Don’t Be A Pain In The Hip!
Hip pain has become a hot topic in Orthopaedics over the last 10 years. Our understanding of the hip anatomy and how to better access it with imaging and surgery has advanced our knowledge with causes of hip pain, which can be treatable.
Femoracetabular Impingement (FAI) is a condition of the hip where the bones of the ball and socket no longer fit perfectly together. Extra bone grows over time around the femoral head (ball) and/or acetabulum (socket) and they rub into each other and cause pain by triggering wear and breakdown of the cartilage and the labrum of the hip.
What is the labrum?
The labrum is a rubbery, cartilage like structure that forms a rim around the hip joint. It attaches to the acetabulum (socket) and provides a suction seal to the femoral head (ball). In addition, it provides extra stability to the hip in extremes of motion, like in dancers, gymnasts and skaters.
What is a labrum tear?
The labrum can tear symptoms may include groin pain, clicking and locking. Most tears occur due to FAI. This condition can start in the teenage years. Overtime, the ball and socket rubs against the labrum, since the joint is no longer mechanically sound. A labrum tear is suspected based on a patient’s history and examination. An FAI diagnosis is made by x-rays and labrum tears are confirmed with an MRI.
What treatment exists for FAI and labrum tears?
Initial treatment of hip labral tears is physical therapy and activity modification. Strengthening of the core muscles and hip muscles can help restore stability to the hip and decrease the stress on the labrum. Occasionally, we will give a cortisone injection into the hip, to help make sure the diagnosis is correct, as other problems can cause hip pain as well and not actually be the hip causing the pain. The injection may also give a long lasting relief. These treatments will not actually “cure” the labrum tear but resolve the symptoms.
Newer treatments, such as Platelet Rich Plasma (PRP) and Stem Cells, are being injected into the hip which may actually heal labrum tears, as well as early arthritis. Short term results have been good, but we are still lacking long term data to evaluate these treatments.
When is surgery necessary?
Arthroscopic surgery can be performed on the hip without opening the joint. With small cameras and instruments, we can enter the hip while applying traction, removing the bone impingement and repairing or debriding (clean-up) labrum tears. This is a highly successful surgery when conservative care fails. Newer research has shown that if we correct the bone abnormalities of FAI early enough, we will be able to prevent the development of arthritis of the hip.
See the doctor!
If you have groin/hip pain preventing you from doing the things you love then come in for an evaluation. Don’t let the problem linger and become irreversible.