Understanding Hip Injuries

Northwestern Medicine
Orthopaedics March 07, 2013
Hip labral tears are a common injury among athletes and dancers. Recently, pop star Lady Gaga was forced to cancel her tour to undergo surgery to repair a torn labrum in her hip. We spoke with Michael Stover, MD, an orthopaedic surgeon at Northwestern Memorial Hospital and professor of orthopaedic surgery at Northwestern Feinberg School of Medicine, about the injury and expectations for recovery.

Q: What is the injury that Lady Gaga sustained?

MS: Lady Gaga injured her labrum. It is the cartilaginous rim of the hip socket.  It serves as a gasket to seal fluid within the joint, allowing for lubrication and improved force distribution in the hip.

Q: How common are these injuries and who is most at risk for it?

MS: Labral tears are very common in the hip, however not all are symptomatic or problematic.   Labral tears most commonly are seen in conjunction with anatomic deformities (differing shapes) of the hip joint, specifically the femoral head and neck (upper leg bone) or acetabulum (hip socket). At times, these deformities can be quite significant, while in other individuals they can be more subtle.

The labrum can be disrupted by limited coverage of the femoral head (hip dysplasia) where it fails under tension, or more commonly by being pinched between the upper femur (femoral head and neck) and edge of hip socket.  Labral injuries may occur over time as the labrum is loaded during activities of daily living, or can have a much more abrupt onset, especially in individuals who demand more of their hip, such as athletes who have extremes of motion or force through the hip.

Q: What are early warning signs of a Labral Tear?

MS: Most will begin to experience pain in the groin area, indicating a possible problem in the hip. The diagnosis is made with a physical examination.  It can reveal limitations of hip motion, especially internal rotation and this is typically associated with pain in the same areas.

Q: How is this type of injury treated?

MS: The diagnosis is confirmed with MRI, which many times will include injection of a dye into the joint.  At times, a CT with two and three dimensional reconstructions is recommended to better understand the deformities.  Not all require surgery to treat and initial treatment should include anti-inflammatories, specialized physical therapy, and at times injections into the joint.  If unresponsive to non-surgical methods, surgery can be recommended.  Most surgeries for impingement can either be done arthroscopically, but more extensive deformities or labral tears associated with dysplasia will require open surgery.

Q: What is the recovery time for this injury?

MS: Recovery time can be shortened if performed arthroscopically by at least a month, as open procedures can require a four to six week period of time until the bone heals. Physical therapy is started immediately following surgery, and will continue two to three months after surgery. Patients with high demands on their hips can be returned to sports or most activities by four to six months.

Q: What should people know about preventing these types of injuries?

MS: There is not a screening method for the deformities, and most occur with activities of daily living or more athletic activities that are usually not avoidable if the deformities exist. Awareness of symptoms and evaluation by individual’s experience in hip pathology is the most important for diagnosis and initiation of appropriate non-operative methods.

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