Labrum is a ring of strong fibrocartilaginous tissue lining around the socket of the hip joint. Labrum serves many functions where it acts as shock absorber, lubricates the joint, and distributes the pressure equally. It holds the head of the femur in place and prevents the lateral and vertical movement of the femur head with in the joint. It also deepens the acetabular cavity and offers stability against femoral head translation.

Diagnosis

Labral tear may be caused by trauma, femoroacetabular impingement (FAI), hip hypermobility, dysplasia, and degeneration. It is one of the rare conditions and is common in athletes playing sports such as ice hockey, soccer, golf and ballet. Structural abnormalities may also cause hip labral tear. Patients may have hip pain, clicking and locking of joint and restricted range of motion. Patients may also experience dull pain on movement of hip joint that may not subside on rest. Hip labral tear is often diagnosed with symptoms, history, physical examination and radiological techniques. Magnetic resonance arthroscopy may be more appropriate for diagnosing hip labral tear.

Treatment

Your doctor may start with conservative treatment prescribing nonsteroidal anti-inflammatory drugs and advising you to rest. These methods may offer symptomatic relief while surgery is required to repair the torn labrum. Your doctor may perform arthroscopic surgery using fiber-optic camera and surgical instruments through the smaller incisions. Depending on the severity of tear, the damaged or torn labrum may be removed or may be sutured.

Hip dysplasia is a condition which is seen in infants and young children as a result of developmental problems in the hip joint. The femur (thigh bone) partially or completely slips out of the hip socket causing dislocation at the hip joint. It is most common in first born baby with family history of the disorder. The exact cause for hip dysplasia is not known. Genetic factors play an important role in causing this birth defect.

The common symptoms of hip dysplasia include:

In normal hip, the head of the femur (thigh bone) fits well into the socket (acetabulum) whereas in hip dysplasia, the socket and femoral head are not congruent because of their abnormal development. Patients with hip dysplasia may have undergone one or more hip operations during their childhood which might have caused considerable skeletal changes and scarring of the soft tissues. Secondary osteoarthritis may develop later in life which may cause pain and stiffness in the hip. This is an indication for total hip replacement surgery. During this surgery, your surgeon enlarges and prepares the socket to receive the acetabular component. A bone graft may sometimes be placed to recreate the roof of defective hip socket.

Femoroacetabular impingement (FAI) is a condition where there is too much friction in the hip joint from bony irregularities causing pain and decreased range of hip motion. The femoral head and acetabulum rub against each other creating damage and pain to the hip joint. The damage can occur to the articular cartilage (the smooth white surface of the ball or socket) or the labral tissue (the lining of the edge of the socket) during normal movement of the hip. The articular cartilage or labral tissue can fray or tear after repeated friction. Over time, more cartilage and labrum is lost until eventually the femur bone and acetabulum bone impact on one other. Bone on bone friction is commonly referred to as Osteoarthritis.

FAI Impingement Types

FAI impingement generally occurs as two forms: Cam and Pincer.

CAM Impingement 
The Cam form of impingement is when the femoral head and neck are not perfectly round, most commonly due to excess bone that has formed. This lack of roundness and excess bone causes abnormal contact between the surfaces.

PINCER Impingement
The Pincer form of impingement is when the socket or acetabulum rim has overgrown and is too deep. It covers too much of the femoral head resulting in the labral cartilage being pinched. The Pincer form of impingement may also be caused when the hip socket is abnormally angled backwards causing abnormal impact between the femoral head and the rim of the acetabulum.

Most diagnoses of FAI include a combination of the Cam and Pincer forms.

Symptoms of FAI

Symptoms of femoroacetabular impingement can include the following:

Risk Factors

A risk factor is something that is likely to increase a person’s chance of developing a disease or condition. Risk factors for developing femoroacetabular impingement may include the following:

Diagnosis

Hip conditions should be evaluated by an Orthopedic hip surgeon for proper diagnosis and treatment. Such as:

Treatment Options

Conservative Treatment (Non-Surgical) Measures

Conservative treatment options refer to management of the problem without surgery. Non-surgical management of FAI will probably not change the underlying abnormal biomechanics of the hip causing the FAI but may offer pain relief and improved mobility.

Surgical Treatment

Hip arthroscopy to repair femoroacetabular impingement is indicated when conservative treatment measures fail to provide relief to the patient. Hip arthroscopy is a surgical procedure in which an arthroscope is inserted into the hip joint to assess and repair damage to the hip. Hip arthroscopy is performed in a hospital operating room under general or regional anesthesia depending on you and your surgeon’s preference.

This surgery is usually performed as day surgery or outpatient surgery, enabling the patient to go home the same day. The arthroscope used in hip arthroscopy is a small fiber-optic viewing instrument made up of a tiny lens, light source and video camera. The surgical instruments used in arthroscopic surgery are very small (only 3 or 4 mm in diameter), but appear much larger when viewed through an arthroscope.

The television camera attached to the arthroscope displays the image of the joint on a television screen, allowing the surgeon to look throughout the hip joint. The surgeon can then determine the amount or type of injury, and then repair or correct the problem as necessary.

In arthroscopic repair of FAI, your surgeon may perform the following procedures:

  1. Chondroplasty: This refers to surgery to repair torn cartilage or a torn labrum. Sutures are used to reattach the torn labrum or cartilage.

  2. Microfracture: This involves drilling holes into bare bone where cartilage is missing to promote the formation of new cartilage.

  3. Labral/Cartilage debridement:</strong> This type of debridement refers to cutting out and removing pieces of torn or frayed labrum or cartilage.

  4. FAI decompression: This involves removing any pressure areas, such as bony bumps, causing the impingement.

  5. Osteoplasty: This refers to a surgical procedure to modify or alter the shape of a bone

For FAI surgery, your surgeon will use a special instrument called a shaver to cut away or debride any frayed cartilage. If the labrum is torn, your surgeon will use sutures to preserve and reattach the labrum.

Any bony bumps present contributing to the impingement will also be shaved away and smoothed. Your surgeon may drill holes in bone that has no cartilage covering it. This technique is called microfracture and stimulates the formation of new cartilage.

Once your surgeon is satisfied with the results the instruments and arthroscope are removed from the portals. The portals (incisions) are then closed by suturing or by tape.

Arthroscopic repair of FAI, offers several advantages to the patients and they include:

Risk And Complications

As with any major surgery there are potential risks involved. The decision to proceed with the surgery is made because the advantages of surgery outweigh the potential disadvantages. It is important that you are informed of these risks before the surgery takes place. Complications can be medical (general) or specific to hip arthroscopy surgery.

Read more about general risk and complications with any surgery and hip surgery here.

Complications are rare after hip arthroscopy surgery, but unexpected events can follow any operation. Please talk to your surgeon for more information on femoroacetabular impingement.

Osteoarthritis, also called degenerative joint disease is the most common form of arthritis. It occurs most often in older people. This disease affects the tissue covering the ends of bones in a joint (cartilage). In a person with osteoarthritis, the cartilage becomes damaged and worn out causing pain, swelling, stiffness and restricted movement in the affected joint. Although osteoarthritis may affect various joints including hips, knees, hands, and spine, hip joint is most commonly affected. Rarely, the disease may affect the shoulders, wrists and feet.

Osteoarthritis is characterized by damaged articular cartilage, cartilage lining the hip joint. Advanced age is one of the most common reasons for osteoarthritis of hip. You may also develop osteoarthritis if you had hip injury or fracture in the past, if you have family history of osteoarthritis, suffering from hip diseases such as avascular necrosis and other congenital or developmental hip diseases.

How do you know that you have osteoarthritis of hip? The characteristic symptoms and diagnostic test helps in diagnosing the condition. You will experience severe pain confined to hip and thighs, morning stiffness and limited range of motion. Based on the symptoms your orthopedic surgeon will perform physical examination, X-rays and other scans, and also some blood tests to rule out the other conditions that may cause similar symptoms.

Management of Osteoarthritis

There are several treatments and lifestyle modifications that can help you ease your pain and symptoms.

Medications
Pain-relieving medications such as NSAIDs, COX-2 inhibitors and opioids may be prescribed. Topical medications such as ointments can be applied over the skin where there is pain. If the pain is very severe, corticosteroid injection can be given directly into the affected joint to ease the pain.

Treatments
Your physiotherapist will teach you exercises to keep joints flexible and improve muscle strength. Heat/cold therapy which involves applying heat or cold packs to the joints provides temporary pain relief. Lifestyle modifications can be done to control weight and avoid extra stress on the weight-bearing joints

Surgery
Hip replacement surgery is considered as an option when the pain is so severe that it affects your ability to carry out normal activities.

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