Ortho Dx: Patient With Hip Pain - Clinical Advisor

Ortho Dx: Patient With Hip Pain

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  • Figure. Magnetic resonance arthrogram of the left hip shows a tear of the anterior labrum.

    Figure. Magnetic resonance arthrogram of the left hip shows a tear of the anterior labrum.

A 35-year-old woman presents to the office with a 4-month history of pain in the left hip that is intensified when she practices karate, specifically when she kicks or rotates the hip. Treatment with oral nonsteroidal anti-inflammatory drugs, physical therapy, and an intra-articular corticosteroid injection has not resolved her symptoms. Magnetic resonance arthrogram of the left hip (Figure) shows a tear of the anterior labrum with normal articular cartilage.

The labrum is a rim of soft tissue fibrocartilage that lines the periphery of the acetabulum. The labrum stabilizes the hip joint by deepening the hip socket and providing a suction seal. Labral tears occur in a high percentage of...

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The labrum is a rim of soft tissue fibrocartilage that lines the periphery of the acetabulum. The labrum stabilizes the hip joint by deepening the hip socket and providing a suction seal. Labral tears occur in a high percentage of asymptomatic patients and are most likely the result of degeneration over time.1

Anatomical variants such as hip dysplasia, pincer impingement (excessive growth of bone on the acetabulum), and cam impingement (excessive growth of bone on the femur) can cause early degeneration of the cartilage and tearing of the hip labrum. Sports that require repetitive hip motion can also increase the likelihood of a labral tear. Symptoms suggestive of a labral tear include groin pain, snapping, or locking of the hip.

If symptoms and physical examination findings suggest a labral tear, and all conservative treatments have failed, arthroscopic labral repair is recommended. Patients may elect to undergo labral debridement, which provides pain relief and a faster postoperative return to activity. However, labral repair has been shown to improve patient outcomes compared with labral debridement. Labral debridement may also increase the likelihood of degenerative arthritis in the hip and the need for a total hip replacement.2,3

Labral calcification may be an indication for treatment with labral debridement alone, but the capsular-labral junction must remain intact to preserve the blood supply to the labrum. Advanced age and hip arthritis often influence the choice of treatment in favor of labral debridement.2,3

Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor-in-chief of the Journal of Orthopedics for Physician Assistants.

References

1. Lee AJ, Armour P, Thind D, Coates MH, Kang AC. The prevalence of acetabular labral tears and associated pathology in a young asymptomatic population. Bone Joint J. 2015;97-B(5):623-627.

2. Domb BG, Hartigan DE, Perets I. Decision making for labral treatment in the hip: repair versus débridement versus reconstruction. J Am Acad Orthop Surg. 2017;25(3):e53-e62.

3. Krych AJ, Thompson M, Knutson Z, Scoon J, Coleman SH. Arthroscopic labral repair versus selective labral debridement in female patients with femoroacetabular impingement: a prospective randomized study. Arthroscopy. 2013;29(1):46-53.

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