The verdict: torn ligamentum teres

[pusinka]

I'm now 4 days post-op from arthroscopic surgery with Dr O'Donnell in Melbourne. There was only a minor little labral tear, so he went searching for something else and found a full thickness tear of the ligamentum teres (the internal ligament that connects the head of the femur with the acetabulum). It was nastily inflamed, and had set up inflammation of the sinovial lining as well. The ligament has now been removed. Fortunately it doesn't seem to have much function in adults, apart from maybe helping stabilise the hip, so losing it isn't that bad. Now the focus of inflammation has been removed, hopefully the rest of the hip will settle in time. Need to rest well for a few weeks and take anti-inflammatories for a few months.
I was really pleased with the surgery team and hospital (the Mercy). Everything went smoothly. No after effects of traction or anaesthesia, although I'm still sore in the hip joint of course! Could fly home to South Australia quite happily after a few days - just asked the airline for a big cushion to sit on to keep my hip elevated and at an open angle.

I'm interested in other peope's experiences with tears of the ligamentum teres - I'd never heard of it before the op, having focussed my attention on labral tears, which is what I thought I had. Thanks.

[TChen]

Pusinka,
Glad everything went well... all the best with your recovery. T

[Vixen]

Good to hear you had a positive experience with JO and his team, be prepared now for the ups and downs of recovery.

[bella]

Hi Pusinka
I am 5 weeks post op. Complete rupture of ligamentum teres (unrepairable) the remnants were debribed, small tear in the anterior labrum was repaired and capsule plicated.

My biggest problem was with stability, unable to stand properly on my leg. Plus pain between the ball of the hip and the top of the pelvis, as if the ball was compressing on the top of the socket and only just being held. I'm not sure if this is fixed as still unable to stand on leg properly.

I refuse to accept that lig teres has no function, if your born with it your suppose to have it! Believe me it does have a function and dont let anyone (especially those who has a their lig teres intact) tell you otherwise! How is your stability? and what pain did you experience? What antinflams are you taking and how long? Please keep us updated on your progress.

[pusinka]

It was great to have that good chat over the phone, and I do wish you all the best for recovery in time. I can certainly sympathise with the grief involved in having to give up activities that you have enjoyed in the past, and wondering what your future holds.
I'm lucky not to have such a level of instability in my hip as you have (although I have unstable joints elsewhere in my body!). I do have to be careful with forward bending, as I can occasionally feel my head of femur shifting in the socket incorrectly. I certainly won't be doing big yoga postures or lotus position for a very long time, if ever, as I think the stretches I used to do are simply too risky now. I wonder how much my hip stability will be affected without a robust ligamentum teres in there.
I have been very pleased with my progress so far. 18 days post-op and I can use the cross trainer at the gym for 25 minutes with no problems. I'm sure this has helped both pre and post-op in maintaining good muscle strength in the legs, pelvic and groin areas, which has protected my hip somewhat from risky movements. It feels like it will be a long time before I get more normal range of motion back, and I need to be careful not to stir up more synovitis, but all-in-all I'm much better now than I have been for a few years.
Let's keep in touch about our progress and any new information we come across. Best wishes. Melanie

[bella]

Hi Melanie, Great to chat to you too. Having major flare up at the moment. Ohhh the pain. Going back on anti inflams. I hope you are making progress. Thanks for all the encouragment. Best wishes

[pusinka]

Hi Bella
I too have had a flare-up, though it's settling again now, thankfully. From what I understand, synovitis does take a long time to settle, so flare-ups are to be expected I suppose. When the flare-up was acute, it really hurt in a very sharp sort of way, but after a few days of settling down, it turned into a deep ache emanating from the hip socket - possibly the same as what you mentioned in your other post (I think it's synovitis pain). Now, after 10 days, it's stopped aching and is much more comfortable. Back to the cross trainer again today and feeling ok.

I was told by JO to take antiinflamms for 7 to 8 weeks, but after discussion with my GP, I have now quadrupled my dose (to the maximum), and added in curcumin powder as well (plus the fish oil) - I'm really trying to blitz the inflammation! I suspect I will keep taking them for a several more months just to be really sure I can get it under control. I do hope you get more comfortable soon - pain can really wear you down.

[adele]

Hello all,

I too had a complete rupture of my ligamentum teres in my left hip, I had an arthroscopy just over 3 months ago with Mr Pritchard. Background info (I had pain my hip for 16 years and was told by docs it was in my head - even got a prescription for Prozac!). I am still feeling very stiff in my joint, especially in the mornings and can't bring my leg inwards as too painful. Has anyone else been having these experiences?

I have also just 2 weeks ago began having the same kind of pain in my right hip and spoke to my physio and believes I have potentially torn the ligamentum teres in this hip as well. Anyone else had this experience? Anyone else with bilateral ligmentum teres ruptures? I don't recall any injury.

Is anyone painfree?

Cheers Adele

[pusinka]

Hi Adele
16 years of hip pain! Wow. I suppose this type of injury is not very common, so it can take a long time to get a diagnosis, but 16 years is a very very long time.... (thank goodness for hip arthroscopy as a diagnostic procedure). Have you had to limit your range of movement for many years, or has the stiffness just come about post-op?
You ask if anyone becomes pain-free after this surgery. I'm 9 weeks post-op and improving steadily. I'm a long way off regaining full range of movement and suspect that will take many more months... I can adduct a little, abduction is still tricky. Flexion is easy peasy and I can do a modified sort of "hands and knees' kneel for a few minutes to pull out weeds from the garden. Rotation is "iffy', esp rotation in flexion, which I believe is one of the most challenging movements for the hip to do.
At least I can walk pain-free, and I even did a little rock and roll dancing a few nights ago with no ill effect. Sitting in a normal chair is still a problem - I attended my son's school graduation ceremony and had hip pain after about 1 hour of sitting. I use a high sit-stand stool at work with no problems. 3 weeks ago I couldn't drive a manual car more than 15 minutes, but can now manage an hour. I've increased to 25 minutes on the cross trainer at ever-increasing level of difficulty (from 3 initially to 12 now). Straight after surgery, there was no more catching, spasming pain from the torn ligament. What pain I get now from time to time is probably from the synovitis. I'm still taking fish oil, curcumin and diclofenac to try to beat the inflammation.
I do have a sense of greater instability in the operated hip - sometimes the head of femur doesn't feel like it's sitting right in the socket, and I find that I need to recruit a lot of muscles in the hip area to control my hip movement better. That's why the exercises from Amir (PT) are important.
I am also doing hydrotherapy and I find it beneficial (Amir was sceptical, but I like it)- I find I can safely achieve a greater range of motion in the water, in a more controlled way e.g. external rotation in flexion, which I find the most challenging. I'm too scared to try this on land yet, as it feels risky still.
So overall I'm feeling positive with my outcome, and patiently expect gradual improvement to continue.
Best wishes, Mel

[adele]

Hi Pusinka,

Thanks for the reply, it's nice to be able to talk with someone who has experienced the same issue of the hip.

I too find driving 'uncomfortable' and slightly painful when I push the clutch in. I'm currently taking paracetamol and ibuprofen as Amir believes it could still be a little of the synovitis. I'm currently doing the xtrainer 20mins on level 7 (sometimes I'd like to do more but there's a 20min limit at the gym). I have also started riding a bike which is something I have never been able to do since I tore the lig teres.

All in all, I guess my hip is much better and I think I'm a little impatient and unrealistic about recovery times. I feel sometimes I get conflicting messages from Amir - an example of this was preop when I was told not to use the crutches for more than about a day and not to limp (maybe I interpreted the info in a different way to what he was meaning). I walked in for my first post op physio appt and felt like I gave Amir a heart attack as he was telling me to slow down (I feel I was only doing as I was told as I tend to take things literally).

I have almost certainly torn the lig teres in the other hip as it feels exactly the same and starting to get worse and I don't know when to get this seen to as I want my Left hip fixed completely first.

I'm glad to hear your recovery is going well.

Cheers Adele