The hip joint is a ball and socket joint with a lot of mobility just like the shoulder joint and just like the shoulder, the hip sacrifices stability for motion. If tearing takes place in the hip and is significant enough and surgery is deemed necessary, two options based on severity are labral debridement and labral refixation. Sure, the hip has some passive stabilizers, including a joint capsule, ligaments, and, like the shoulder, a fibrocartilage labrum. The acetabular labrum deepens the socket portion of the joint called the acetabulum and essentially suctions onto the femoral head to increase the congruency of the joint, creating more stability. It also helps dissipate forces across the hip joint and acts as a shock absorber much like the menisci in the knee. This intra-articular structure is oftentimes implicated in anterior hip and groin pain associated with femoral-acetabular impingement (FAI) which can lead to labral degeneration overtime such as fraying or complete tearing.
Debridement vs. Refixation
If the tearing is significant enough and surgery is deemed necessary, two options based on severity are labral debridement and labral refixation. Debridement entails shaving down the “beat up” or degraded portion of the labrum. With debridement, the next step is for the degraded portion to be suctioned from the joint. Refixation is done when the labral tissue is of good quality. An anchor is put into the acetabular bone and a suture that is attached to the anchor is then fed through the torn portion of the labrum and tied down to the acetabulum. With refixation, the goal is to allow the labrum to scar down in place to the bone and perform the necessary functions of the labrum.
Peri-Acetabular Osteotomy or Femoral Osteochondroplasty
Depending on the mechanism behind the labral degeneration, additional procedures may be indicated such as Peri-Acetabular Osteotomy or Femoral Osteochondroplasty. Basically, if the rim of the acetabulum has what is called over coverage of the femoral head we end up with a pincer impingement. The solution is to trim down a portion of the rim that overhangs. CAM impingement occurs when excessive bone formation occurs on the femoral neck abutting the acetabular rim. In this case, the solution is to shave down the bone growth on the femoral neck to create a spherical shape of the femoral head.
After surgery rehab progression is a bit different based on the extent of the surgery, but the constants are a gradual progression in ROM such that we are conscious of allowing the labral tissue to heal and take to the acetabulum. Strengthening will address the core and hips in a stepwise manner progressing through isometrics, concentric, and eccentric strengthening. From there we move into functional strengthening and movement patterns as we get toward 6-8 weeks post-op. These include squatting, deadlifts, lunges, lateral step downs, and single-leg RDLs, just to name a few. After progressing through functional strengthening, plyometric training can begin around 3-4 months post-op, working toward a running progression between 4-6 months out from surgery. Return to sport testing is generally started in the 6-8 month time frame depending on the level of the athlete. This timeline is all based on set criteria and not necessarily time and again depending on the type of procedure performed, the times can be accelerated or more conservative.
If you have experienced a tearing in your hip and are ready to start your rehab post-surgery, whether it has been debridement or refixation. Give us a call today, 843-256-8173, or visit us online. We would love to help you get your body back to where it was! This will take time but you can do it!