Surgically repairing hip joints can relieve persistent pain and possibly prevent hip replacements later in life.
One common source of persistent pain in a hip joint can be a tear in the labrum, cartilage that functions like a gasket, sealing together the ball and socket of a hip joint. The labrum provides shock absorption, joint lubrication and pressure distribution, according to Current Reviews in Musculoskeletal Medicine.
Labral tears are thought to be common, affecting as many as two out of three people, but it’s hard to know exactly how common because most people who are affected don’t experience any pain, said Dr. Matthew Smith, an orthopedic surgeon with Mercy Orthopedic Associates.
But persistent pain lasting several months can be indicative of a tear needing treatment through physical therapy, steroid shots or surgery.
It used to be common practice to remove a torn labrum, but now, it can be repaired through a minimally invasive surgery called an arthroscopy, Smith said.
“Hip arthroscopy is, in the grand scheme of orthopedics, new and becoming more and more prevalent,” he said. Smith started at Mercy a year and half ago, and he is the only surgeon in the area offering repair and reconstruction of hip labrums.
A labral tear can cause arthritis as the cartilage in the joint wears away, eventually leading to painful bone-on-bone contact within the joint and the need for a hip replacement, he said.
The first labral repairs were done about 20 years ago. So not enough time has passed to determine if a labral repair completed on a teenage patient prevented the need for a hip replacement when the individual became a senior citizen.
“The hope is that when they are 70, they haven’t gone on to develop end-stage arthritis. … But I don’t think anybody can for sure say that yet,” he said.
If a patient has already started to develop arthritis at the time of the repair, the less likely the patient is to avoid a hip replacement, said Dr. Wayne Johnson, a spokesman for the American Academy of Orthopaedic Surgeons. However, a repair is preferable to a replacement, in part because replacements carry higher risk of medical complications, such as blood clots, and a patient’s legs not being the same length.
Labral tears can happen quickly in an accident, but they tend to develop slowly over time, Smith said.
Tears are commonly caused from bumps in the bone of the hip joint wearing on the cartilage. Those bumps can be shaved down to help prevent wear and tear on the joint that can lead to arthritis as well, he said.
Often, pain from a labral tear encompasses the outside of the hip, forming a “C” shape. Patients may experience pain from a labral tear while running or cycling or doing squats, he said.
However, identifying a labral tear as the cause of the pain can sometimes take a year and a half to two years, Smith said.
“It’s not uncommon for pain in this region to be misdiagnosed, undiagnosed or completely missed altogether because it gets blamed on a hernia or a strain,” he said.
Through X-rays, Smith can determine if a patient has bumps within their hip joint, and through an MRI, he can determine if a labrum is torn, he said.
When Smith treats hip pain, he often starts with less invasive techniques, such as steroid shots to address inflammation. He will also inject blood rich in platelets that naturally contain growth hormone to encourage healing in the area. Smith said he will also refer patients to physical therapy for their pain.
If those strategies are ineffective, Smith said he will talk about surgery with a patient. Smith said the surgeries are generally covered by insurance, but he could not say how much they generally cost at Mercy. Hip arthroscopies can cost between $23,000 and $33,000, according to TheAmerican Journal of Sports Medicine.
To repair a labrum, Smith will partially dislocate the hip joint to make room for his instruments. The medical tools will enter the body through two or three incisions about 2 centimeters wide, he said.
He uses an X-ray machine to guide a camera into place to allow him to see the inside of the joint. Typically, labrums tear away from the hip bones, so he will anchor a labrum to screws he will put into the hip bone.
He can also reconstruct the labrum with cadaver tissue if all of it or pieces of it are missing.
During the same procedure, he can shave off bumps from the hip bones that caused the tear, he said.
After surgery, patients are typically in a brace for about three weeks and on crutches for three to six weeks, he said. Typically, it takes four to six months for a patient to return to sports, he said.
Patients in their teens and 20s can need labral repairs, and the majority of Smith’s patients are athletes at Fort Lewis College because he provides medical services to student athletes. However, the tears can happen to anyone who leads an active lifestyle.
Older patients from 30 years old to about 70 can benefit from the procedure to prevent wear within their hip joints.
“We can, hopefully, preserve what they have so we can delay and prevent the need for early hip replacements,” he said.
mshinn@durangoherald.com
The graphic for this story was reproduced with permission from OrthoInfo. © American Academy of Orthopaedic Surgeons. http://www.orthoinfo.aaos.org
