Anatomy of the Hip
The hip joint is a “ball and socket” type joint composed of the femoral head (ball) and the acetabulum (socket). The socket is lined by an important ring of cartilage called the acetabular labrum. This structure serves an important role in hip stability and allowing for the normal motion of the hip. When damaged it can be responsible for catching, locking, and pain. The articular cartilage of the hip is similar to that found in the knee and shoulder – a specialized type of tissue that coats the ends of the bones and allows for a smooth, painless gliding of the joint. When this tissue is damaged the patient will develop hip pain and swelling followed by arthritis of the hip where the majority of the cartilage is worn away. Dr. Boykin specializes in the treatment of labral tears and chondral damage.
How Hip Labral Tears and Chondral Damage Occurs
Labral tears and damage to the articular cartilage (chondral damage) are thought to occur by one of two major mechanisms:
- Traumatic events – these may include a contact type sports injury, a fall, auto accident, or any type of trauma that results in an injury to the hip joint. These injuries may be a spectrum from a twisting injury to a subluxation (partial dislocation) to a full dislocation (when the ball is completely out of the socket) or fracture of the hip.
- Overuse injuries – patients who participate in sports and athletic activities requiring repetitive motion of the hip may develop damage to the joint over time. This is especially true in patients who have femoroacetabular impingement (FAI), with underlying bony abnormalities that predispose the labrum and cartilage to injury.
Symptoms of a Labral Tear or Chondral Damage
The symptoms of labral tearing and damage to the cartilage are similar to those listed in patients with FAI (since patients with underlying FAI usually present when they develop pain from injury to the labrum and cartilage). These include:
- Pain deep in the groin
- A pinching sensation in the front of the hip when the hip is flexed and rotated
- Catching or locking of the hip
- Grinding of the hip with motion
- Difficulty squatting down and coming back up
- Trouble competing in sports that require repetitive movement of the hip
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..