Hip Labral Tear Surgery Success Rate
Hip pain can be disabling making even a simple step a challenge. What is the hip labrum? What is hip labrum surgery? Is surgery necessary for a torn hip labrum? Will cortisone injections help a hip labral tear? What is the hip labral tear surgery success rate? Are there other options? Let’s dig in.
What Is the Hip Labrum?
The hip joint is a ball and socket joint with the acetabulum being the shallow socket. The labrum is a ring of fibrocartilage and connective tissue attached to the acetabulum. The labrum provides support to the hip, deepens the shallow joint and increases the surface area of the acetabulum by 28% (1). Tears in the hip labrum can occur as a result of direct trauma and activities that require external rotation such as soccer, hockey, and golf. Unfortunately, up to 74% of all hip labrum tears are not associated with any known specific cause or event (2). Labral tears are reported more in females than males (3).
Before We Can Consider the Hip Labral Tear Surgery Success Rate, What Is Hip Labrum Tear Surgery?
Hip labrum surgery involves the insertion of a narrow-gauge camera and operating instruments into the hip joint. This is called arthroscopy and allows the surgeon to visualize structures inside of the hip joint including the labrum. Small labral tears are some times “repaired” with stitches. More commonly there is debridement which involves removing a portion of the labrum. There has been a rapid increase in the number of hip arthroscopies in the United States over the last 20 years. From 2007 to 2014 the number increased by 117% (4). The insertion of the surgical camera and instruments into the small, tight hip joint requires partial dislocation of the joint by means of a traction table. The most common complication of hip labrum surgery is nerve damage with an incidence of 16.5% (5). Nerve damage is more common in women than men and increases with longer traction times.
Is Surgery Necessary for a Torn Hip Labrum?
No! Tears in the hip labrum can be present in many patients who have no hip pain. That is right – labrum tears may not be associated with hip pain. This has been demonstrated by Kumar (6) and Duthon (7). In another study 69% of patients with no hip pain had labral tears on MRI (8). To better understand how to read your own hip MRI please click on video below.
If you have a labrum tear on hip MRI please be cautious as this may not be the source of your hip pain. It is important to undergo a thorough evaluation examining all possible sources of hip pain. Physical therapy, anti-inflammatory medications and activity modification are first line treatment options that have been demonstrated to be beneficial (9).
The efficacy of hip labrum surgery has recently been questioned. Why? In a recent study, 80 patients with hip impingement and labral tears were randomized to surgery or physical therapy. At the end of 2 years there was no significant difference in outcome between those who underwent surgery and those you had physical therapy (10). In a critical review of 26 studies, it was demonstrated that while patients who underwent hip arthroscopy had earlier pain reduction and improved function, they had more residual hip pain and reduced function long term in comparison to those who underwent conservative, non operative treatment (11).
Hip labral tear surgery success rate is not well documented. A recent study reported a re-operation rate of 6.3% after hip arthroscopy. 2.6% of these patients went underwent total hip replacements (12)
Do Hip Labrum Tears Get Worse?
Tears in the hip labrum can heal only in the young (13). Hip labrum tears are common in patients with no hip pain. Therefore a complete evaluation of all possible sources of hip pain is critical and must include the lumbar spine and sacroiliac joint both of which can cause referred hip pain.
Will Cortisone Injection Help a Hip Labral Tear?
Steroid injections are very powerful anti-inflammatory agents which can potentially reduce the swelling and discomfort in the short term but can have significant side effects. Steroids are toxic to cartilage (14). Steroids can also led to bone collapse and bone death (avasular necrosis). In a recent study of patients with hip osteoarthritis that received steroid injection, 22-24 % of treated patients developed developed bone death and collapse at 9 months (15). In the presence of labral tears, steroid injections have been demonstrated to have little therapeutic effect (16).
Are There Non-Surgical Treatment Options?
Yes. Platelet rich plasma has been beneficial in those who failed conservative care. In a recent study, PRP injections reduced pain scores and increased hip function at two and eight weeks (17). In a different study hip PRP injection was effective in reducing pain and increasing function at 12 months(18).
The hip labrum is an important structure that provides support to the hip ball and socket joint and is prone to injury. Unfortunately the majority of the tears are not associated with any known specific cause or event. Hip labrum surgery is an arthroscopic procedure where the damaged labrum is either repaired or removed. Surgery complications include nerve injury which is more common in women. Surgery has been shown to be no better than PT and is associated with reduced long term hip function. Hip labrum tears are present in patients with no hip pain and as such should not be labeled as the source of hip pain until a thorough evaluation of all possible pain sources including the lumbar spine and SI joint has been completed. Steroid injections are associated with significant side effects including cartilage injury, bone death and bone collapse and have little therapeutic evidence. PRP injections are an effective non surgical option in the treatment of hip labral tears.
1.Tan V, Seldes RM, Katz MA, Freedhand AM, Klimkiewicz JJ, Fitzgerald RH. Contribution of acetabular labrum to articulating surface area and femoral head coverage in adult hip joints: an anatomic study in cadavera. Am J Orthop. 2001;30(11):809-12.
2. Santori N, Villar RN. Acetabular labral tears: result of arthroscopic partial limbectomy. Arthroscopy. 2000;16(1):11-5.DOI: 10.1016/s0749-8063(00)90121-x
3. Dorrell JH, Catterall A. The torn acetabular labrum. J Bone Joint Surg Br. 1986;68(3):400-3.
4. Truntzer JN, Shapiro LM, Hoppe DJ, Abrams GD, Safran MR. Hip arthroscopy in the United States: an update following coding changes in 2011. J Hip Preserv Surg. 2017;4(3):250-7.doi: 10.1093/jhps/hnx004
5. Larson CM, Clohisy JC, Beaulé PE, et al. Intraoperative and Early Postoperative Complications After Hip Arthroscopic Surgery: A Prospective Multicenter Trial Utilizing a Validated Grading Scheme. Am J Sports Med. 2016;44(9):2292-8.DOI: 10.1177/0363546516650885
6. 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
7. Duthon VB, Charbonnier C, Kolo FC, Magnenat-Thalmann N, Becker CD, Bouvet C, Coppens E, Hoffmeyer P, Menetrey J. Correlation of clinical and magnetic resonance imaging findings in hips of elite female ballet dancers. Arthroscopy. 2013 Mar;29(3):411-9. doi: 10.1016/j.arthro.2012.10.012.
8. 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 Dec;40(12):2720-4. doi: 10.1177/0363546512462124.
9. Dierckman BD, Ni J, Hohn EA, Domb BG. Does duration of symptoms affect clinical outcome after hip arthroscopy for labral tears? Analysis of prospectively collected outcomes with minimum 2-year follow-up. J Hip Preserv Surg. 2017;4(4):308-17. doi: 10.1093/jhps/hnx023
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):572-9.DOI: 10.1136/bjsports-2016-096618
11. Shin JJ, de Sa DL, Burnham JM, Mauro CS. Refractory pain following hip arthroscopy: evaluation and management. J Hip Preserv Surg. 2018;5(1):3-14. doi: 10.1093/jhps/hnx047
12. 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 May;46(6):1306-1314. doi: 10.1177/0363546517751912
13. 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 Apr-Jun;8(2):e28. doi: 10.2106/JBJS.CC.17.00133.
14. 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
15. Radiological Society of North America. “Hip steroid injections associated with risky bone changes.” ScienceDaily. ScienceDaily, 29 November 2017. <www.sciencedaily.com/releases/2017/11/171129090440.htm>.
16. 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 Apr;22(4):750-5. doi: 10.1007/s00167-014-2862-3.
11. Meftah M, Rodriguez JA, Panagopoulos G, Alexiades MM. Long-term results of arthroscopic labral debridement: predictors of outcomes. Orthopedics. 2011;34(10):e588-92. DOI: 10.3928/01477447-20110826-04
12. De Luigi AJ, Blatz D, Karam C, Gustin Z, Gordon A. Use of Platelet Rich Plasma for the Treatment of Acetabular Labral Tear of the Hip: A Pilot Study. Am J Phys Med Rehabil. 10.1097/PHM.0000000000001237.DOI: 10.1097/PHM.0000000000001237