Hip > Acetabular Tear > Treatments

   Arthroscopic Repair

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 your arthroscopic 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, which can lead to pneumonia.

   Since 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.

   Wear a loose pair of pants or other clothing that will fit comfortably over your 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.

Arthroscopic surgery for an acetabular labral tear generally takes one to two hours to perform.

   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.

   A 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.

   Surgeons 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.

   An 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.

   Damaged 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.

   Incisions 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 medicine. Hip 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 arthroscopy:

   You 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.

   There 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 hours.

    Wait 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.

   The 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.

   Crutches 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 after surgery.

   For 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 as tolerated.

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.

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 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.

The arthroscope 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 or MRI. 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.