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The most common symptom in patients with hip disorders and labral tears is pain in the groin. Clicking or snapping in the groin may also occur. A bulging area in the groin is more likely to be hernia. Pain on the side of the hip is commonly related to trochanteric bursitis or gluteus medius tears. Pain in the buttock is generally related to the low back or sacroiliac (SI) joint but may be related to a hip problem.
Hip disorders are evaluated by a thorough history (patient interview), physical exam, and appropriate imaging. Make an appointment to have your hip fully assessed.
The three types of imaging you may need are: 1) x-ray, 2) MRI, and 3) CT scan.
X-ray is the most common imaging modality we use and provides a good overview of the bony structure of the hip. Most patients will need to have x-rays taken when they come in for an appointment. Even if you have had x-rays taken in the past, we may obtain additional specialized views to look for FAI.
MRI is an imaging technique that uses magnets instead of radiation in order to obtain detailed images of the body. MRI gives us the best look at the soft tissues (labrum, tendons, cartilage). We often obtain an MR arthrogram, a special type of MRI in which contrast fluid is injected into the joint, when a labral tear is suspected. MRI is not performed in the office and requires an appointment. UC San Diego Health has several MRI machines so that most patients can schedule their MRI within a few days of getting insurance approval.
CT Scan is the third type of imaging we use and provides a very detailed picture of the bony anatomy of the hip. This is particularly important in cases of complex FAI. With the advanced imaging technology available at UC San Diego, we are able to create a 3-D map of your hip so that recontouring of the hip joint during surgery can be as accurate as possible.
We use several non-operative treatments for the hip, including medications, physical therapy, and injections.
The most common medications used for hip disorders are anti-inflammatories like ibuprofen or naproxen. These medications reduce pain by decreasing the inflammation within the hip and surrounding tissues. Some patients take glucosamine and chondroitin supplements and ask if these will help their hip. There is no evidence that these supplements will significantly reduce hip pain, but there is also little research in this area.
Physical therapy is commonly used for hip disorders. Physical therapy will not cure a labral tear or bony abnormality but can help to reduce symptoms. Your physical therapist can help reduce inflammation around the hip and can teach you exercises to strengthen the hip muscles. The therapist can also help identify movements that exacerbate or worsen your hip symptoms. Physical therapy does not help in every case: a good rule of thumb is if it hurts, don’t do it.
Active Release Therapy or ART is a specialized type of therapy that combines physical therapy and deep massage techniques. This can be particularly helpful in hip disorders because the hip is surrounded by several layers of muscle, which can contribute to hip pain. ART may be used before or after surgery.
We often use injections in the diagnosis and treatment of hip disorders. A diagnostic injection places medication with in the hip joint. If this injection causes a significant decrease in your pain, this verifies that the problem is within the hip joint. Diagnostic injections are given before surgery to confirm a diagnosis.
Injections may also be therapeutic; that is, they help to treat the disease. This is especially helpful when inflammation is a key factor in your hip pain. We can give an injection into the trochanteric bursa or around an inflamed iliopsoas tendon to significantly reduce pain.
Because the hip is buried under several layers of muscle, hip injections are given by the radiologist with the help of x-ray, not in the office. This ensures accurate placement of the medication. Most injections involve a combination of two medications: an anesthetic (numbing medication) and a strong anti-inflammatory (similar to cortisone).
While each hip arthroscopy is specific to the individual patient, certain elements are common to many hip surgeries. These include treatment of the labrum, shaving of the bone, and removal of inflamed tissue.
Treatment of the Labrum: Labral tears are treated during hip arthroscopy with either refixation (repair of the labral tissue using suture) or debridement (removal of a small portion of the labrum), depending on tear type and the patient’s age.
Shaving of the Bone: When abnormalities of the bony shape of the hip ball or socket occur, such as in FAI or hip impingement, the most direct way to address the problem is to actually reshape the bone. We use specialized bone shavers to remove the excess bone and recontour the hip. We use portable x-ray in the operating room to improve the accuracy of the bone reshaping.
Removal of Inflamed Tissue: Most of the pain you feel from you hip is due to nerve endings that have become irritated in the presence of inflammation. Much of this inflamed tissue is torn labrum and synovium, the lining of the joint. This inflamed tissue is shaved away during hip arthroscopy.
All patients must use crutches after hip arthroscopy, usually for 2 weeks. Some patients will need to be on crutches longer, for example if a labral refixation is performed.
Careful rehabilitation after hip arthroscopy is essential to achieving a great result. Patients see a physical therapist 3 to 5 days after surgery and usually continue in therapy for several months. You will come in for your first post-operative visit with your surgeon at 10 to 14 days. Although most of our patients are off crutches and back to normal activities within a few weeks, full recovery, especially for athletes, takes at least a few months.
Small areas of cartilage injury can be treated with hip arthroscopy and a technique called microfracture. However, once osteoarthritis (a loss of cartilage involving the entire hip joint) has set in, arthroscopy will not help, and hip replacement or hip resurfacing, is the best option.
Hip dysplasia or congenital dysplasia of the hip is a malformation of the hip socket that occurs in the womb. In hip dysplasia, the hip socket is too shallow, resulting in eventual breakdown of the hip joint. Labral tears sometimes occur in patients with hip dysplasia but do not seem to respond as well after hip arthroscopy. Currently, most patients with hip dysplasia are not candidates for hip arthroscopy but may be candidates for another procedure called peri-acetabular osteotomy.