Hip Instability and Labral Reconstruction

Hip Instability and Labral Reconstruction by Dr. Ron Gregush

Meeting Notes:

Arthroscopic hip surgery, typically involving 2-4 incisions, is common for treating labral tears and femoroacetabular impingement (FAI), a prevalent cause of hip pain due to cam and pincer impingements. The former occurs with activities like prolonged sitting and squatting, while the latter results from extra bone growth. FAI symptoms include pain during activities, discomfort from prolonged sitting, and a "C-sign" indicative of clicking in the hip joint.

The labrum, crucial for deepening the hip socket and creating a suction seal for stability, has limited healing capacity due to poor blood flow. Labral tears, mainly chronic and degenerative, are more common in individuals with conditions like hip dysplasia. They can also occur acutely. In the general population, labral tears are a less frequent pain cause, but increased mobility in hypermobile individuals raises the risk, and their labra are often thinner.

The iliofemoral ligament is vital for stability and can lead to other issues like bursitis when unstable. Treatment options include NSAIDs, rest, and physical therapy, which is particularly effective, alleviating pain from hip labral tears and FAI in about 50% of cases. If necessary, arthroscopic surgery aims to remove bony impingements, repair or reconstruct the labrum, address instability, and manage pain. Labral repair is more effective than debridement alone.

For more severe cases, labral reconstruction is an option, creating a thicker, better-quality labrum that provides improved stability and less pain due to reduced innervation. The benefits of this procedure appear to be long-lasting.