Diagnosis of Hip Labral Tears and Chondral Damage
Dr. Boykin will initially perform a detailed history and physical exam to determine the cause of the pain in the hip. This will include an assessment of FAI, range of motion, tightness of the muscles around the hip, strength, hip instability, and diseases of the lower spine. All patients will initially have hip specific radiographs (X-rays) to assess for bony hip abnormalities, FAI, and other causes of hip pain. A MRI of the hip may also be needed to give a more detailed view of the damage to the labrum and/or articular cartilage which is not seen on X-rays. This type of testing will allow Dr. Boykin to confirm the diagnosis as well as to determine the severity of the injury and to ensure that there are no other injuries in the hip joint (fractures, etc.).
Treatment Options for Hip Labral Tears and Chondral Damage
The treatment for labral tears and chondral damage will depend on the severity of the patient’s symptoms and damage to the hip joint. Typically the first line of treatment is non-operative consisting of rest, activity modification, weight loss, physical therapy to strengthen the hip and core musculature, and non-steroidal anti-inflammatory drugs. If these modalities fail to provide relief the next step may be an injection into the hip joint of local anesthetic and corticosteroids. This will reduce the inflammation and pain in the hip and also help Dr. Boykin in determining the exact cause of the pain and how a patient will respond to a surgical intervention. In cases where the above methods have failed, or those who initially present with more severe damage, a surgical treatment may be recommended.
When to Have Surgery for Hip Labral Tears and Chondral Damage
The surgical treatment of diseases of the hip, including labral tears and chondral injury has evolved over the past decade. Initially these injuries could only be treated with an open surgery, requiring a dislocation of the hip to provide access; however, improved techniques and advances in instrumentation now allow many of these injuries to be treated with minimally invasive arthroscopic surgery. In the vast majority of cases, Dr. Boykin will perform an arthroscopic surgical approach to the hip using small incisions, a camera, and special instruments to treat the damaged areas.
In the orthopedic research literature, better results have been found with techniques that preserve a torn labrum rather than simply take away the diseased tissue (called debridement); therefore, Dr. Boykin makes every attempt to repair a damaged labrum and save the original tissue. If the labrum is damaged beyond repair, Dr. Boykin may perform a labral reconstruction to create a new labrum with tissue from the outside of the hip.
With damage to the articular cartilage, the surgical treatments depend on the extent of the injury. In cases where there is a small area of damage, flaps, or loose pieces of cartilage, Dr. Boykin will perform a chondroplasty to remove the loose bodies and trim down the damaged area back to a stable base. If there are areas of full thickness cartilage damage, Dr. Boykin may opt to perform a specialized procedure called microfracture to try and regrow a cartilage type tissue and cover the area of exposed bone.
In many cases, the above mentioned procedures will be performed in conjunction with the treatment of FAI. Patients who already have advanced arthritis of the hip with a severe loss of cartilage are not candidates for the arthroscopic procedures as this treatment has been found to not be beneficial in these cases. Dr. Boykin will use his experience in order to determine which surgery a patient will better recover from to provide the patient with the best chance of returning to their activities. These procedures have been shown to be highly successful in getting active people, including professional athletes, back to their sports and activities.
For information regarding labral tears, chondral damage, or any other hip-related injury, feel free to contact Dr. Robert Boykin, Orthopedic Surgeon serving Asheville, Arden, Fletcher and surrounding North Carolina communities..