Hip > Acetabular Tear > Treatments

   Open Labral Surgery

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.

   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.

   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.

   Discontinue the use of any anti-inflammatory medicine a week prior to surgery, to prevent excessive bleeding during the surgical procedure.

   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.

   Make 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:

   You 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.

   Arrange for someone to drive you home when you are released.

   Pack 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.

   Take 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.

   General 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.

   Patients 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.

   Any 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.

   Rarely, 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.

   The 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.

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:

   After 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.

   Staples 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.

   Keep 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.

   Gently move your toes, ankles, and knees as much as possible to help circulate blood.

   A balanced diet, iron supplements, and proper hydration may help restore healthy tissue.

   The 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.

   Expect 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.

   Because 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.

STRETCHING

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.

AEROBIC EXERCISE

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 easier.

STRENGTHENING EXERCISES

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.

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 treatment.