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.
Getting a second opinion from a surgeon who is as qualified
as the surgeon who gave the initial diagnosis is advisable
in any case.
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
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.
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.
the use of any anti-inflammatory medicine a week prior
to surgery, to prevent excessive bleeding during the
to refrain from smoking for at least a week prior to
surgery. Smokers are at greater risk for many complications,
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
sure the orthopedist performing the surgery is board-certified,
which can be determined by calling the American Board
of Orthopaedic Surgery at 919-929-7103.
At most medical centers, you will
go to "patient admissions" to check in for
your open labral 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
for someone to drive you home when you are released.
a bag for someone to bring you the day after surgery
that contains a full length robe, toiletries, underwear,
personal phone numbers you may need, and any other items
you would like to have around during your hospital stay.
Patients generally wear hospital gowns for the majority
of their stay. Therefore, one change of clothing is
really all that is necessary. Bring a loose pair of
shorts or sweatpants that will fit comfortably over
your hip 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.
Open hip surgery of for acetabular
labral tears usually takes two to three hours.
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.
usually are placed on their sides. Surgeons typically
make a large, 12 to 20 centimeter incision along the
top of your hip and upper thigh.
damaged tissue around the tear is cut away to expose
healthy tissue. This process is called debridement.
The usual procedure removes torn labral tissue so it
cannot irritate movement in your hip.
your labrum also may have to be stapled or sewn onto
the bone surface at the rim of pelvis socket (acetabulum)
if the tear has loosened the connection to the bone.
incision is usually closed with stitches and you are
taken to the recovery room.
After surgery to repair your torn
acetabular labrum, you usually stay in the recovery
room for at least two hours while the anesthetic wears
off. Your hip will be bandaged with white gauze pads
and may have ice on it. You may have a tube inserted
into the incision for a few hours that allows excess
fluid to drain from the incision. 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. Antibiotics and
blood thinners (anticoagulants) also may be administered
to help avoid infection and blood clots. You should
try to move your feet, ankles, and knees while you are
in the recovery room to improve circulation. 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. You
may have to stay in the hospital for two to five days.
| Post-op in Hospital
After surgery for acetabular labral
tears, some patients remain in the hospital for as long
as two to five days. Nurses typically apply a fresh
bandage on the first post–operative day. The bandage
may need to be replaced once or twice while at home
and the nurses can teach you to change the bandage yourself.
If surgeons had to dislocate your hip to remove your
labrum, you may be instructed to use a wedge–shaped,
foam pillow called a hip abduction pillow. It helps
keep your legs spread apart and held in a proper position.
There will likely be pain, and you can expect to be
given pain medication as needed. 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. The nurses
will not give you more than your doctor has prescribed
and what is considered to be safe. Though physicians
generally limit bearing weight on your leg, you will
be instructed to sit up and move around to help circulate
blood. Beginning in the hospital, you probably will
need to use a walker or crutches while your hip heals.
Your physician, nurse, or a physical therapist will
teach you to use your walker or crutches and begin gentle
rehabilitation exercises to avoid muscle atrophy. Routinely,
patients return for check–up visits three to five
times after open surgery. Most patients receive a prescription
for pain medication. You will be unable to drive a car,
so be sure to have arranged a ride home.
Here is what you can expect and how
you can cope while recovering at home from open acetabular
labrum tear surgery:
this procedure, there is usually pain and discomfort
for about two weeks. If needed, take pain medication
as instructed. The pain tends to decrease each day after
surgery. Check with your doctor if unexpected pain arises.
are usually removed about two to three weeks after surgery.
You may need to change your bandage yourself once or
twice during the first week at home after surgery as
instructed by the nurses in the hospital. You can normally
stop using bandages when the wound is dry.
your staples dry. Depending on your surgeon's advice,
the time you are instructed to keep the incision dry
varies, usually from two to three weeks.
move your toes, ankles, and knees as much as possible
to help circulate blood.
balanced diet, iron supplements, and proper hydration
may help restore healthy tissue.
pain may make it difficult to move around your house
and perform even simple household tasks like cooking,
bathing, and laundry. Try to have friends or family
members available to visit you once or twice a day for
several weeks. If you live alone, your insurance company
decides whether you qualify for a nurse. Otherwise,
you can hire help through a social worker at the hospital
who can put you in contact with nursing and therapy
agencies in your area.
to begin range of motion and walking exercises within
two days of surgery. You should not remain sedentary
because you run the risk of developing blood clots and
bedsores. Your physician usually refers you to a physical
therapist who can help you learn to walk after surgery.
This usually takes three to six weeks.
some people can regain strength without supervised physical
therapy, your physician will evaluate your ability to
walk and prescribe further physical therapy as needed.
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
take pressure off the bones so your thighbone puts less
pressure on the acetabular labrum. Stretching and light
exercise can begin when the pain associated with your
labral tear subsides to a tolerable level. Pain is highly
variable in different people after surgery. 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 increase 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 reinjury 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 that you avoid the activity
that led to the injury, as well as activities that cause
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.
Reinjury usually can be avoided by returning to a level
of itness that will allow the performance of activities
without uncontrolled motion at the hip.
| Treatment Introduction
The most common treatment for acetabular
labral tears is an open procedure, involving a large
incision that can expose the bones and soft tissues
in your hip. Open surgery usually is prescribed if your
labral tear is large, arthroscopic surgery is not feasible,
your hip is unstable, meaning it is at risk for dislocation,
or you still have symptoms despite six months of conservative