Tear > Treatments
Preparing for Surgery
While you are preparing to undergo
surgery, the decisions you make and the actions you
take can be as important as the procedure itself in
ensuring a healthy recovery. Make sure you have received
any equipment you will need when you get home from the
hospital. You should receive prescriptions or recommendations
for items like crutches, ice packs, and heating pads
from your doctor when your surgery is scheduled. Your
surgeon should ask about any difficulties with urination
and/or sexual function before surgery. Understand the
potential risks and benefits of the surgery, and ask
your surgeon any questions that will help you better
understand the procedure. It can also help to talk to
someone else who has undergone the same surgery. Any
physical problems, such as a fever or infection, should
be reported to your surgeon, and you should notify your
surgeon of any medication you are taking. Try to refrain
from smoking for at least a week prior to surgery. Smokers
are at greater risk for many complications, including
infection. If possible, practice walking with your crutches
in case you need to use them after surgery. Crutches
also may be given preoperatively for a period of partial
weight bearing when the diagnosis of an acetabular labral
tear is made.
At most medical centers, you will
go to "patient admissions" to check in for
surgery. There may be a separate department for inpatient
surgery, so be sure to ask your doctor. After you have
checked in to the hospital or clinic, you will go to
a holding area where the final preparations are made.
The paperwork is completed and the area around your
hip may be shaved, though this is not always necessary.
You will wear a hospital gown and remove all of your
jewelry. You will meet the anesthesiologist or anesthetist
(a nurse who has done graduate training to provide anesthesia
under the supervision of an anesthesiologist). Then,
you will walk or ride on a stretcher to the operating
room. Most patients are not sedated until they go into
the operating room. Here are some important steps to
remember for the day of your surgery:
will probably be told not to eat or drink anything after
midnight on the night before your surgery. This will
reduce the risk of vomiting while you are under general
anesthesia, which can lead to pneumonia.
you will most likely be able to go home within a few
hours of surgery, and because the anesthetic and pain
medications may make you drowsy, arrange for someone
to drive you home when you are released.
a loose pair of pants or other clothing that will fit
comfortably over your bandage when you leave the hospital.
it easy. Keeping a good frame of mind can help ease
any nerves or anxiety about undergoing surgery. Distractions
such as reading, watching television, chatting with
visitors, or talking on the telephone can also help.
surgery for an acetabular labral tear generally takes
one to two hours to perform.
anesthesia is typically used for this type of surgery,
though in some cases a spinal or epidural anesthetic
is used. The anesthesiologist will administer the anesthesia
once you are in the operating room.
process called distraction helps create space for the
surgical tools to be inserted. Your leg is secured into
a traction device. A special operating room table is
used that has a post that fits between your legs and
foot holders that aid in positioning the hip. This places
pressure on your pelvic floor (perineum), and may result
in genital numbness or post-operative dysfunction for
several days to weeks. Twenty-five to 50 pounds of force
is applied to your hip through the foot holder on the
operative side. The traction partially separates the
ball and socket joint of the hip to allow the introduction
of the arthroscope and surgical instruments.
typically make two or three small three- to four-millimeter
incisions to create "portals" in the front,
back, and side of your hip for the surgical instruments.
arthroscope - a tiny camera about three to four millimeters
in diameter - and microsurgery instruments are inserted
through the portals in your hip. During surgery, the
camera can be shifted to a different portal to give
surgeons alternate viewpoints of your hip tissues.
tissue around the tear sometimes will be cut away to
expose healthy tissue. This process is called debridement.
The torn acetabular labrum usually has no potential
to heal and is therefore removed. This is analogous
to a torn meniscus in the knee, which is similarly removed
when it cannot heal.
are usually closed with stitches and you are taken to
the recovery room.
Most patients are able to leave the
hospital within a few hours after surgery, though occasionally
a patient who has difficulty controlling pain may stay
overnight. Your hip generally is wrapped with gauze
and may have an ice pack over the incisions in the recovery
room. You usually stay in the recovery room for at least
two hours while the anesthetic wears off. General anesthesia
wears off in about an hour; spinal anesthesia may take
up to two hours or more. You will be given adequate
pain medicine, either orally or through an IV (intravenous)
line, as well as instructions for what to do over the
next couple of days. In addition, you will be given
an appointment to return and a prescription for pain
arthroscopy often is no more painful than knee arthroscopy
as most patients feel comfortable in a few days. The
early pain associated with the procedure is controlled
with narcotic painkillers. Be sure to ask for medication
as soon as you feel pain coming on, because pain medication
works best on pain that is building rather than on pain
that is already present. However, the nurses will not
give you more than your doctor has prescribed and what
is considered to be safe. You should try to move your
feet and knees while you are in the recovery room to
improve circulation. Do not be alarmed if you have genital
numbness, as this may be caused by the nature of the
traction device. Your temperature, blood pressure, and
heartbeat will be monitored by a nurse, who, with the
assistance of the doctor, will determine when you are
ready to leave the hospital or, if necessary, be admitted
for an overnight stay. It is likely that you will be
able to bear some weight on your hip, but your surgeon
may suggest that you use crutches or a cane for a couple
of days. For most people, crutches are used only until
you feel steady on your feet and are comfortable getting
in and out if chairs. Depending on the size of the labral
tear, however, you may be instructed to only put partial
weight on your hip for up to four to six weeks. Physicians
may recommend that patients over age 65 continue using
crutches or a cane for a longer period of time. As soon
as you are fully awakened, you are usually allowed to
go home. You will be unable to drive a car, so be sure
to have arranged for a ride home.
Many people spend seven to 10 days
at home before returning to work after arthroscopic
surgery for an acetabular labral tear. You may be partially
incapacitated, but physicians generally recommend you
start gentle leg motion as soon as possible after surgery.
Here is what you can expect and how you can cope after
will likely feel pain or discomfort for the first few
days, and you will be given a combination of pain medications
as needed. Usually you are given both a narcotic painkiller
and an anti–inflammatory.
may be some minor drainage on the bandage since fluid
may have accumulated during the surgery. Expect some
blood to show through the bandage during the first 24
until you can stand comfortably for 10 or 15 minutes
at a time before you take a shower. You can probably
shower and swim the day after arthroscopy.
dressing on your hip is usually removed one day after
arthroscopy or during the first follow–up visit.
In routine arthroscopy two or three follow-up visits
typically are needed.
or canes occasionally are needed for six to eight weeks.
Depending on the size of the labral tear, patients can
usually start bearing some weight on their leg immediately
two or three weeks after surgery, you may experience
night sweats and a fever of up to 101 degrees. Your
physician may suggest acetaminophen, coughing, and deep
breathing to get over this. This is common and should
not alarm you.
Physical therapy, if needed, should begin the same week
as the surgery. Patients should increase their activities
Light exercise is one of the most
effective ways to relieve strain on your hip tissues.
It helps stimulate circulation and strengthen the muscles,
ligaments, and tendons around your hip. Strong muscles
help support the structures of the hip and diminish
abnormal forces in the acetabular labrum. Stretching
and light exercise can begin when the pain associated
with your labral tear subsides to a tolerable level.
The key is to work with your therapist to find a balance
between low–impact and weight bearing activity.
Too much weight bearing can damage your labrum tissue,
but some weight bearing is needed to maintain bone strength.
In conjunction with a healthy diet, exercise also can
help you lose weight, which reduces stress on your hip.
In the first few weeks of rehabilitation, your physical
therapist usually helps you gently stretch the muscles
in your hamstrings, quadriceps, buttocks, groin, and
back, while flexing and extending your hip to restore
a full, pain–free range of motion. Many patients
receive effective pain relief from daily stretching.
When pain has decreased, physicians generally recommend
at least 30 minutes of low–impact exercise a day.
You should try to cut back on or avoid activities that
put stress on your hips, like running, jumping, and
strenuous weight lifting. Cross–training exercise
programs often are prescribed when you have a labral
tear. Depending on your preferences, your workouts may
vary each day between cycling, cross–country skiing
machines, elliptical training machines, swimming, and
other low–impact cardiovascular exercises. Walking
usually is better for injured hips than running, and
many patients prefer swimming in a warm pool, which
takes your body weight off your hips and makes movement
Strength training usually focuses on moving light weights
through a complete, controlled range of motion. Your
physical therapist typically teaches you to move slowly
through the entire motion with enough resistance to
work your muscles without stressing hip bones. Once
your physical therapist has taught you a proper exercise
program, it is important to find between 30 minutes
and an hour each day to perform the prescribed exercises.
Since acetabular labral tears can
be caused by a variety of factors and may occur in conjunction
with more serious injuries like hip dislocations and
fractures, preventing re-injury may require you to examine
the way you work and play. Degenerative joint diseases
like arthritis can complicate your recovery and put
you at risk for future acetabular labral tears even
after treatment. Be sure to talk to your physician about
appropriate preventive measures for slowing the progress
of joint disease. Your physician or physical therapist
can check to see if you have a leg-length discrepancy
that is altering your gait and putting abnormal stress
on your labrum. This can be corrected by orthotics,
which are padded inserts worn inside your shoe. Incorrect
posture when you are sitting, walking, or running can
put pressure on your labrum. If you sit for prolonged
periods, have an expert assess your posture. Try to
shift positions, and take regular breaks where you get
up and walk around. Make sure your chair is ergonomically
correct. If prolonged sitting causes hip pain it should
be avoided. Have your walking and running gait checked
for any abnormalities that could be putting stress on
your lower back and hips. A physical therapist can help
you correct any discrepancies. Contact sports and activities
increase your chances of re-injuring your hip. Your
physician may advise you to avoid contact sports and
high-energy activities like downhill skiing. Sports
that require you to bend forward, like cycling and horseback
riding, also may put you risk of reinjuring your acetabular
labrum. If you are going to engage in physical activity,
particularly sports that involve running, jumping, and
twisting, make sure to adequately stretch the muscles
in your hips and lower back beforehand. Labral tears
can be caused by traumatic events, such as a car accident,
or non-traumatic in origin. Physicians typically recommend
avoidance of the original injury activity and activities
that risk high stress or uncontrolled motion at the
hip joint. Conditioning and rehabilitation are an important
part of the recovery process in any injury. In fact,
many injuries are a direct result of insufficient conditioning
or strength. Re-injury usually can be avoided by returning
to a level of fitness that will allow the performance
of activities without uncontrolled motion at the hip.
| Treatment Introduction
can be both a useful diagnostic tool for determining
the cause of your hip pain and a less painful surgical
procedure for sewing a torn acetabular labrum back together
or, more commonly, removing pieces of an irreparable
labral tear. Hip arthroscopy is still relatively new
and not as common as open surgery, but it has a quicker
recovery time and less risk of complications. Arthroscopy
may be particularly useful if your hip pain is difficult
to diagnose and MRI images or an arthrogram do not conclusively
show a torn labrum. Your physician can often insert
the tiny camera into your hip joint, take a close look
at the structures within the hip joint and treat any
abnormalities that may be found. Candidates for surgery
include patients who have been diagnosed with a labral
tear through careful history, physical examination,
and appropriate diagnostic studies – arthrogram
Usually a period of conservative care is prescribed
and patients who fail to improve are surgical candidates.
Physicians generally prescribe surgery for patients
who experience more pain and have greater difficulty
moving their hips. Arthroscopy of the hip is still relatively
uncommon and only performed in certain centers, primarily
because it is very difficult to do and often requires
special arthroscopic equipment.