June 27, 2023

Author

Thierry Pauyo, MD

Author

Thierry Pauyo, MD

Hip Labral Tear Surgery: Restoring Hip Function and Relieving Pain at a Premier Montreal Surgical Clinic
A hip labral tear can cause significant discomfort and limit one's ability to perform daily activities. Thankfully, individuals in Montreal, Quebec, can turn to the Canadian Private Surgery Clinic for advanced hip labral tear surgery. In this blog post, we will delve into the intricacies of hip labral tears, the surgical solutions offered at our clinic, and the renowned orthopedic surgeons who specialize in restoring hip function and relieving pain.

Anatomy or Athletics? Deciphering the Causes of labral tears

Every athlete, whether a high school player or a professional, wants to get better at what they do. They’re always seeking ways to enhance their performance. While there’s a certain limit to how much an athlete’s natural talent can take them, one area that they can always improve is power generation. Power is essentially the force or energy that athletes create to perform actions in their sports. We’ve been learning more about how this power gets created thanks to developments in the study of something called the kinetic chain.

The kinetic chain is like an energy relay race through our body. When an athlete does an action like a tennis serve, a boxing uppercut, a gymnastic vault, or a ballet turn, they’re using the kinetic chain. This energy starts at the ground, moves up through their legs, along the spine, and into their arms. It’s like a wave of force that gets passed from one body part to another, with each body part contributing to the overall power of the movement.

Engineers first started talking about the kinetic chain. They described it as a series of linked segments—like links in a chain—connected by joints. In medicine, the term kinetic chain refers to the coordination of different body parts moving together. More specifically, in our legs, there are fifteen key muscles that are part of this kinetic chain. Most of these muscles are connected to or cross the hip joint.

It might be tempting to say that the hip joint is the most important part of the kinetic chain. It’s not quite that simple, but the hip joint definitely plays an important role. However, understanding issues that cause hip pain without arthritis can be quite complex due to the intricacies of this joint’s structure and function. So, we’ll delve into this topic, looking at these kinds of hip problems, what causes them, and how they’re initially treated.

Understanding the Mechanisms of Labral Tear Pain

The hip is a really stable joint because of how it’s structured. It’s a “ball and socket” joint, meaning that the ball-shaped end of one bone fits into a cup-like socket of another bone. This, along with the strong ligaments and muscles around it, keeps the hip stable. For a long time, doctors thought that because of this stability, hip injuries would be rare unless there was a serious accident. Hip issues were often chalked up to groin “pulls” or hip flexor muscle strains.

This was because the medical field thought the hip, unlike other commonly injured joints like the shoulder, was very stable due to its ball-in-socket design. However, recent studies have shown that the ball-shaped end of the thigh bone (femoral head) isn’t perfectly round. These studies have also shown how the femoral head moves and twists within the socket (acetabulum) during movement.

In the past 20 years, there’s been a shift in how we understand hip issues. Various conditions that can cause disability and non-arthritic hip pain are now recognized. These include conditions like femoral acetabular impingement (FAI), dysplasia (abnormal growth or development), and hip instability. Studies have also shown that the soft tissues around the hip play a major role in keeping the joint stable, even more than the bony structure itself.

As we gain more understanding, doctors are working to make the diagnosis and treatment of hip issues simpler. This has led to an approach where they think of the hip in two layers, like peeling an onion.

The inside layer includes the cartilage and the labrum, which is a type of cartilage that lines the hip joint. These parts make up the inside of the joint. If you’re feeling pain because of a tear in your labrum, doctors can inject a numbing medication or steroids right into this inner layer, which usually gives some temporary relief.

The outside layer involves all the muscles and tendons surrounding the hip. If the hip joint moves in unexpected ways, perhaps due to intense sports or physical activities, it can lead to injuries in this layer. This can cause conditions like tendinitis and muscle strain. These problems are typically treated with dedicated physical therapy to strengthen the muscles and improve movement.

Impingement

Impingement is a condition where certain parts of the hip joint rub together in a way they shouldn’t. We’ve learned about impingement thanks to researchers like Murray, Solomon, and Harris, who noticed a link between a certain shape of hip joint, called the “pistol grip deformity,”
and hip osteoarthritis.

In femoral acetabular impingement (FAI), there are two common types: Pincer and CAM. In Pincer impingement, the rim of the hip socket (acetabulum) sticks out too much and rubs against the neck of the thigh bone (femur). This can happen in certain conditions, like when the acetabulum is tilted backward (retroversion) or when the hip socket is abnormally deep (protrusion or coxa profunda). This rubbing damages the labrum and leads to wear and tear.

In CAM impingement, the ball at the top of the thigh bone isn’t round, causing it to rub against the labrum in the hip socket. This rubbing tears the labrum and can even shear off the cartilage from the bone underneath it.

Subspine impingement is another type of impingement. Here, a part of the hip bone called the anterior inferior iliac spine (AIIS) grows too much or is misaligned, and rubs against the thigh bone when the hip is flexed. The AIIS usually projects downwards from the hip socket and can rub against the labrum, capsule, and rectus femoris tendon, a tendon in the front of the hip. This condition can often be seen following certain types of fractures in adolescents or in conditions where the acetabulum is tilted backward.

Ischiofemoral impingement is another type of hip impingement that causes non-arthritic pain. The ischiofemoral space (IFS) is an area between two parts of the hip, where quadratus femoris muscle passes through it. If the IFS gets too small, it can squeeze the quadratus femoris muscle and cause pain. Conditions that bring hip bone closer to the middle of the body, can lead to ischiofemoral impingement. This condition can be identified on MRI scans, which show swelling in the quadratus femoris muscle.

Impingement is associated with labral tear, and a person can have a mix of these different types of impingements.

Principles of Treatment for Labral Tears

Treating non-arthritic hip pain can be a tough problem because there’s a lot we still don’t fully understand. Even though we’ve categorized certain causes of pain, they often don’t occur alone. We still aren’t sure if one issue, like impingement, can cause instability during certain sports or activities. We also don’t have all the answers about how impingement impacts other conditions like dysplasia, or how important instability of the thigh bone is. Plus, there’s still debate about how to treat some of these conditions because we don’t fully understand how they develop over time.

Treating Femoral Acetabular Impingement (FAI) and Labral Tears

Non-Operative Treatment vs. Surgery

The goal of treating FAI and labral tears with hip arthroscopy is to preserve the hip and prevent arthritis that might lead to joint replacement. Hip arthroscopy for labral tears is a surgical procedure that doctors use to inspect and repair damage inside your hip joint, specifically to the labrum. During a hip arthroscopy, a surgeon makes small incisions around your hip and inserts a tiny camera, known as an arthroscope, to see inside the joint. The surgeon can then use miniature surgical instruments to fix the tear, either by sewing it back together or by reconstructing the damaged parts.

Remember, this procedure is done in a minimally invasive way, meaning it uses small cuts instead of a large one. This can make recovery quicker and less painful compared to more invasive surgery.
On the other hand, we don’t fully understand the role of non-operative treatments like physiotherapy with the current studies in the scientific literature. While it’s certainly beneficial, we’re not sure just how good physiotherapy alone can help patients with labral tears.

Does FAI and Labral Tear Cause Arthritis?

When you visualize a large irregularity in the shape of the top of the thigh bone (the “CAM” deformity) pushing into the hip socket, it seems logical to think that FAI might cause arthritis by putting too much stress on the cartilage. This irregularity is measured by the alpha angle, and larger angles have been linked with more severe cartilage damage, arthritis, and a higher likelihood of needing a hip replacement. In contrast, other types of impingement, like Pincer, subspine, and ischiofemoral impingement, don’t have as clear of a link to arthritis.

Can the Labrum Heal?

The usual treatment for FAI involves removing the irregular parts of the hip joint, fixing any issues with the labrum (a ring of cartilage in the hip socket), and closing up the joint capsule. While it’s clear that fixing the hip joint helps treat impingement, we’re less sure about how to handle the labrum.

The labrum is a horseshoe-shaped piece of cartilage that helps stabilize the hip joint. It doesn’t get much blood flow, which can make healing challenging. Animal studies suggest that a repaired labrum heals with scar tissue when it’s put back in place next to the bone. Additional studies show that patients report less pain and better function in the first few months after labrum repair, compared to just cleaning up the damaged tissue, and these benefits seem to last in the short term and mid term.

How Much Arthritis Can We Tolerate for Labral Repair Surgery?

The Tönnis grade is like a rating scale that doctors use to tell how bad arthritis appears on hip X-rays. A score of 0 means there’s no arthritis, while scores 1 to 3 show the arthritis is getting worse. In a recent study, it was found that people with a score of 0 who had surgery for FAI didn’t need a hip replacement later on. However, about 1 in 6 people with a score of 1 did need a hip replacement, and the likelihood was about the same for scores 1 through 3. Also, if a patient’s hip joint space is really narrow (less than 2 mm, which means the arthritis is really bad), hip surgery is more likely to end up in a hip replacement and less likely to make the patient feel better. So, while this type of surgery can help slow down the development of arthritis, its benefits when arthritis is already present aren’t as good.

Expert Hip Labral Tear Surgery at the Clinic

At our surgical clinic in Montreal, skilled orthopedic surgeons with expertise in hip injuries and labral tears provide exceptional care to patients. We employ state-of-the-art surgical techniques, including hip arthroscopy, to address labral tears effectively. The surgery involves repairing or reconstructing the torn labrum, restoring stability and function to the hip joint.

Expert Surgeons at the Clinic

Our surgical clinic boasts a team of expert orthopedic surgeons specializing in hip injuries and hip labral tear surgery. Our surgeons have extensive experience and a commitment to delivering the highest standard of care. They stay updated with the latest advancements in hip labral tear treatments, ensuring patients benefit from the most effective surgical techniques and technologies.

Catering to Montreal and Canadian Patients:

The Canadian Private Surgical Clinic is dedicated to serving patients in Montreal and throughout Canada. With a focus on delivering top-tier orthopedic care and renowned surgeons, the clinic attracts patients from across the country. They understand the unique healthcare needs of the local Montreal community and offer specialized services tailored to meet those needs.

At the Canadian private clinic, patients receiving hip arthroscopy for labral tear can expect first-rate care, expert surgeons, and a strong commitment to restoring hip functionality and alleviating pain. With our expertise in hip labral tear treatments, and dedication to serving Montreal and Canadian patients, the Canadian Private Surgery Clinic is a leading destination for individuals seeking comprehensive care for their hip labral tears. Contact us today.

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