The Side Effects of Hip Labrum Surgery: Brian’s Story

By Chris Centeno, MD /

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side effects of hip labrum surgery
Yesterday was my last day seeing my patients at the licensed, advanced stem-cell-culture site in Grand Cayman. It’s been a great week, capped off with a heartfelt thank you from a young medical student we have been able to help through the years. His thanks are really the quintessential reason every doctor is a doctor—to help people and improve lives. Brian’s story of the side effects of hip labrum surgery also highlights what happens to many hip arthroscopy patients, so his history is important to discuss.

Hip Arthroscopy

The hip labrum is the lip around the socket of the ball-and-socket hip joint. If you have hip pain and an MRI shows a labral tear, there’s a pretty good chance you’ll end up getting hip arthroscopy. The goal is usually to “repair” the labrum, but it’s often also to reshape the socket part of the hip joint. Are either of these surgeries needed? What are the side effects of hip labrum surgery? Here are some things to consider:

Brian’s Important Story

When I first saw Brian, he was miserable due to the side effects of hip labrum surgery. He had pain in his groin and right low back/butt, and an MRI still showed a labral tear despite two failed surgeries. Physical therapy hadn’t helped. In fact, it was the two hip labrum surgeries that caused him to go from an active young man with pain who was pursuing his premed studies to not being able to walk any distance and putting his medical-school education on hold.
Below are the before and after hip labrum stem-cell-injection MRIs. Note that the left image is after two surgeries, and the MRI still shows that the labrum is torn. In this image the labrum is the triangle-shaped dark structure inside the yellow dashed circle. The bright spot in the middle of that dark triangle indicates a tear. The post-stem-cell-injection-procedure image is on the right. The procedure was a precise ultrasound-guided injection of the patient’s own stem cells into the tear. Note the triangle-shaped labrum in the after image (inside the dashed yellow circle) is now almost uniformly dark, indicating no or less tear.
avoid hip labrum surgery
Once we got the labral issue sorted, Brian was able to walk again and to begin to function more like a normal student. What was interesting from our talk yesterday was that after we treated the hip, his symptoms returned to what they were before the hip labrum surgeries set him back. What did that mean? While his hip was messed up, it wasn’t the primary cause of his pain. What was? Given multiple exams and diagnostic injections, it was his low back. That meant that it was time to begin to focus treatment on that area and unravel those layers of the proverbial onion. This brings us to his treatment yesterday: a stem cell injection into the low back disc.
Here is his story in his words:

“I first noticed hip discomfort in 2008, and at the time did not appear concerning so I was recommended for physical therapy. By 2011 I had visited 3 different medical physicians, and my hip discomfort had not improved, but rather worsened and as a result an MRI arthrogram was ordered for my hip. The radiology came back showing that I had an acetabular labrum tear. When the diagnosis was shared with me I was informed that it is not uncommon for people to have labrum tears, and that many people don’t even know they have one as they’re asymptomatic. Nonetheless I was informed to follow-up with an orthopedic surgeon who specializes in arthroscopic hip repairs (fun fact he was actually one of the guys who helped to innovate the procedure). When I spoke with him he informed me that my presentation was classic for a labrum tear. I was intending to begin medical shcool in 2012, and as I was not improving with physical therapy, the physician felt confident I would have relief from the acetabular labrum repair with femoroplasty and acetabuloplasty and be ready for school. Following the arthoscopic hip surgery in March 2012 the news that I received was that my hip socket during the surgery ended up appearing very different in person as compared to the CT and MRI’s that were performed prior. The physician had called my mother on the phone and mentioned that the cartillage damage was more extensive than he thought, and that he did the best he could do to suture and mend the cartilage. 

After three months of rehabilitation I did not notice my symptoms improving, and actually felt a lot worse than I did prior. When I followed up with my surgeon, I shared my experience with him and he felt confident that additional shaving of the head of my femur and acetabulum would allow my hip socket to have better articulation and relief of my symptoms. The decision of having an additional hip arthoroscopy proved to be a major mistake as the corrections that were made to my hip socket were such that I lost the ability to walk. I thought that in a couple weeks following the surgery I would be able to start bearing weight again, but after a couple months I was dismayed to discover that I was unable to bear any weight at all on my leg without falling, and that any position beyond horizontal brought me extreme pain. My sleep, which was difficult prior to the hip arthroscopies, became unaccomplishable without the use of narcotics and after 3 months of vicodin I was waned off and placed on up to 4800 mg Neurontin.

While this was going on my family and I continued to schedule referrals to physicians who, though many were well intended, were not very helpful. The feedback we received ranged from: drug seeking behavior, anxiety about starting medical school, psychosomatic, and even when my symptoms were taken seriously the only solution that was on the table was a hip replacement. This absolutely terrified me, and my unwillingness to undergo a hip replacement was usually followed by advise that I needed to find a way to get on with my life then. Words can’t do justice to how emotionally, psychologically, and physically debilitating this experience was for me. Not being taken seriously or having my symptoms explained as drug-seeking behavior, though did lead me to a great cognitive-behavioral therapist, was an awful experience to go through. 

My family and I spent 10 months, during which I was not able to walk without the use of crutches, in and out of doctor’s offices as well as posting my medical information online in search of help. This brought us to Regenexx, and after one discussion on the phone I experienced more empathy than any of the other 15 physicians I saw in person. Since then my walking has been restored, my sleep has been getting better, I no longer take neurontin or vicodin, I have begun medical school, and I have grown from feeling completely depressed and hopeless to optimistic that a functional life is in store for me.

While the orthopedic surgeon who performed my arthroscopic surgeries made mistakes, I do not blame him for it. I honestly believe, whether this is true or not, that he was doing the very best he could within his knowledge and ability. From my experience in healthcare I have discovered that there are not a lot of options in the minds of many physicians, whether surgeon or not, besides physical therapy, medication, and surgery. Is it because of the regulated atmosphere of healthcare? Is it because of the preferential treatment that pharmaceutical companies receive from the FDA? Is it due to the medical training that prepares medical students for Step/Board exams rather than patient care? Has the process of specialization in healthcare caused confirmation bias in certain fields? While these questions are the correct ones to ask, the answers I do not have. As I continue with my medical training I will continue to be wrestling with these questions, but as a result of my experience I have found myself to have a deep appreciation for physicians who take their patients seriously and have the desire to solve complex problems.”

Yesterday I injected his torn L5-S1 low back disc. This was likely causing the symptoms on the bottom of his foot (through irritation of the S1 nerve). However, it was injecting his SI joint that caused his usual groin pain, the same pain that he initially sought care for many years ago! So it’s likely that even though he had a labral tear, it wasn’t causing his pain. His SI joint was the real cause. Hence the reason why labral surgery never got rid of the pain.

The upshot? It’s been a pleasure getting Brain back on track in his medical education. We found a kid struggling to walk, with his medical-school education on indefinite hold due to the side effects of hip labrum surgery, and now he’s finally finished his first year of medical school! Hopefully Brian will use this experience to motivate himself to be the kind of physician who thinks outside the box!

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20 thoughts on “The Side Effects of Hip Labrum Surgery: Brian’s Story

  1. AL

    WOw….;incredible story considering I have the same problems except I have hip labrum tears in both hips plus SI and multiple disc issues…Great work Chris…………

    1. Regenexx Team Post author

      Thanks Al!

  2. Kathy Steere

    How long does a stem cell repair to joints, etc . Before you can see results on a MRI?

    1. Regenexx Team Post author

      Kathy,

      It really depends on what’s been treated with what procedure. This gives an idea of the number of different Interventional Orthopedic Procedures we do:http://www.regenexx.com/explain-interventional-orthopedics/ Importantly, significant progress is not always measurable via MRI Please see:http://www.regenexx.com/stem-cell-cartilage-regeneration/ That said, here are some updates with MRI’s at different time points: This was an ACL procedure: https://regenexx.com/results/live-patient-outcomes/knee-outcomes/ This was a stem cell procedure for knee arthritis: https://regenexx.com/blog/can-stem-cells-help-knee-arthritis/ This was a rotator cuff tear treated with stem cells: http://www.regenexx.com/blog/update-severe-shoulder-rotator-cuff-tear-treated-with-stem-cells/ And this Hip Arthritis: http://www.regenexx.com/hip-arthritis-stem-cell-injection/

  3. Cheryl

    Glad I read this, my new MRI says labarum tear, bone spurs, cam type impingement on right hip, alpha angle of femur >55°, rooroo, sounds like surgery to me with the alpha angle thing, how else can that be corrected?

    1. Regenexx Team Post author

      Cheryl,
      The Alpha Angle of Femur>55 degrees is describing what’s called FAI, or Femoro-acetabular impingement . That and the bone spurs and labral tear are all symptoms of hip instability, so determining the cause of the instability and treating that is the goal, as removing your body’s attempt to stabilize the joint obviously doesn’t address the actual issue. Please see: http://www.regenexx.com/blog/removing-hip-bone-spurs-hip-impingement-no-better-nothing/ and https://regenexx.com/blog/bone-spur-pain/ and http://www.regenexx.com/hip-bone-spur-removal/ and http://www.regenexx.com/hip-labrum-surgery-complications/

      1. Cheryl Lilienstein

        I am a PT, 65 yo, and read those articles, not specifically helpful to me…. The acetabular enlargement I have is medial, causing iliopsoas bursitis/inflammation, successfully treated twice with anti-inflammatory injections into the IP bursa (thus locating source and giving temporary pain relief). I was a dancer earlier in life and my hip architecture allowed more hip ROM than most. My strength/length balance was normal until I’d been hiking a lot and started having medial hip pain about a year ago. I also have what looks like a central acetabular chondral defect, (appears to be a tear, not a worn away spot) with some subchondral bone loss behind it , but joint space is NORMAL and has not changed in past year. I am trying to figure out what might be the best sequence or process to address these two issues that are related but in different locations in my hip . So:
        1. Do you have an opinion about repair for CAM impingement in this case?
        and
        2. To repair the chondral defect, microfracture has been tentatively recommended, (tentative because my age/sex is a factor.)
        Given that, do you think stem cell injections could replace (or supplement?) the microfracture? What would be its affect on healing of the medial rim of the acetabulum if I decide to have the contour revised? IF I decide to do stem cell therapy, and IF I decide to do the hip revision, would you recommend injecting stem cells BEFORE or AFTER a revision with microfracture?

        thanks for your advice.

        1. Regenexx Team Post author

          Cheryl,
          If you’d like to see if you’d be a good candidate for a Regenexx Procedure, please submit the Candidate form, so we can speak about your case specifically. In general terms, CAM impingement is a symptom of instability as bone spurs are your body’s attempt to stabilize an unstable joint. Removing them leaves the joint more unstable. Addressing the instability, rather than the bone spurs is the important issue. http://www.regenexx.com/hip-labrum-surgery-complications/ Microfracture is an invasive procedure with unimpressive results. http://www.regenexx.com/blog/knee-microfracture-results/ Generally speaking, addressing the issues with Intervetional Orthopedic autologous stem cell and or platelet procedures is a more targeted approach without the collateral damage. Please see http://www.regenexx.com/explain-interventional-orthopedics/ and http://www.regenexx.com/the-regenexx-procedures/hip-surgery/

  4. Nina

    Great read. Ty

    1. Regenexx Team Post author

      Nina,
      Glad you enjoyed it!

  5. Christina Wolf

    My Daughter is 24 years old, has had 4 hip surgeries, 3 on the right, and 1 on the left for Labarum tears, with the last surgery using tissue from a cadaver. My Daughter has been in hip pain since she was a Sophmore in HS, she played soccer and ran track all through school, lost a scholership to run in College due to the pain, and surgery number 2. Many years of Physical Therapy, pain medications, steroid shots, etc. There are many sleepless nights due to her pain, nights she is working, crying because the pain is so bad, and the feel of her leg going out. As a Parent this is by far the hardest thing I have ever gone through, watching my Daughter in constent pain, and the helpless feeling that I can not take the pain away. Tomorrow she is going in for stem cell therapy, not by bone morrow, but the other. I pray that in time she will be pain free and live the life of a normal 24 year old who wants to continue her education. It has been promising reading all of the postitive comments. There is so much more to her story that I can’t even begin to tell, but after reading above, I felt the need to tell some of her story… Thank you

    1. Regenexx Team Post author

      Christina,
      Hoping the best for your daughter tomorrow and going forward! There is simply nothing worse than watching your child in that type of pain. Your story reminds me of this case: http://www.regenexx.com/blog/figuring-out-a-complex-patient-with-an-si-joint-cyst-interventional-orthopedics/ Not that I’m suggesting the problem is the same, but demonstrating the kind of investigative thought process and a toolbox of customizable procedures and techniques it takes to get to the bottom of complex issues like these. These are some important questions to ask of stem cell Providers: http://www.regenexx.com/blog/top-10-questions-orthopedic-stem-cell-providers/

  6. Amy

    My daughter was 13 when she was diagnosed with bilateral torn labrum. One doctor wants to do repair on each hip the other wants me to put her through dysplasia surgery in addition to labrum tears! I just don’t know what to do. The firt doctor said nothing about dysplasia . Who do I trust and what do I do??!! She still playing volleyball but in a lot of pain

    1. Regenexx Team Post author

      Amy,
      Making the right medical decisions regarding our children can be very confusing. Given the conflicting diagnoses, the drastic treatment plans, and the research that shows that labral tears are not often the cause of pain, the type of exam that can track down what actually is going on would be a good place to start. Please see:http://www.regenexx.com/hip-labrum-stem-cell-procedure/ and http://www.regenexx.com/hip-pao-surgery-recovery/and http://www.regenexx.com/hip-labrum-pain/ You can get this type of exam at these locations (If you’re in network the exam is ususally covered by your insurance): http://www.regenexx.com/find-a-physician/

  7. Ann

    Orthopedic stem cell procedure has now been around since 2005, 12 years; there appears to be a fair amount of good data supporting the efficacy of this treatment modality. When can we expect insurance companies to cover these procedures? Seriously, it is ridiculous that this next generation of stem cell treatment is still not considered a main stream treatment.

    1. Regenexx Team Post author

      Ann,
      Agree! We will need to wait and see if upcoming changes to healthcare will be more patient-centric…

  8. Carla Carlyle

    After ultrasound mri and mri arthiscopy test I was diagnosed with right hip labreal tear!! Its a work injury so the only treatment I have had is 1 cortizone that only lasted 5 days!! So basically I have had NO HELP!! At this point I am off work thanks to my medical dr because wc refused to take me off!! For 4 months that sat me in a chair on light duty and it caused more pain from sitting!! At this point my right side from my hip down is in constant pain and spasms and i only get relief from heat and layin flat with pressure off my hip!!. I have walked with a bent knee since injury also because stretchin the leg put causes me pain! My question is with goin untreated for a year will surgury even help now??

    1. Regenexx Team Post author

      Carla,
      We’d need to examine you. Sounds like more going on than a hip labral tear. These are the locations you can get that type of exam: https://regenexx.com/find-a-physician/

  9. alia

    Over 4 years dealing with a bad hip, multiple physical therapists, labrum and impingement repair surgery, more physical therapy, and still not able to return to normal activities, I’m glad I’ve come across this website. No one seems to have any answers about what exactly the problem is. Still have same pain as before surgery, and now have new and different pain after the surgery. Some doctors recommend stem cell or platelet rich plasma treatments, other doctors say those kinds of therapies only work on muscles and tendons, not joints. And of course insurance doesn’t cover. I’m feeling really trapped and helpless, so any insight would be be very helpful!

    1. Regenexx Team Post author

      Alia,

      We’ve actually helped tens of thousands of patients avoid joint surgery. Unfortunately Hip Labrum repair surgery often makes things worse, as it does not address the issue and creates new ones. Sounds like what’s been missing has been correct diagnosis and a treatment plan to address it without causing more damage. We would need to examine you to advise. If you’d like to see if we can help, please submit the Are You a Candidate form to the right of the Blog.

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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