Labral Tear/Repair

What is it?

The acetabulum (hip socket) is surrounded by a ring of fibrocartilage called the labrum. The labrum provides stability to the hip joint by deepening the socket and protecting the joints surface. A labral tear occurs when a part of the labrum is pulled away from the socket causing separation. These tears can be caused by a sudden specific injury or from “wear and tear” from repetitive motions. Osteoarthritis can also be a cause of a labral tear due to the overall degeneration of the hip joint.

In order to properly diagnose a labral tear your doctor will perform a physical examination as well as order an MRI of the hip. X-rays will be taken to evaluate the bony structure of the hip because it has been found that having an abnormally shaped femur can increase your risk of a tear.

What are the treatment options?

If the cause of the labral tear is arthritic, then your doctor will most likely choose a treatment plan that is focused on treating the arthritic joint as a whole.

If the labral tear requires surgery usually a minimally invasive technique called a hip arthroscopy will be performed. During a hip arthroscopy the surgeon will make very small incisions and insert a small camera into the hip. Using the camera’s images the surgeon can guide small tools around and perform the repair. The tear may require fixation, utilizing a suture to repair the tissue or require debridement, which is the removal of a small section of the labrum. The type of repair will depend on the tear.

Sometimes it is possible to treat the pain with physical therapy, by strengthening the hip muscles, restoring normal neuromuscular control and improving posture.

Procedure Goals

The goal of hip arthroscopy is strikingly different from other hip surgeries, e.g. total joint replacement or fracture stabilization. Oftentimes, the patients undergoing hip arthroscopy procedures are quite athletic and the goal is to return them to sports or activity as quickly as possible. Early weight bearing and range of motion exercises are emphasized. Progressive strengthening programs are started early and cross training activities are encouraged early in the rehabilitation process.

What to Expect

Full recovery from surgery usually takes 4 to 6 months

Day of Surgery

The day of the procedure, you will need to arrange for a ride to and from the procedure and arrange for help at home.

Wear shorts or loose pants.

Do not eat or drink anything after midnight for arrivals before noon. Otherwise, do not eat or drink anything seven hours prior to your arrival at the surgery center.

If crutches or a walker are needed, please rent or borrow them prior to your surgery.

You will be contacted by Lawrence Surgery Center to set up your patient account. They will inform you of your pre-operative instructions as well as tell you when to arrive for surgery.

After Procedure

You will most likely have some sort of weight bearing restriction after surgery, depending on the exact procedure performed. You will need to use crutches or a walker for support. Typically, crutches are used for four weeks with toe touch weight bearing.

You will need to make a follow-up appointment in clinic for the day after surgery to have your dressing changed. A water proof tegaderm dressing will then be applied so you can shower.

Discharge Instructions

Diet

• You may resume your regular diet. However, start slow with clear liquids and gradually work your way back to your normal diet. This will help prevent nausea and vomiting.

Weight-Bearing Status

• Typically crutches are used for 1-4 weeks with touch down weight bearing. This will be determined after surgery based upon procedure.

Hip Care & Bathing

• Keep your dressing in place until your first post-op visit 
• Dressing will be changed at your first post-op appointment 
• Tegaderm dressing will be placed which will allow you to shower immediately 
• No bath or swimming until the bandages are removed 
• If the tegaderm dressing becomes loose or falls off, replace with over the counter water proof bandages 
• Keep incision dry until sutures are removed (usually 14 days after surgery)

Circulation

• To encourage circulation wiggle your toes, ankle and feet. Ankle “pumps and circles” should be performed several times each hour to help decrease swelling. 
• Perform glute sets by squeezing your buttocks together. Hold for five to ten seconds, performing up to ten repetitions every hour.

Cold Therapy

• To help reduce pain and swelling, apply an ice pack to the surgical area for 20 to 25 minutes every one to two hours for the first 48 hours and then as needed to help control pain and swelling. 
• To avoid frostbite, place a towel or t-shirt between the ice pack and your skin. 
• It is not necessary to use ice while sleeping. 
• We recommend the use of a cold therapy unit, which is often an out of pocket expense. The advantage of this unit is that the temperature can be regulated, allowing for continuous use for several hours at a time. 
• Use of ice during your rehabilitation and physical therapy phase is also beneficial.

Pain Medication

• Your physician will give you a written prescription for pain medicine as you leave the surgery center. Take your pain medication as prescribed. You may want to take it regularly for the first 48 hours after surgery. Do not take any additional Tylenol. 
• While you are asleep in the operating room, a long acting numbing medication may be injected into the surgical area to help relieve your immediate postoperative discomfort for up to 24 hours. When you first notice tingling or throbbing, begin taking your pain medicine so it will become effective before the local anesthesia wears off. 
• No driving while taking any narcotic pain medication! 
• The pain medication may cause some nausea so take it with food. 
• The pain medication and general anesthesia may also cause constipation, so you may need to take a stool softener, fiber bar, Metamucil or prune juice to prevent constipation. 
• Dr. Pro also recommends taking 325 mg of Aspirin for six weeks after surgery for DVT prophylaxis.

Follow-up Care

• Watch for temperature > 101.5F, persistent numbness and tingling, persistent bleeding or drainage from the wound, foul odor, progressively worsening pain that is unresponsive to pain medication, chest pain or difficulty breathing. If you have any of these symptoms, call the office if during normal business hours or go to the nearest emergency room. 
• Please make sure to follow instructions given to you by your physician, they may have specific instructions to your care
• If you do not have a postoperative appointment set-up already, please call the office to schedule an appointment for 7-10 days after surgery at (785)843-9125.

Rehabilitation Plan - Exercises

A formal rehabilitation program after hip arthroscopy is highly recommended in order to restore hip and trunk range of motion, restore lower extremity strength and decrease pain. Your therapist will tailor your rehabilitation program to you based on your goals.