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If you’ve experienced deep pain in your hips or groin area, you know how concerning it can be. But what is it exactly? Have you torn something? Is there a strain or a pull somewhere? Could it be serious? It’s important to consult a physician when you have this kind of limiting pain in your hip joints or hip area, but even more important is obtaining an accurate diagnosis and a treatment option that provides the best long-term, sustainable results. But how do you know which treatment option is right for you?

Is it a tear or something else?

The first step is making sure you have the correct diagnosis for your pain. When you have pain in your hip area, you will need to know exactly how serious it is.

One possible diagnosis that some patients experience is a tear in the hip labrum. The hip labrum is located around your hip socket, that ball-and-socket joint that makes the movement of your waist and hips possible. The hip labrum is the layer of cartilage that exists around that socket, and can be torn or injured either through trauma or the wear and tear that comes with our joints aging (1).

While a labral tear can easily be identified through an MRI, it’s important to not assume that a tear can be the only source of a patient’s hip pain. Why? Research has shown that hip pain can occur even without a labral tear, as well as the opposite: People with labral tears may not even experience hip pain! As a matter of fact, in one study, 69% of patients evaluated without hip pain actually had labral tears and didn’t experience any real pain (2-4).

If you develop hip pain and an MRI shows a labral tear, it may be possible that that tear is the source of your pain, but it is just as possible that the pain is caused by something else entirely. This matters because it helps to inform your treatment plan; patients don’t want to undergo expensive, invasive surgical treatment to repair a labral tear, only to find out that it was not the source of their pain, which still persists, even after surgery.

Another possible diagnosis for hip pain problems is something called Femoroacetabular Impingement, or FAI. In fact, FAI is the most common reason that patients end up undergoing arthroscopic surgery on their hips. Having FAI simply means a development of bone spurs in the hip area, whether on the socket (pincer) or on the bottom of the ball (cam). A bone spur is an area where the bone has grown bigger; this may or may not cause pain in the hip area.

While bone spurs can be the cause of hip pain, it is not necessarily the root cause for every patient experiencing hip pain. For example, in one study, the pincer bone spur was shown to be protecting the hip joint from further arthritic breakdown, as opposed to actively hurting the joint (13). In another study, more than 90% of healthy young adults without hip pain also had FAI, as evidenced by an MRI (14). Because of this, it’s important to understand that treatment options designed to fix an FAI issue may not be the best for pain relief.

Can a labral tear heal itself? Do I really need to treat it actively?

Labral tears are known for being incredibly difficult to heal. The hip labrum can really only heal itself without treatment in the very young (5). However, as discussed above, hip labral tears that don’t cause pain are very common, and a labral tear may not be the source of your pain.

What are my options to alleviate my hip pain?

There are a variety of treatment options available for patients experiencing hip pain. Here are just a few, along with the advantages and disadvantages of each of these most commonly recommended options:

  • Surgery: One option to attempt to treat hip pain is hip arthroscopy, or surgery on the hip joint. While this is commonly recommended by surgeons who find labral tears or FAI on a patient’s MRI, remember that those diagnoses are not necessarily the cause of the underlying pain.

    In one of the largest high-level studies to date, comparing hip arthroscopy to physical therapy, there was no difference in the outcome of the two groups (11). This means that surgery did not outperform physical therapy when it came to pain treatment, despite it being more invasive and more serious. Although a different study showed that patients with labral tears and FAI did better with just surgery than through physical therapy alone, still another study showed that, while patients reported earlier pain improvements with surgery, there were also indications that the patients who had undergone surgery had worse residual hip pain and function longer-term (10). We also know that patients who have arthritis experience worse outcomes with hip surgery for labral tears or FAI (11).

    The research on success rates from hip arthroscopy for labral tears has not been a convincing argument in favor of using surgery as a primary or sole treatment option.

  • Physical Therapy: Physical therapy is another option to treat hip pain, labral tears, or FAI. It can be thought of as either a primary treatment option, a sole treatment option, or a tertiary treatment option used in tandem with something like surgery.

    Physical therapy has been shown to help FAI. As an example, in one small study, hip and trunk stabilization exercises helped reduce hip pain and improve hip function (8). Patients considering physical therapy should be mindful that their therapists are focusing on strengthening the core muscles that control spine and hip stability.

  • Cortisone: Steroid shots like cortisone, or corticosteroids, can help reduce inflammation for patients with hip pain, labral tears, or FAI. However, cortisone shots can also be very toxic to orthopedic tissues such as cartilage (6). For examples, new research shows that cortisone injected into a joint will increase the loss of normal cartilage in that joint. Additionally, a 2014 study demonstrated that a cortisone shot used to treat hip pain in patients with a labral tear provided only limited benefit (7).

Are there any other alternative treatment options with positive success rates for hip pain?

At Centeno-Schultz, we’ve pioneered an alternative treatment to hip arthroscopy for labral tears and hip pain. Our treatment procedure is what’s called the Percutaneous Hip Labroplasty procedure, or the Perc-Hip Labroplasty, for short. This procedure can be done through a needle, without invasive surgery, and allows for quicker recovery with less downtime for our patients.

As opposed to using surgical methods to cut pieces out of the cartilage or socket, or rebuilding or reshaping the whole hip joint, we focus our methods on helping the labral tear to heal. Our procedure involves a precise x-ray and ultrasound-guided injection directly into the damaged labrum, carried out by our doctors, who are all musculoskeletal specialists with advanced training. Because no surgery is performed, the Perc-Hip Labroplasty doesn’t come with the same complications, extended recovery period, or downtime as a surgical procedure like hip arthroscopy. As a matter of fact, our patients typically require no real downtime aside from listening to their bodies and not pushing themselves post-injections. This procedure is backed by extensive research with plenty of published patient data proving the success rate of these injections versus a more invasive major surgery.

Ready to find relief?

Life’s too short to live in pain. Take advantage of new innovative treatments that are helping people avoid hip arthroscopy for labral tears, with its long recovery time and suboptimal result rates. Get back to doing the activities you love, faster and without surgery. 

References

(1) Naraghi A, White LM. MRI of Labral and Chondral Lesions of the Hip. AJR Am J Roentgenol. 2015 Sep;205(3):479-90. doi: 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:1016/j.joca.2013.08.009

(3) 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: 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 Dec;40(12):2720-4. doi: 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 Apr-Jun;8(2):e28. doi: 2106/JBJS.CC.17.00133.

(6) McAlindon TE, LaValley MP, Harvey WF, et al. Effect of Intra-articular steroid vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial. JAMA. 2017;317(19):1967–1975. doi: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 Apr;22(4):750-5. doi: 1007/s00167-014-2862-3.

(8) Aoyama M, Ohnishi Y, Utsunomiya H, Kanezaki S, Takeuchi H, Watanuki M, Matsuda DK, Uchida S. 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. 2017 Nov 16. doi: 1097/JSM.0000000000000516

(9) Palmer A, Ayyar G, Fernquest S, Dutton S, Mansour R. Arthroscopic hip surgery compared with physiotherapy and activity modification for the treatment of symptomatic femoroacetabular impingement: multicentre randomised controlled trial BMJ 2019; 364 :l185 doi: https://doi.org/10.1136/bmj.l185

(10) Kierkegaard S, Langeskov-Christensen M, Lund B, Naal FD, Mechlenburg I, Dalgas U, Casartelli NC. 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 Apr;51(7):572-579. doi: 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 May;46(6):1306-1314. doi: 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 Feb;44(2):454-9. doi: 1177/0363546515612448.

(13) Agricola R, Heijboer MP, Roze RH, Reijman M, Bierma-Zeinstra SM, Verhaar JA, Weinans H, Waarsing JH. 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 Oct;21(10):1514-21. doi: 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. 2011 Aug;260(2):494-502. doi: 10.1148/radiol.11102354.

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