Different Labral Tear Hip Treatment Options

Hip labral tears can be very painful and debilitating. Reducing pain and restoring hip function should be the goal of any hip labral tear treatment. There are a variety of treatment options from conservative measure to drugs, injections, and surgery.

Treatment Depends on the Type and Severity of the Labral Tear

Labral tears are classified on where in the hip they are, how they look (or their morphology), and if they may be detached or not. The severity of the injury usually depends more on how bad the patient’s symptoms are and how they respond to conservative therapy. Also, the cause of the labral tear is likely most important as far as guiding treatment.

For instance, if the labral tear is caused by muscular imbalances leading to more stress forces on the labrum, correcting those imbalances with physical therapy can address that. If the labral tear is caused by an abnormally shaped or positioned bone (dysplasia) from an injury or genetic condition, surgery may be required to correct the underlying defect. 

At-Home Remedies for Minor Labral Tears

When you first experience hip pain or you are first diagnosed with a hip labral tear, you may just try basic at-home therapies.

Activity Modification

The simplest thing one can do for hip labral pain is just avoid the activities that cause pain. Typically, these are high-impact activities like running or jumping, or activities that require deep flexion or rotation of the hip.

This can help limit pain and further injury, but the risk is too little movement could lead to stiffness in the joint, which can make things worse over time.

Hot and Cold Applications

Heat can help provide some muscle relaxation and blood flow to the area and may help pain. Infrared heat can provide deeper, penetrating heat, which is good for blood flow and metabolism closer to the labrum.

The risks with superficial heat is skin burns from prolonged exposure, so make sure the temperature is not too high and the heat is not applied for too long. For infrared heat, you tend to want to stick with two or three 30-minute sessions a day, as more can cause more harm than good.

Ice can reduce swelling and soreness, but ice can inhibit blood flow and healing, so you don’t want to ice for longer than a few minutes at a time.

Non-Surgical Treatment Options Hip Labral Tear

These are the typical treatment options available if patients are seeking non-surgical methods.

Physical Therapy

A good physical therapist can evaluate your posture, alignment, symmetry and muscle function and develop an exercise and mobility program to address imbalances. They also can do modalities that can help loosen tight muscles, reduce pain, improve hip motion and reduce the stress on the labrum. Physical therapy can help facilitate self-healing of the labrum.

There is little risk to physical therapy.

Medications – NSAIDs

Non-steroidal anti-inflammatory drugs such as ibuprofen and Aleve may be used to help with pain and inflammation.

However, while these drugs can help alleviate pain and symptoms temporarily, they carry many risks. They can inhibit healing or make you more prone to further injury. They are known to increase the risks of stomach bleeds, heart attack and stroke, kidney injury, bone loss, decreased testosterone, and chronic pain.

Pain Injections

Some pain physicians may suggest a local anesthetic and steroid injection into the hip joint. The goal of this is to help determine if pain is coming from the hip joint such as the labrum but not specific to it.

The steroid can help inflammation and pain but can also damage cartilage and labral tissue, is toxic to stem cells (healing cells), increases the risks of bone loss, can increase the risk of hip surgery failure or infection if that is needed, and has many other potential systemic side effects.

Surgical Treatment Options for Hip Labral Tear

Surgery is sometimes recommended for labral tears that do not respond to conservative therapy and usually is a last line treatment.

Hip Arthroscopy

This surgery involves inserting a small camera in the hip and performing surgeries through small portals instead of cutting open the hip. However, since the hip is a small joint, the surgeon has to apply traction on the hip to open it up to allow the camera to fit in the hip.

This can cause additional damage to the hip capsule/ligaments that can make the hip more unstable after surgery.¹

• Arthroscopic labral debridement: This is the most common labral surgery and involves removing parts of the torn or damaged labrum. 
• Arthroscopic hip labrum repair: In this surgery, the damaged or torn labrum is sewn together. This surgery is less common, due to many labral tears being difficult to repair. 
• Periacetabular osteotomy (PAO): During this surgical procedure, the hip socket (acetabulum bone) is carefully repositioned to ensure a more precise fit with the humeral head. This technique is typically utilized in cases where significant hip dysplasia, characterized by an abnormal femur shape, is evident.

Regenerative Treatment Options for Torn Hip Labrum

Now there are ways to help labrum when conservative treatments are not helping enough, which can be an alternative to surgery. These regenerative therapies help stimulate the body’s own ability to heal.

Platelet-Rich Plasma (PRP) Treatments

PRP (or platelet-rich plasma) involves obtaining blood from a vein in a simple blood draw, centrifuging (spinning) that blood to separate the components, then isolating and concentrating the platelets.

At the Centeno-Schultz Clinic, we use specialized lab personnel to do this, so we can concentrate more platelets and customize the treatment to each patient for better outcomes. PRP has growth factors that help stimulate soft tissue healing, similar to what happens when you heal from a cut on your skin.

PRP works well for mild to moderate labral tears when patients do not have arthritis and they are younger.

Bone Marrow Aspirate Concentrate

BMAC or bone marrow aspirate concentrate contains stem cells and is obtained by taking bone marrow from the iliac crest (hip bone) in a safe and comfortable way. The bone marrow is processed similarly to PRP to concentrate the cells in the marrow.

Stem cells are the most powerful healing cells. BMAC is used for more severe labral tears, labral tears in conjunction with arthritis, and for symptomatic tears in older patients.

In addition to using PRP or BMAC to help heal labral tears, we will also look for associated injuries that can help the overall dysfunction, such as those with the hip capsule, hip ligaments, and hip tendons.

We also will treat any other areas such as the spine or knee that may be contributing to the hip dysfunction and pain, so we take a very comprehensive approach.

Prognosis of a Torn Labral in the Hip

Some people with a torn labral may have little to no symptoms. If the tear does hurt, some young patients with no arthritis may heal on their own with conservative care over two to three months.

If conservative care fails, PRP and stem cells can help heal labral tears with minimal down time and full recovery of three to six months. If surgery is performed, full recovery may take six to 12 months.

How the Centeno-Schultz Clinic Can Help

Labral tears can be incredibly debilitating, but there’s always hope. At the Centeno-Schultz Clinic, we provide cutting-edge regenerative medicine solutions for symptomatic labral tears. Our expertise includes PRP and bone marrow concentrate treatments, which harness the power of stem cells.

Our goal is to help you get back to doing what you love without resorting to risky drugs or invasive surgeries.

Christopher J. Centeno, MD

Christopher J. Centeno, M.D. is an international expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate in orthopedics. He is board-certified in physical medicine and rehabilitation with a subspecialty of pain medicine through The American Board of Physical Medicine and Rehabilitation. Dr. Centeno is one of the few physicians in the world with extensive experience in the culture expansion of and clinical use of adult bone marrow concentrate to treat orthopedic injuries. His clinic incorporates a variety of revolutionary pain management techniques to bring its broad patient base relief and results. Dr. Centeno treats patients from all over the US who…

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John Schultz, MD

John R. Schultz M.D. is a national expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate for orthopedic injuries. He is board certified in Anesthesiology and Pain Medicine and underwent fellowship training in both. Dr. Schultz has extensive experience with same day as well as culture expanded bone marrow concentrate and sees patients at the CSC Broomfield, Colorado Clinic, as well the Regenexx Clinic in Grand Cayman. Dr. Schultz emphasis is on the evaluation and treatment of thoracic and cervical disc, facet, nerve, and ligament injuries including the non-surgical treatment of Craniocervical instability (CCI). Dr. Schultz trained at George Washington School of…

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John Pitts, M.D.

Dr. Pitts is originally from Chicago, IL but is a medical graduate of Vanderbilt School of Medicine in Nashville, TN. After Vanderbilt, he completed a residency in Physical Medicine and Rehabilitation (PM&R) at Emory University in Atlanta, GA. The focus of PM&R is the restoration of function and quality of life. In residency, he gained much experience in musculoskeletal medicine, rehabilitation, spine, and sports medicine along with some regenerative medicine. He also gained significant experience in fluoroscopically guided spinal procedures and peripheral injections. However, Dr. Pitts wanted to broaden his skills and treatment options beyond the current typical standards of care.

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Jason Markle, D.O.

Post-residency, Dr. Markle was selected to the Interventional Orthopedic Fellowship program at the Centeno-Schultz Clinic. During his fellowship, he gained significant experience in the new field of Interventional Orthopedics and regenerative medicine, honing his skills in advanced injection techniques into the spine and joints treating patients with autologous, bone marrow concentrate and platelet solutions. Dr. Markle then accepted a full-time attending physician position at the Centeno-Schultz Clinic, where he both treats patients and trains Interventional Orthopedics fellows. Dr. Markle is an active member of the Interventional Orthopedic Foundation and serves as a course instructor, where he trains physicians from around the world.

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Brandon T. Money, D.O., M.S.

Dr. Money is an Indiana native who now proudly calls Colorado home. He attended medical school at Kansas City University and then returned to Indiana to complete a Physical Medicine and Rehabilitation residency program at Indiana University, where he was trained on non-surgical methods to improve health and function as well as rehabilitative care following trauma, stroke, spinal cord injury, brain injury, etc. Dr. Money has been following the ideology behind Centeno-Schultz Clinic and Regenexx since he was in medical school, as he believed there had to be a better way to care for patients than the status quo. The human body has incredible healing capabilities…

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Reference:

1. Carlos R Arriaza, Carlos Andrés Navarrete, Jaime Palos, Carlos Suarez-Ahedo, Traction-related complications in hip arthroscopy for 26 years. A systematic review, Journal of Hip Preservation Surgery, 2023;, hnad007, https://doi.org/10.1093/jhps/hnad007.