Arthroscopic Hip Labral Repair w/ Femoroplasty

What is Arthroscopic Hip Labral Repair with Femoraloplasty?

Introduction:

Arthroscopic hip labral repair with femoroplasty is a minimally invasive surgical procedure used to treat injuries to the hip labrum and abnormalities in the femoral head (thigh bone). This procedure is often recommended for patients who have a damaged labrum, which is the cartilage that helps stabilize the hip joint, and/or abnormal bone structures that cause hip impingement.

The hip labrum is a ring of cartilage that lines the outer edge of the hip socket (acetabulum) and provides stability, cushioning, and support to the hip joint. When the labrum is torn or damaged, it can lead to pain, instability, and difficulty moving the hip. Femoraloplasty is the process of reshaping the femoral head to correct any bony impingements or deformities that may be contributing to the labral tear or hip dysfunction.

The combination of these two procedures aims to restore hip joint function, reduce pain, and improve mobility, particularly in patients with hip impingement or femoroacetabular impingement (FAI).

Why is Arthroscopic Hip Labral Repair with Femoraloplasty Needed?

This procedure is typically indicated when a patient experiences:

Hip pain: Often in the groin or front of the hip, which can be aggravated by activity, especially activities that involve deep hip flexion or rotation.
Labral Tear: The labrum can tear as a result of injury, repetitive motion, or developmental conditions, leading to hip instability, clicking, or locking sensations.
Femoroacetabular Impingement (FAI): A condition where there is abnormal contact between the femoral head and the acetabulum due to bony growths (often called cam or pincer lesions). These abnormalities can lead to labral tears, cartilage damage, and pain.
Limited range of motion: If the bony impingement or labral tear affects the function of the hip joint, movement can become restricted, causing difficulty with activities such as walking, running, or squatting.

How is Arthroscopic Hip Labral Repair with Femoraloplasty Performed?

The procedure is typically performed using arthroscopy, which involves making small incisions through which a camera (arthroscope) and specialized instruments are inserted to view and repair the joint. Arthroscopy allows for a minimally invasive approach, leading to smaller incisions, less tissue disruption, and a quicker recovery compared to open surgery.

Steps of the Procedure:

Anesthesia: The surgery is performed under general anesthesia or spinal anesthesia (regional numbing of the lower body), depending on the patient and the surgeon’s preference.
Incisions and Arthroscope Insertion: Small incisions (typically 2-3) are made around the hip, and the arthroscope is inserted to allow the surgeon to view the inside of the joint on a monitor.
Labral Repair: If the labrum is torn, the surgeon will repair it by reattaching it to the bone using sutures or anchors. If the labrum is damaged beyond repair, it may be partially or completely removed, depending on the extent of the injury.
Femoraloplasty: If femoroacetabular impingement is present, the surgeon will reshape the femoral head and/or acetabulum to remove any bony impingements (cam or pincer lesions). This helps to restore normal hip joint mechanics and reduce the risk of further labral damage.
Joint Inspection and Closure: The surgeon will inspect the hip joint for any other damage or abnormalities and ensure that the labrum is properly repaired. The incisions are then closed with sutures or staples, and the joint is carefully cleaned.

The procedure typically takes about 1-2 hours, depending on the complexity of the tear and the extent of the femoraloplasty.

Post-Surgery Care and Recovery:

Immediate Post-Surgery (First Few Days):

Pain and Swelling: After surgery, you may experience pain, swelling, and bruising around the hip. Pain medication and ice packs are typically used to manage these symptoms.
Rest and Elevation: You will be advised to rest and elevate your leg as much as possible to reduce swelling.
Crutches or Walker: You will likely use crutches or a walker for several days to avoid putting weight on the hip joint while it begins to heal.

Rehabilitation (Physical Therapy):

Rehabilitation is a critical part of recovery to restore mobility, strength, and function to the hip joint. Physical therapy will help to guide the recovery process.

Phase 1 (0-6 weeks): The focus during the first few weeks is on reducing pain and swelling, improving range of motion, and avoiding weight-bearing activities. Gentle passive movements may be done by the physical therapist.
Phase 2 (6-12 weeks): As healing progresses, active range-of-motion exercises and light strengthening exercises will be introduced. This phase focuses on regaining hip mobility and reducing stiffness.
Phase 3 (3-6 months): At this point, more intense strengthening exercises for the hip muscles (such as the glutes, quadriceps, and hip flexors) will be added. The goal is to regain strength and stability in the joint.
Phase 4 (6-12 months): After 6 months, most patients are able to resume normal daily activities and sports, but high-impact activities may need to be introduced gradually.

Long-Term Recovery:

Full recovery can take 6 to 12 months depending on the extent of the surgery and your adherence to rehabilitation. It is important to follow your surgeon’s recommendations and not rush back into activities to avoid re-injury.

Potential Risks and Complications:

As with any surgery, there are some risks involved with arthroscopic hip labral repair with femoraloplasty, including:

Infection: There is a risk of infection at the incision site or deeper within the joint.
Blood Clots: Although rare, blood clots can form in the leg after surgery, especially if the leg is immobilized for long periods.
Nerve or Blood Vessel Injury: Nerves or blood vessels near the hip joint may be inadvertently injured during the procedure, leading to numbness, tingling, or other complications.
Stiffness or Limited Range of Motion: Some patients may experience stiffness or a decrease in joint mobility following surgery.
Re-tear or Failure of the Labral Repair: In rare cases, the labrum may not heal properly or may tear again, requiring further treatment or surgery.
Ongoing Hip Pain: Some patients may continue to experience pain or discomfort after surgery, particularly if the labrum was severely damaged or if the femoraloplasty was not entirely successful.

Benefits of Arthroscopic Hip Labral Repair with Femoraloplasty:

Pain Relief: This procedure can significantly reduce or eliminate the pain associated with a torn labrum and hip impingement, allowing you to return to normal activities.
Improved Mobility: By repairing the labrum and reshaping the femoral head, the procedure can restore full range of motion to the hip joint, making everyday activities such as walking, sitting, and bending easier.
Minimally Invasive: Arthroscopic surgery involves smaller incisions, less soft tissue disruption, and a faster recovery compared to open surgery.
Return to Sports: With proper rehabilitation, many patients can return to sports and other physical activities with reduced pain and improved function.

Long-Term Outlook:

Most patients experience significant improvements in pain, function, and mobility following arthroscopic hip labral repair with femoraloplasty. The combination of labral repair and femoraloplasty addresses both the soft tissue and bony aspects of the hip joint, providing a comprehensive solution to hip instability and impingement.
Full recovery may take up to 12 months, but many patients can return to daily activities much sooner, depending on their rehabilitation progress and activity level.

When to Contact Your Surgeon:

You should contact your surgeon if you experience:

Signs of infection, such as fever, redness, or increased drainage at the incision site.
Severe pain or discomfort that doesn’t improve with medication.
Swelling, bruising, or stiffness that worsens or doesn’t improve.
Numbness, tingling, or weakness in the leg or foot.
Difficulty moving the hip or resuming activities.

Conclusion:

Arthroscopic hip labral repair with femoraloplasty is an effective procedure for treating hip labral tears and femoroacetabular impingement (FAI). By repairing the damaged labrum and reshaping the femoral head, this surgery can significantly reduce pain, improve joint stability, and restore mobility to the hip joint. With proper rehabilitation, most patients are able to return to their normal activities and sports within 6 to 12 months.

If you have a hip labral tear or femoral impingement, we are happy to take care of you!