Labral Tears / Femoro- Acetabular Impingement / Hip Arthroscopy/THA. Dr Allen Turnbull Hip and Knee Surgery
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1 Labral Tears / Femoro- Acetabular Impingement / Hip Arthroscopy/THA
2 Hip Anatomy Labrum Fovea Femoral Head Articular Cartilage Ligamentum Teres
3 Labral Tears
4
5 Function of Labrum Deepens acetabulum by 20% Creates a seal of the hip joint Maintains hydrostatic pressure enhancing lubrication Maintains negative pressure enhancing stability Reinforces acetabular rim Protects edge of articular cartilage
6 Labral Tears Causes FAI (50%) Degenerative Trauma Developmental Dysplasia
7 Dysplasia
8 Trauma
9 FAI Pincer Cam
10 Protrusio
11 Pincer FAI
12 Cam FAI
13 FAI
14 Labral tear Symptoms Groin pain Buttock pain Clicking Locking Stiffness
15 Labral tear Signs Restricted ROM IR in flex Positive impingement Pain with forced flex ext
16 So Anyone Groin pain Irritable hip No arthritis
17 Think labral tear
18 Investigation Xray
19 Exclude other causes of groin pain OA RhA Tumours Fractures
20 Look for anatomy that predisposes to impingement Protrusio Lateral and anterior bumps
21 Bone scan Exclude arthritis Exclude other pathology
22 MRI Exclude other pathology Look for bumps Assess chondral damage Check labrum
23 Cam Labral Tear
24 Remember Sensitivity % Specificity?? 20 % asymptomatic patients labral tear on mri
25 Remember Can have labral tear that does not hurt
26 So Symptoms and signs must fit
27 If they don t Probably something else
28 Remember Can have labral tear with negative investigations
29 So Signs and symptoms fit Other pathology excluded
30 Treatment warranted
31 Treatment Not all need surgery
32 First line Stretches Modification activity Analgesia NSAIDs Tolerance Injection steroid
33 Image Guided Intra-articular Injections with LA/Corticosteroid For diagnosis of intraarticular pathology 88% sensitive 100% specific 90% accurate
34 If first line inadequate Surgery
35 Surgery Repair labrum Resection labrum Correcting pathological anatomy Acetabular resection Removal bump
36 Surgery Open Arthroscopic
37
38
39 Technique GA Traction Table to distract hip joint Image intensification
40 Degenerate tears
41 Traumatic tears
42 Correct bony pathology
43 Acetabular Osteoplasty
44
45 Femoral Osteoplasty
46 Hip Arthroscopy Rehabilitation Plenty of advice little evidence Principles First 6 weeks Protect repaired tissue Avoid bony overload (prevent fracture) 6-12 weeks Regain ROM and normalise gait 3-6 months Strengthening and plan for return to sports
47 Rehab Protocol for Labral Repair or Femoral Osteectomy Week 1-3 Touch weight bearing Stationary bike Limit hip ROM Flexion 0-90 Abduction 0-25 External Rotation 0-25 Weeks 4-6 Partial weight bearing (25-50%) Gentle passive ROM hip within above limits Weeks 7-12 Full weight bearing Full active ROM hip and knee 3-6 months Stretching Closed chain strengthening Core strengthening Non-impact activity (elliptical trainer) progressing to light jogging 6 months Return to sports
48 FAI results in Restricted rom Labral tears Chondral damage Premature arthritis
49 Chondral damage
50 FAI is the most common cause of early onset idiopathic OA
51 Remember Arthroscopy wont help chondral damage
52 So Once there is significant chondral damage scope is not indicated
53 And that If there is a labral tear in the presence of OA Dealing with the labral pathology wont help
54 Results Labral and FAI Surgery 80% good to excellent results 80% return to sports?prevent/slow progress of arthritis Poor results with arthritic changes
55 What if there is significant OA?
56 Treatment Activity modification Wgt loss Analgesia NSAIDs
57 These fail Surgery
58 Surgery Total hip replacement
59 Remember Difficulty does not increase with severity of disease
60 Remember Results are independent of timing of surgery
61 Remember Complication rates do not increase with age
62 So Only indication for Sx is pain that justifies going through the surgery
63 THA Uncemented Good bearing surface Regular surveillance
64 Thank you
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