Acetabular Labrum tear

Dear hipsters

For the past six odd years, Ive struggled with knee and (buttock) hip pain, and seen whats seems like hundreds of different docs. Finally found a physio who stuck with me, and on his advice, I hit the gym with a trainer.

Hip pain was initially diagnosed as Gluteus Medius tendonopathy. Did loads of butt work.. didnt improve. Meanwhile my patello femoral knee pain improved dramatically after a few months, but the butt kept on aching! Was doing some heavy adductor work in the gym which felt good for the knee, but one morning i woke up and there was a pain in the groin part of my hip, which hurt when i tried squeezing the knees together..

Suspected labrum tear...MRI showed a tear traversing the full width of the base of mid anterior acetabular labrum. Of course then came the injection. The anasthetic was supposed to be long acting so that i could take my time to really check it out but the doc decided short one would do "too bloody expensive" were his words, and I couldnt really tell. Pain on adduction was still there. Cortisone had a flare up effect that night and it hurt in the butt very badly.... The next few days were relatively blissfull. Felt good!! Groin pain was there butt i could live with it.

On the third day I did my ususal chores and the butt pain was back.. Now about to see a surgeon to get his opinion.

My questions are.

1) whats the chance that my tear has been with me for 6 years and been the cause of all the butt pain?

2) If its been with me for so long, why has it emerged only now?

3) My surgeon is Michael O'Sullivan in Sydney.. will see him next week, but any comments on success or failures or anything?

Cheers

You might want to ask your Orthopeadic about Femoral Impingment. This is a very undiagnosed problem that results in hip pain, sometimes in the butt. Effectively the head of the femur is ever so slightly misshaped (not visible on a standard x-ray) and over time as it 'hits' the acetabular it will finally tear the labrum. The excercises you described will have agravated such a condition. Have a look at the following link for more information.

http://www.physsportsmed.com/issues/...005/larson.htm
It can be very effectively treated with either an arthroscopy or hip surgery.

You might want to ask your Orthopeadic about Femoral Impingment. This is a very undiagnosed problem that results in hip pain, sometimes in the butt. Effectively the head of the femur is ever so slightly misshaped (not visible on a standard x-ray) and over time as it 'hits' the acetabular it will finally tear the labrum. The excercises you described will have agravated such a condition. Have a look at the following link for more information.

http://www.physsportsmed.com/issues/...005/larson.htm

It can be very effectively treated with either an arthroscopy or hip surgery.

Sounds like the same history for the athletes i have seen in the past. I have now rehab`d 8 athletes who have undergone labrum repair.

Recently, two problem cases have suffered from quite sizeable osteophytes both on the acetabular rim and the femoral neck which were butting up against each other and destroying the labrum. With arthroscopy the labrum was destroyed and was delaminating in the socket at the superior aspect (imagine between 11 and 1 on a clockface).

The surgeon i have used recently is Dr Philippon in Vail, Colorado. He is pioneering loads of hip arthroscopy work and is a fantastic man to speak too.

Good luck


Sunderland FC (UK)

thanks for the reply.... Its now exactly 3 weeks after my arthroscopy and while i'm still tender in the groin region, im quite surprised to say that the butt pain has decreased quite dramatically. Im scared to actually believe it since im loving it too much to ever go back, but there are a few factors that are making me pessimistic, which are that i've been taking it extremely easy since the op, and It might be the effects of the cortisone i had injected prior. I guess i should remain positive or at least enjoy it while it lasts

I wonder. If the tear was caused by my femur hitting it repeatedly because of its deformed shape, and the surgery removed that part of the labrum that it was hitting, do i have more space for hip flexion. the reason i ask is because im not entirely sure what debridement looks like or how much was removed.

The scope revealed that the rest of the joint was clean and undamaged but would the surgeon be immediately aware if my femur was misshaped? Or could they have missed it in the MRI because they werent looking for it?

Its early days yet, but so far im so glad its done.
Thanks for your replies again.

James,

I am currently booked in for an arthroscope early Feb, with Dr M. O'Sullivan as my surgeon.

Can you tell me a little about the operation and how is the recovery going.

thanks

Dan

Hi James,

I too have been diagnosed with your condition. I have had had a rough 6 months. After Xray, MRI and CT investigations, they found that I had not only acetabular tear but also lesions on femoral head which resulted in further investigation and delay in treatment for labral tear. Lesions turned out to be nothing to worry about however I still am in a great deal of pain. I have had 2 cortisone injections to no avail (I reacted badly to the last - flare and fever for 1week post injection) and am scheduled to see Dr Michael O'Sullivan for a surgical opinion.

Can you tell me a little about the operation? How long was it before you were up and about?

All the best with your recovery,

Amy.

Hi Amy,
I had no other chondral damage other than a great big tear in the labrum, so I believe just a straight labral debridement is easier post op than when they have to clean up the ball and/or socket as well. To answer your question, i limped out of the hospital without crutches and it took about a week before i could walk around the house without much difficulty. Two weeks later and i could walk some distance. Now its a month later and im walking up and down Bondi on the soft sand daily and it feels great. Its still painfull at the end range of flexion, (bringing knees to chest) and full extension is also a bit painfull, but this is normal. i was worried that i would be out of action for much longer than this, but I was surprised to find that a nagging pain in the buttock region had significantly reduced almost immediately, so I can basically say that I am better off almost immediately after the operation.

I am curious to know your symptoms, and others with labral tears. No one gave me a straight answer as to why a tear in the groin region would refer pain to the upper buttock region, except my physio who suggested that a the tear changed my bio-mechanics which caused weak gluteus muscles and eventually inflammation in them. this sounds good except why the sudden relief in the butt pain.

Anyone else out there with suggestions on why??

Hope it goes well for you Amy. Dr O'sullivan was very friendly and helpfull and i'm told he does this procedure very well

Ps that last post was from me... i forgot to sign in and sign my name.

James

James,

Noted your response to Amy.

Initially my condition was misdiagnosed as torn muscles, which then changed to nerve damage.

Eventually ended up with Dr O'Sullivan following successful diagnosis by another specialist.

My injury is a radial tear in acetabular labrum with incomplete tear at chondro-laberal junction. Including chondral wear at acetabular rim, possibly from femoral head rubbing.

I have suffered ongoing pain in the top of the buttock area since July last year, with associated numbness down my leg to the knee and sometimes beyond.

Had cortisone injection just before Christmas, which didn't work.

Your physio is on the right track. Prior to the correct diagnosis, I had accupuncture sessions when regular physio didn't work. In hindsight the pain must have worked its way outwards from the joint, affecting the muscles. These sessions helped deal with the local pain in greater trochanter muscles, which must have become inflamed.

regards

Dan

Hi, I'm living in Tauranga, New Zealand.
I'm to go for Arthroscopic surgery on my right hip, for a labral tear repair and removal of a cyst. This is booked for Tuesday, 14th February.
Although I've had several other unrelated surgeries, I'm a bit nervous about this one as I can't seem to get much information.
I've only recently heard that surgery isn't always successful long-term.
As I've had the problem for 9 years -
(was doing an exercise in aquarobics when I felt a "snap", and it's taken 8 1/2 years to get a correct diagnosis with a new surgeon I visited last August. He knew straight away what it was because of my symptoms and an MRI confirmed it) -
I'm keen to get some relief at long last, but now having second thoughts if the surgery won't be long term relief from the pain.
Can anyone give me peace of mind I'm doing the right thing going ahead with the surgery, as it's not too late to pull out.
My surgeon is very hard to get hold of and is only here once a week.
Thanks, Lynne

I am 7 days post Hip arthroscopy to repair/"clean" out the labral tear I had as well as remove some cysts. I had Perthis Disease as a child (causing avascular necrosis) which caused my left hip joint to be flattened thus causing a tear of the acetabular labrum.

So far the pain that I had in the groin and the buttocks region has been resolved. I have had no pain since the surgery which so far seems to good to be true.

My first day of therapy was on the fourth day and was placed in the bike to do some cycling and leg lifts. Yesterday was my second day of therapy and they had me do some strengthening exercises after cycling for about 15 minutes. By the way, the first five minutes of cycling yesterday were painful as I felt my hip get "stuck". I was told it was probably from adhesions that were forming. After the initial onset, the pain went away and the hip was doing good.

I started having some pain today in the buttock region; however, it is probably from being on my feet for about two to three consecutive hours. My ortho specialist did tell me to take it easy for a week or two.

For those who are having the surgery, My BEST TO YOU...For me it was the best decision I could have made... The ortho said I was too young for a hip replacement (I'm 36 yrs old) and that this would at least lengthen the time before I need one.

Lynne,

I'm currently at day 4 post arthroscopy for a labral tear. I had a labral debridgement & chondroplasty. My post-op has been similar to James. I have pain in the butt region, however I also have pain in right calf muscle, which is similar to a severe cramp. My whole leg was numb for about 15 hours after the procedure, which was a lot longer than the anaesthetist stated it would be. Calf muscle may have cramped as a result without me feeling it.

I fully understand your concerns about having the procedure, as the specialist who diagnosed my condition stated he would not recommend an arthroscopy as it would only give short term relief.

I decided to take a leap of faith, place my trust in the Orthopaedic Surgeon and go ahead with the procedure. At this stage I'm glad I did.

Dan

Title of previous posts incorrect - should have been as above.

Dan

Thanks for the replies guys.
After a lot of soul-searching, I've decided to go ahead with the surgery on Tuesday, as after living with the damn pain for 9 years, it can't be any worse having the op, and it's worth a try to be, hopefully, pain free.
Thanks again.
Kindest regards, Lynne

Me Again,
After reading some of the messages re groin pain, etc can I just say that instead of being mis-diagnosed as I have been for 8 1/2 years, suggest a labral tear to your doctor. My surgeon tells me a labral tear in the hip joint is the most mis-diagnosed problem.
Physio makes the problem worse, which I can certainly verify, as after 2 different physio sessions, I could hardly walk with the pain, for over a week afterwards.
Acupuncture was a waste of time and money. Nothing will fix a labral tear except surgery.
Don't be fobbed off as I was, to about 6 different doctors. One wanted to do exploratory surgery in the groin. Thank god I declined, and found a good Orthopaedic surgeon who after 5 minutes of listening to my symptoms, diagnosd a labral tear, and this was confirmed with an MRI.

Hi,
I am 4 days post-op from a left hip arthroscopy. I am progressing quite well, but It has been a long, hard road to diagnosis and treatment of a torn labrum.

In April of 1999, I tripped, fell down the stairs, and landed on my buttocks. At first, I thought I had escaped injury. Ten days later, I experienced pain in my hip, groin, buttock, and lower back to the extent that I could hardly walk. My hip x-ray was normal. After several weeks of Physical Therapy, my pain subsided, but the buttock pain remained. Eventually, I consulted two different orthopedic physicians and had a MRI and bone scan. Both the MRI and bone scan were normal. I tried deep tissue massage therapy and while it offered some relief, I still had buttock pain. I was convinced that the medical community could not determine the cause of my pain and eventually, I started taking Celebrex. The ?stink? over Vioxx and Bextra last year (2005) caused me question the wisdom of continuing on Celebrex. By this time, my hip was snapping more than 60 times a day, the buttock pain was worse, and I had quit my twice-daily walks. I decided to see another (third) orthopedic physician, who suggested that I might have a torn labrum or loose body. He ordered a MRI arthrogram that turned out to be a technically poor study (due to artifact), but it did suggest a superior-lateral labral tear. I was referred to Dr. John Clohisy, Associate Professor, Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, who specializes in disorders of the hip and knee. Dr. Clohisy first tried conservative measures. He sent me to a Physical Medicine specialist at Washington University for a direct injection of cortisone into my hip, followed by Physical Therapy. Neither the cortisone injection nor Physical Therapy provided relief. Dr. Clohisy then offered to perform a diagnostic arthroscopy, and I was ready!

Undoubtedly, the pain after surgery hasn?t been any worse than what I have experienced for the past almost seven years. I would describe the post-operative pain as more a ?soreness?. I only needed crutches for the first 48 hours. I am to start Physical Therapy one week post-operatively, and follow-up with Dr. Clohisy two weeks post-op. I am grateful that Dr. Clohisy didn?t ?write me off? as did the first two orthopedists. If you reside in the St. Louis area, Dr. Clohisy has an excellent reputation.

To Lynne: I'm glad I had the surgery

June Bg

Greetings all,

I'm glad to have found this forum to check out the experiences of others and share those of my own. I'm a 42 y.o. fairly avid cyclist who experienced my first hip pain in Jan. 2004 while doing plyometric exercises (giant skipping, explosive sprints, etc.) during a "boot camp" workout program. My initial symptoms were a dull ache and pressure when taking long strides and pain when running. I saw a PT and had some deep muscle work soon after the injury but without any real improvement. I was able to ride strenuously that cycling season but still unable to run so I visited a local orthopedist and after an MRI discovered I had a labral tear.

The ortho also diagnosed "pistol grip" deformity - referred to as femoroacetabular impingement (FAI) ? and recommended an open surgical dislocation procedure to reshape the head of my femur. Since I had never experienced hip problems before, the thought of undergoing this fairly major surgery seemed excessive. The ortho also said he could simply arthroscopically remove the torn labrum but that it wouldn?t address the underlying impingement issue.

Thinking I was being conservative, I opted for arthroscopy and in early Dec. 2004 had the surgery without incident and with really good results ? at least initially. I was off crutches and pain meds in 2 days, back at the gym riding a stationary bike in 2 weeks and out riding my bicycle in early Jan 2005 (on an unusually warm Maine winter day). By mid-Jan I was weight training with no apparent ill effects.

Unfortunately, in early Feb 2005 I had a cycling accident where my bike slid out from under me and I ended up doing a split on my recovering hip. The pain was intense and I knew immediately that I had really messed it up again. Upon my visit to the local ortho a couple weeks later, I was informed that even if I had re-torn my labrum the underlying pistol grip had to be addressed in the course of repairing the tear. I still wanted to avoid the open surgical dislocation and sought out a second opinion with one of the most prominent hip arthroscopists in the US.

In July 2005, I had another MRI and CT scan done and the ?expert? wasn?t able to find any obvious signs of labral tears. He also wasn?t a big proponent of the impingement theory for explaining why tears often occur in the first place. So I had my local orthopedist recommending open surgical dislocation and the ?expert? telling me I was fine and not to worry. The trouble was (and continues to be), my hip still hurts and I can?t strenuously ride my bike, run, hike or ski.

After the fair amount of research I?ve done on FAI I?m now convinced I should?ve taken the initial advice offered by my local orthopedist (address the impingement with the open procedure) and that the ?expert? probably misjudged my case. In fact, there seems to be a growing body of literature that supports the idea of FAI as a significant underlying cause of labral tears. Much of this literature also suggests that if left untreated, FAI will almost inevitably develop into degenerative arthritis and that reshaping the femoral head can slow or halt this process.

Consequently, I?ve got an appointment in a few weeks with my local ortho to finally accept that I need to have the open surgical dislocation. I can?t bear the thought of being consigned to a life of inactivity and hope to regain some of my previous physical capabilities and remain active well into my later years. I?m too young to have an old worn out hip! And it sounds like all of you are, too!

Thanks for the opportunity to share my story and I?ll check back frequently to see how you?re all doing. Also, if any of you would like links or PDFs of the documents I?ve found in my research just send me an email (fdillon1@maine.rr.com) and I?ll send them to you. (You could also do a Google search for ?femoroacectabular impingement? or ?pistol grip deformity.?)

Good luck!

Fred Dillon
Portland, Maine (USA)

Great article from the journal Physical Therapy
Lewis CL, Sahrmann SA. Acetabular labral tears. Phys Ther. 2006;86:110 ?121.
http://www.ptjournal.org/PTJournal/J...010600110p.pdf

Hi South Florida,
I have a few years on you at 56, no 57 today. I was being attacked by a BIG dog whilst running before Christmas and propped then turned to face dog, about 130 deg.behind on other side. A car arrived so dog didn’t get a taste but when I tried to start running again a sharp pain made me limp home.

Deteriorated over week, had x-ray..... untreated Perthes, no sign of recent trauma? (never diagnosed since infancy but couldn’t win foot races at school)..... 2 Months later, condition worse & still cant work, saw specialist and asked for MRI- now waiting to get result.

Always loved running, yoga, riding bike, bushwalks, farmwork, carpentry & building. This hip has had a serious workout and I have been on glucosamine with chondroitin & MSM, for all my joints, for 5yrs.and felt great. Right leg 20mm short and not as flexible in hip as left.

Now I am a serious cripple and have my bet on acetabular labral tears, from femoroacetabular impingement. I have the groin and butt pain and one down the front to the kneecap and below; a sharp pain also where my leg threatens to give way and the nagging pain in bed that interferes with sleep. I experience discomfort whilst sitting, on feet or lying down.
From utter defeat after sitting on the ground with head in hands I have stood up and walked away normally without a limp and only a slight hint of discomfort at extent of gait. But not for long because its unstable and can be anywhere inbetween at any moment.

I have had problems with both knees in the past, the left needed a small piece of damaged cartilage shaved off that would become displaced in the joint and a cyst that formed because of the cartilage damage, then strangely in the right, the arthroscope found nothing wrong.....Hmmm! (I now suspect the pain was referred from the hip)

Please keep us informed of your progress. I would also like to hear more about your Perthes history and anyone else’s experience, as this diagnosis is new to me. I have not heard of Perthes before.

All the best
Greg
Aus

Hello,
I am a physical therapist in the U.S. and I have been experiencing low back buttock and leg pain for the past 10 years on and off. Recently, it was made worse by taking up golf. I had two sessions of physical therapy in the last 4 years, which helped temporarily and many deep tissue massages which also helped temporarily. My symptoms are now localized to the groin and buttock. I finally decided to consult an orthopedic surgeon because I am no longer able to play any sports, do yoga or dance like I used to. Preliminary x-rays and physical exam point to labral tear of the hip and I am scheduled for an MRI in 3 days. The surgeon stated that arthroscopy is only successful in 30% of cases. Is this what you all have found?? He basically said I'd have to live with it. What is your advice?
S

Hi S, I'm a physio in Melbourne, Australia with a special interest in chronic hip, groin and LBP mainly because I spent years sorting out my own problems as well as my patients. The simple answer to your question about hip pathology and hip scopes is that we don't really know. If we compare the historical progression of a similar pathology and procedure in the knee, for example the first knee scopes, it took many years before sufficient evidence was avaliable regarding best practice in managing those conditions. Comparatively, hip joint pahtology (excluding OA) ia a relatively new phenomen and as such we are still exploring the best methods for both assessing severity of pathology as well as the most appropriate management. At Melbourne University they have a specialised hip study group who investigate just that. At the end of the day hip pathology is not an isolated problem, the compensations and interactions with other musculoskeletal components are complex and require sound clinical assessment and reasoning when deciding on an individualised treatment plan. As a PT a good starting point is a thorough look at a your lumbo-pelvic biomechanis and stablity as wellas looking at your aggravating activites to decide on the best ways to impove your weakness and manage your hip load. Pilates can be a good way of implementing it into a busy lifestyle (it worked for me). There's another whole thread on the surgical side of things on this forum so check that out too.
Cheers
Thihan - sorry about the long post.

Quick addit: to properly answer the question about what to do, have a read of the acetabular labral tear article someone posted the link to earlier (damn .. wish I'd written that one). If the MRI is inconclusive then I would say explore all rehab and conservative measures fully before undergoing surgery. If however you have a tear then it needs invasive treatment (this may be just an injection or a full arthroscope or both). I have found this stepwise approach has saved quite a few (me included) from surgery but of course it all depends on the chronicity/severity of the problem and the pain of course.

Thihan,
Thanks for the reply. I have had two rounds of PT in the last 4 years, and I am a Pilates instructor. When I can do Pilates, it does really help, but overall the problem is getting worse. The MRI will confirm if it is a tear, but it most likely is. I read the referenced article by Shirley Sahrmann et.al. and another by Dr. Farjo from University of California. It seems that arthroscopic surgery is becoming more popular for the hip, but still very few surgeons are performing it....I will certainly seek a second and possible third opinion before signing up for surgery. And I may also try a very concentrated round of self-PT with a combo of Sahrmann muscle balancing exercises and Pilates just to be conservative first.
Thanks for the advice.
S

Hello All,

I am a 20 year old female who has a history of joint problems. I had a capsular shift performed on my shoulder at the age of 17.

After 5.5 months of frustration and misdiagnosis I am 7 days post op from Hip Arthroscopy + Labral Debridement.

I presented with severe pain in groin for no apparent reason. I am an active cyclist and whilst I had had a fall some months prior to the onset of pain, the sudden onset meant that there was no link to the fall.

Xray, CT and MRI investigations showed an Acetabular Labral Tear and moderate non-specific synovitis. Lesions on the Femoral Head were also shown which were possibly an indication of an Osteoid Osteoma (a benign bone tumor which causes night pain). This was later ruled out after they scared me by telling me that it might be a malignant tumor! The injury was so severe that I was basically on crutches for 5 months.

I was treated with 2 cortisone injections to no avail.

I have heard a lot about arthroscopy patients having little success after surgery and was fairly sceptical about the procedure but I have to say one week out I have no pre-op pain at all.

I was in hospital for three days (usually this is a day procedure but I had quite a lot of debride taken out).

A little about the procedure: it takes about 2.5 hours. Both legs were placed into vascular stockings and the leg that was to be operated on was placed into traction.Two small incisions are made on the outer thigh region where probes are inserted.

I walked out of hospital aided by crutches and continue to use them now one week later.

I had physio two days ago - passive movement is fantastic. I am still very sore and sorry but it is only going to get better from here in. My physio expects that I will be able to walk unaided in another week (slower than what other people have posted but we all heal differently!). The main thing that the groin pain is gone.

After months of chronic pain I now have relief and can get on with life.

To people who feel that there are no non-evasive treatment options left - I say "GO FOR IT". What have you got to loose?

:confused: Anyone interested in post-op recovery.

It is now 3 weeks, + 3 days since procedure. I've had a couple of physio sessions, including weight bearing exercises.

Still experiencing pain while sitting, with hip not taking any weight. Any change in direction, or sudden rotation of the hip causes it to "catch", resulting in sharp pain. Hopefully ongoing physio will strengthen muscles around joint, aiding recovery.

Anyone experienced similar symptoms?


Dan

Hi -
I'm a 26 year old female distance runner. After 4 months of groin pain, I finally went for an MRI. I have an acetabular labral tear in my right hip. I am scheduled for surgery on the 22nd of this month. I was wondering if any of you have had arthroscopy or have any insight as to whether or not I should follow through with it.
I have spend January and February swimming and riding the stationary bike, getting electric stim and ultra sound.
Thanks so much.
Rory

It is interesting that the stats show that 8 times as many hip arthroscopies (per head of population) are done in Victoria than NSW. I know of some people who have flown down from Sydney to Melbourne to get one done.

I would only recommend hip arthroscopy if other management fails. I think guided injections of local into the joint help a lot with diagnosis. Still a lot to learn for the orthopods about this procedure, although like anything else, there will be some surgeons who do hip scopes to make money and others who will be selective.

Hi Dan,

I know what you mean. I have had other joint surgery in the past (shoulder capsular shift - very invasive) and the body takes time to heal. It took around 6 weeks with my shoulder before I stopped getting the "catch" sensation.

I am sure that once you have regained muscle stability in and around the joing that you will no longer experience that "catch" sensation.

I am finding at the moment that I am compensating for pain by overusing my glutes at the moment and as such I am unbalanced. Did you have this problem? My physio keeps telling me off for walking with a stiff leg!

All the best.

Dan,
Sounds like you are still having some difficulties, which you may want to discuss with your physician and physiotherapist. Your pain in sitting may be due to pulling of your hip flexor muscle, specifically iliopsoas, when unsupported. Use back support when sitting and try not to sit with knees below the hip as this cantilevers the joint forward somewhat. Twisting and sudden movements are probably not a good idea at this stage in your healing. Remember, the body takes at least 6-8 weeks to heal injured tissue, then you have to regain the proper muscle control and strength which can take another 6-8 weeks. Be patient, but be an advocate for your rehab, make sure you get all your questions answered.
S
PT in US

Quote:

---

Originally Posted by injuryupdate

It is interesting that the stats show that 8 times as many hip arthroscopies (per head of population) are done in Victoria than NSW. I know of some people who have flown down from Sydney to Melbourne to get one done.

I would only recommend hip arthroscopy if other management fails. I think guided injections of local into the joint help a lot with diagnosis. Still a lot to learn for the orthopods about this procedure, although like anything else, there will be some surgeons who do hip scopes to make money and others who will be selective.

---

Hey I'm not sure if you were writing that response to me. In regards to the "guided injections of local" would that be the same procedure as the injection for the MRI?
Thanks,
Rory

Hey everyone, its 2 months to the day since the op. Reading back on all these replies reminded me how fast time has gone. I'm into my next phase of physio which involves riding an excersise bike, and slowly strengthening the glutes and light core work. My range of movement has increased since last post (bout a month ago), which is re-assuring that all is looking good. My butt pain is sooo so different to how it was. Spent a few lazy days at home and by the end of it was quite comfortable in bed.... looking back to pre op days that would have been an unbearable amount of inactivity. I recently flared up the hip by doing something silly, and the annoying butt pain came back. few days later, all was calm again. So in comparison, Im doing fine. My physio told me not to have any expectations till at LEAST 6 months which i was prepared for, so by using my progress as a timeline i reckon everything is pretty good.

Dan, I reckon you had a few more things wrong with your hip joint and so more fiddling around, probably explains the slower recovery. Don't despair mate, if you get to do some light slow cycling, ( I hired a little excersise bike) you'll find that it loosens up the joint and gets the blood flowing around the hip..but only after you get the go ahead. Sitting means your femur is close to the part of the labrum where they worked on (assuming your's was like most others, in the front) so naturally it will hurt more, but in time your pain free range will increase.

Cheers all.
J. French

Hi

I'm a PT working in the UK and have had all the recognised symptoms of a labral tear. The results of the MRI arthrogram are inconclusive showing a cyst and degenerative changes only. Has anyone else had these symptoms and similar MRI findings and subsequently been found to have a labral tear?

:D Hey Jeff, PT, Claire & others,

Thanks for the replies fellow painsters. Jeff, this discussion has expanded somewhat from your original post and based on the global responses, this is the only forum on the subject. Shame it was not available when many of us were being misdiagnosed.

I have been undertaking physio, including light stationary bike work etc for the past couple of weeks. Originally advised my recovery would take 3 months to return to pre-injury status. Based on previous posts, I will need to discuss with surgeon and re-evaluate. My age may also be a factor in recovery, as I'm 44.

Dan

My appoligies James. That will teach me for attempting to reply to two forms of media at the same time.


Dan

Greetings,

I've been following these posts with interest and some perplexity in that none really seem to address what may be the underlying cause of labral tears in many cases, namely femoroacetabular impingement (FAI). I appreciated Thihan?s observations that hip pathologies can be very complex and not very well understood, but in the case of FAI it would seem to be a relatively straightforward mechanical issue. As I mentioned in my Feb 13th posting, there seems to be a growing body of literature that supports the idea of FAI as a significant underlying cause of labral tears. Much of this literature also suggests that if left untreated, FAI will almost inevitably develop into degenerative arthritis and that reshaping the femoral head can slow or halt this process. Have any of you other folks posting to this thread had any experience with surgical procedures to address FAI?

Any assistance / feedback would be greatly appreciated.

Fred Dillon, Maine, USA

Below are excerpts from an article by Dr. Tom Sampson from San Francisco.

INTRO
Hip pain in younger individuals has been associated with abnormal morphology of the hip joint itself. In recent times, there?s been more attention paid to acetabular and femoral morphology and its association with femoroacetabular impingement syndrome. Femoroacetabular impingement may reduce motion due to pain typically in flexion and internal rotation. This is due to the impinging bump of femoral head neck bone either overloading the articular cartilage causing chondral injury or delamination defects of the anterior acetabulum with separation and tearing of the adjacent labrum. There are two types of FAI; 1) Cam impingement in which there is an increase in the anteriolateral radius of the femoral head mismatching with the radius of the acetabulum 2) Pincer impingement in which there is a short offset between the head and the neck allowing the neck to abut against the rim of the acetabulum and labrum...

CONCLUSIONS
Femoroacetabular impingement occurs in late adolescents and young adults and may be a precursor to early hip arthritis. Reinhold Ganz and his Bern Hip Group and Jeff Mast have made significant contributions to our understanding of femoroacetabular impingement. They have demonstrated that its early correction may alleviate pain and prevent the progression of arthritis of the hip. An arthroscopic equivalent to the open surgical dislocation has been presented. Our experience has shown it can be done safely and effectively with favorable early results. Patients are off crutches quickly and no hardware is left behind as with the trochanteric osteotomy done in the open procedure. Only after a thorough study will we be able to compare the long term outcome with those of the open procedure, however the early results are very favorable and is a less invasive procedure is more desirable...

For the full article, see the following link:

http://www.aana.org/pdf/FallCourse/d...aanafall05.pdf

I completely agree with you Fred, FAI and femoral bossing (as well as other mechanical dysplasias) are a big contributor to soft tissue pathology of the acetabulum. However in Australia just getting the "establishment" to agree on what is dysplastic and what isn't can be a long process. The best example is my own hips, which presumably started off poorly designed (labrador hips) but were exacerbated by 10 years of competitive karate and kickboxing. I had every scan avaliable (all NAD on report) and saw multiple orthopods with many different opinions. It was only as a physio ,when I was able to do my own research on hip dysplasia and met a Melbourne Sports Doc with a particular interest that we were able to diagnose the problem. If you look at my xrays now, it's bleeding obvious what the problem was. Treatment wise in Melbourne, hip athroscopy is the only real option but as you say doesn't treat the problem of impingement, just gets rid of some of the damaged tissue. I've rehabed quite a few post op hip scopes in the last 5 years (more every year) and outcomes are quite varied (especially in chronic cases), but my gut feeling is that the best responders are those with minimal dysplasia and straight internal hip derangement. It looks like the US is well ahead regarding awareness of the hip as a pain source in younger populations as well as the more invasive surgical procedures (ie osteotomies) which may be required to treat them.

I'm a conservative type at the best of times so I suppose the whole idea of taking a hammer and chisel to my femoral neck just gives me the willies especially when my symptoms are managable. Your thoughts and experiences would be most appreciated on outcomes for more extensive surgical intervention.

Hi again,

Thanks for the quick reply, Thihan - and despite your sense that the US may be further along in hip awareness, I still had to go all the way to Australia to find this forum! Wonder if it says something about the general state of affairs in the US health care system? But that's for another thread entirely...

I also appreciate your conservatism before resorting to bone carpentry - although in my case it appears I may have been better off having the surgical dislocation and femoral head reshaping (or preferably the arthroscopic equivalent) instead of the simpler arthroscopy to remove torn labral tissue.

I'm now faced with a second surgery on the same hip with thinning cartilage. My biggest fear is that the "horse is already out of the barn" and there's not enough cartilage remaining to justify the procedure. If this is the case, I guess I become a candidate for total hip replacement - which would really be a bummer since I probably won't be able to resume any of my pre-injury activities - at least not at the same intensity that maintains the fitness level to which I've become accustomed.

I’ve got an appointment with the local ortho doc in another week and a half and will keep you posted on how I make out. In the mean time, I’ll also probably check with Dr. Sampson in San Francisco and / or Dr. Philippon in Vail, Colorado.

Cheers,

Fred

Femoral-acetabular impingement is just the latest trendy diagnosis. Could be thought of as the sports hernia of the 00's. Seems a good excuse to push patients into premature surgery and secure another mortgage repayment

Also need to consider that hip arthroscopy is HEAVILY operator dependent.