looked great. I just want this pain to go away. I can’t wear jeans anymore only leggings and I feel like I have to break out my crutches whenever I am walking for long periods of time. I am only 21 and I want to be normal again.

    1. Regenexx Team Post author

      Kaitlin,
      So very sorry to hear that you have been subjected to all of this at your young age. Unfortunately results like these are not unusual. Surgery is damage to accomplish a goal. The issue is in so many cases the damage far outweighs the benefit. We’d need more information through the Candidacy process, but as in the blog you commented on, we establish what’s currently going on and can usually help. To see if you would be a Candidate, please submit the candidate form. https://regenexx.com/blog/surgery-controlled-damage-accomplish-goal/ and https://regenexx.com/blog/hip-labrum-stem-cell-procedure/

  7. Dima

    I was hit by a car in 2013. There was damage to my hip and lower back. The arthroscopic surgery on the hip seemed to have helped with labral tear, but both of my legs were shutting down because of L3-L4 nerve damage. The back surgery seemed to have alleviate the leg pain, but my hip hurts every time the weather changes or it gets really cold outside. After 4 years I am just tired of pain.

    1. Regenexx Team Post author

      Dima,

      Hips and backs are intricately related and referred symptoms are usually not considered. If you’d like to explore if there is anything that can be one, please submit the Candidate form. Please see: https://regenexx.com/blog/hip-replacement-back-pain/

  8. Helen

    Hi. I’m 8 months post arthroscopy, for cam impingement and Lambrum tear. I have previously been through this process with my right hip, which did not work and I had hip replacement. I am very active both at work and hobby but pain is severe and I limp all the time. Until a yr in been told there may be improvements but getting aam injection into joint to help eleviate pain and diagnostic procedure. Wish I could just have replacement as other is great but only 48 and they r still reluctant. Pain is really getting me down with sleep effected and likely to have to go sick from work before too long.

    1. Regenexx Team

      Hi Helen,
      Very sorry to hear about your situation. That’s a lot of surgery, and sadly, there is a good chance it was unnecessary. Cam impingement is your body’s attempt to stabilize an unstable hip, so treatment should focus on determining the cause instability and addressing that and repairing the labral tear. Please see: https://regenexx.com/blog/hip-fai-surgery-side-effects-procedure-doesnt-work-rct/ and https://regenexx.com/blog/hip-labrum-stem-cell-procedure/

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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