Hip Preservation is an area of orthopedic medicine that is focused specifically. on preserving a patient’s natural hip joint, either by repairing or replacing damaged tissues or structures or reshaping the bone and the repositioning the hip socket to create a well-aligned joint that offers a the proper bio-mechanical function and pain free movement. In younger and active patients with hip pain it’s important to get the proper diagnosis and treatment to avoid early on-set arthritis and/or a hip replacement in the future.
Labral tears are common; in fact, some studies show that 67% of all teenage athletes have a labral tear and 93% of youth hockey players have a labral tear in the hip. The good new is that not everyone with a labral tear has pain or symptoms that need treatment, but when young, active athletic individuals do experience pain in the hip, it is good to know that there are specialists available who are trained specifically to diagnose and treat hip pain.
The labrum is fibrous tissue that lines the socket of the hip joint and it protects the underlying cartilage, and provides a seal between the ball and socket of the joint. When the ball and socket don’t fit together properly, it can lead to impingement in the hip joint. As you move, and with repetitive motion or extended motion, the hip joint causes the bone to bump or “impinge,” and the labrum gets pinched. This impingement can lead to labral tears and ultimately cartilage damage in the hip joint. Femoroacetabular impingement or FAI, as it is commonly called, is often the reason behind a labral tear.
Hip dysplasia is another condition that can commonly cause a labral tear in the hip. Hip dysplasia is the numberone cause of arthritis in women less than 50 years old and often it leads to pain and the eventual necessity for early hip replacement. Interestingly, 90% of the cases of hip dysplasia are diagnosed in infants. 10% are diagnosed in young adults when they start to have hip pain and often when it is found that they have pain from a torn labrum.
Hip dysplasia is when the socket does not form in the normal shape and orientation. Usually, the hip socket forms directly over the ball of the hip. In patients with dysplasia, the socket may instead be tilted, shallow, and not properly aligned or covering the ball. When the hip socket is misshapen, the ball either rides on the edge of the cup, damaging the labrum, or (in severe cases) is also able to ‘slip out’ of the joint causing pain and cartilage wear.
As hip dysplasia damages the lining of the joint, and it can also hurt the soft cartilage – the labrum- that lines the socket portion of the hip joint and this is what leads to a labral tear of the hip. In the normal hip, the labrum is on the edge of the socket. In the dysplastic hip, because the socket is shallow and tilted, the labrum is directly over the ball. The force that the ball exerts on the socket when you stand, run, jump, is far greater than the force is directed at the socket in the normal hip. This is why a in a patient with dysplasia, the labrum takes on more force and is more likely to be damaged and need repair.