Labrum Repair for Impingement Surgery

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Overview

Femoroacetabular impingement (FAI) is a condition where the hip bones are abnormally shaped and the ball (femur or thigh bone head) and socket (acetabulum) joint of the hip bones rub against each other due to abnormal contact. Bone spurs form around the femoral head and/or acetabulum preventing smooth gliding movement of these bones against each other. This condition can damage the articular cartilage (smooth cushioning surface of the ball and socket) and/or cause a tear in the labrum (soft elastic tissue around the rim of the socket) in the hip joint. The progression of this injury to the tissues in the hip joint can result in degenerative joint disease and arthritis.The two common types of hip impingement are pincer and cam impingement. Pincer impingement occurs due to over-coverage of the socket, whereas cam impingement occurs when the abnormally shaped femoral head doesn’t fit well in the acetabulum. Sometimes, both types are present together and are called combined impingement. Impingement can also occur after less common conditions such as Perthes Disease (pediatric avascular necrosis of the hip) or after a Slipped Capitofemoral Epiphysis (SCFE).

Surgical Procedure

FAI can be treated with an operation called a mini-open direct anterior approach or a surgical hip dislocation (SHD). Both options are surgical procedures that are performed to repair or reconstruct the labrum and remove the protruding bony areas of the hip joint, thereby allowing an impingement-free range of motion of the hip.

The goals of surgery include:

  • Repair torn labrum.
  • Reshaping the protruding region of the ball and/or socket.
  • Perform microfracture and/or transplantation of cartilage.

The doctor makes an incision to access the hip joint. If a dislocation is needed, a small portion of the femur (thigh bone) will be cut (osteotomy) in order to dislocate the ball from the socket so that all the parts of the hip joint can be visualized. The dislocation allows repair of the labrum tears and reshaping of the bony abnormalities of the ball and/or socket. The procedure requires an overnight hospital stay. It is not recommended in patients with significant hip degeneration or older patients.

In less severe situations, a mini-open procedure can be performed as an outpatient procedure. The mini-open approach utilizes a naturally occurring plane between muscles and avoids cutting through or splitting muscles. The labrum can be repaired and ball and/or socket can be reshaped to eliminate the impingement areas. 

Post-operative care

You will be on overnight intravenous fluids and medications to relieve pain and on anti-coagulation therapy to prevent clots in the veins after the surgery. Patients are usually discharged the day following surgery. Physical therapy will be started the day after surgery, after which the patient may be discharged. After the FAI surgery, you will require 3 to 6 months of rehabilitation to recover and perform activities without obstruction.

Risks and complications

As with any surgical procedure, hip surgery may involve the following potential risks and complications.

  • Hip dislocation and instability
  • Extra bone formation in the soft tissues
  • Nerve injury
  • Avascular necrosis of the hip (dead bone of the femoral head)
  • Femoral neck fracture
  • Scarring
  • Infection
  • Deep vein thrombosis (blood clots in the veins)

Benefits

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If you've ever been told that you need hip treatment, get a second opinion and explore an option that works best for you.

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