labral repair Archives | Jeremy M. Burnham, MD

Bone & Joint Clinic of Baton Rouge | Sports Medicine


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All Posts Tagged: labral repair

Hip Arthroscopy with Labral Repair – Postoperative Protocol

*Rehabilitation protocol adapted from Brian Busconi, MD

Bracing, Crutches, and CPM Machine

  • Crutches: 4 weeks
    • After arthroscopic hip surgery to repair a torn labrum, it is important to protect the repair while the labrum is healing. For this reason you will need to use crutches for 4 weeks.
  • Brace: 4-6 weeks
    • A brace is often used to help protect the repaired labrum and hip capsule.
  • Continuous Passive Motion (CPM)

Motion Restrictions

  • Days 0-10: Hip flexion of no more than 90 degrees
  • Weeks 0-3: Limit hip extension to 0 degrees, no internal or external rotation

Medications

  • Pain medications will be prescribed after your hip arthroscopy procedure.
    • It is very important to follow the directions exactly.
    • Your surgeon will work with you ensure optimal pain control.
  • Heterotopic Ossification Prophylaxis: Naproxen 500mg, twice a day, for 4 weeks.
    • Heterotopic ossification, or abnormal bone formation in the soft tissues.
    • It is a rare, but well-known, complication after hip arthroscopy.
    • Naproxen is a non-steroidal anti-inflammatory (NSAID) that helps to prevent heteropic ossification.
    • If Naproxen is prescribed for you, it is very important that this medicine is taken according to the instructions.

Phase 1 (Weeks 0-3)

Goals: Protect Healing Tissues, Reduce Inflammation, Restore Range of Motion

Weeks 0-2

Passive Range of Motion

  • Hip circumduction with hip in 70 degrees of flexion (3 sets for 5 minutes)
  • Flexion to 90 degrees for 20 reps
  • External Rotation in Flexion (70 degrees flexion, 20 reps)
  • Supine Abduction: 25 degrees for 20 reps
  • Side lying piriformis stretch
  • Quadriceps stretch (prone without hip extension)

Strengthening

  • Ankle pumps (progress to Theraband)
  • Isometrics: glutes, quads, abdominals, hip abductors and adductors
  • Gluteal slides (start at postoperative day #2-3, progress to standing by day 10)
  • Short arc quadriceps exercises
  • Side lying hip abduction
  • Bridge

Cardiovascular

  • Stationary bike (starting immediately)
  • Elliptical (with brace, starting at postoperative day #5)
  • Aqua jogging
  • Alter-G at 50% body weight (with brace)

Week 3

Passive Range of Motion

  • Hip Circumduction (with hip in 70 degrees of flexion, 3 sets for 5 minutes)
  • Flexion (to 90 degrees for 20 reps)
  • External Rotation in Flexion (hip flexed at 70 degrees, 20 reps)
  • Supine Abduction (limited to 25 degrees, 20 reps)
  • Side lying Piriformis Stretch
  • Quadriceps Stretch (prone without hip extension)
  • Prone Internal and External Rotation (with knee flexed to 90)

Strengthening

  • Ankle pumps (progress to Theraband)
  • Isometrics: glutes, quads, abdominals, hip abductors and adductors
  • Gluteal slides (start at postoperative day #2-3, progress to standing by day 10)
  • Short arc quadriceps exercises
  • Side lying hip abduction
  • Bridge

Cardiovascular

  • Stationary bike
  • Elliptical
  • Aqua jogging
  • Alter-G at 50% body weight

Phase 2 (Weeks 4-6)

Goals: Protect Repaired Tissue, Prevent Muscular Inhibition, Restore Gait Pattern
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Femoroacetabular Impingement (FAI)

What is FAI?

FAI stands for “femoroacetabular impingement,” or hip impingement for short. FAI occurs when extra bone around the hip bumps up against the labrum and cartilage in the hip joint, resulting in pain and ultimately stiffness and early arthritis.

Symptoms of FAI

FAI can start off with just mild pain in early stages. Most of the pain is felt in the groin area, although it sometimes hurts on the outside or back of the hip. In many cases the pain can progress to severe levels. Untreated FAI can lead to stiffness and early arthritis. Occasionally, labral tears or an inflamed psoas tendon can cause snapping or catching sensations in the hip.

Anatomy of the Hip Joint

The hip joint can be thought of as a ball-and-socket joint. The femoral head is the ball, and the acetabulum is the socket. The hip labrum serves as a gasket around the socket to add stability to the hip. Sometimes extra bone grows on either the ball or socket side. This extra bone results in an abnormal shape that not bumps against, or impinges, against other structures in the hip. The result of this can be anywhere from mild pain at first, to a tear of the labrum and damage to the cartilage.

pincer impingement osteoplasty labral repair hip arthroscopy FAI cam impingement

Credit: unknown

When the extra bone occurs around the femoral head (or the ball), it is known as Cam Impingement. When it occurs around the acetabulum (socket) it is known as Pincer Impingement. When it occurs on both areas, it is mixed impingement. Both types of impingement result in similar symptoms, although each causes unique patterns of damage to the cartilage and the labrum.

Diagnosis of Hip Impingement

The diagnosis of FAI is made based off a thorough history and physical examination, and imaging tests consisting of x-rays, MRI, and sometimes ultrasounds. Injections can be used to both treat the pain and to identify the location of the pain. The abnormal bony shape causing FAI can usually be identified on plain x-rays, although sometimes a CT scan is performed to help see the deformity in 3 dimensions. The MRI can help identify tears to the labrum and damage to the cartilage.

pincer impingement osteoplasty labral repair hip arthroscopy FAI cam impingement

MRI showing cam impingement and a tear of the labrum. Credit: Gallo RA, Silvis ML, Stuck D, Mosher TJ, Lynch S, Black KP. Hip Labral Tears Among Asymptomatic Hockey Players Identified on MRI: Two-year Follow-up Study. Poster presentation, American Orthopaedic Society for Sports Medicine, Annual Meeting, Chicago, Illinois, July 10-13, 2013

Treatment of FAI

FAI is treated in many ways. In some cases, nonsurgical methods such as physical therapy or injections are helpful. In other cases, surgery is performed. Most the time, surgery is performed arthroscopically using 2-3 small incisions. An arthroscope (small camera made for the joint) is used to visualize the hip and assist in repairs. If there are labral tears, they are usually repaired back to the bone. The extra bone causing the impingement (either the cam or pincer lesion) is resected back to a more normal shape. Other conditions can be treated during the surgery including snapping of the psoas tendon.

 

More Femoracetabular Impingement Resources

Arthroscopic Treatment of FAI:

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