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Hip Labrum Surgery Complications: Making the Hip Unstable…

POSTED ON IN Hip Latest News BY Chris Centeno

hip labrum surgery complications

This week while practicing down in Grand Cayman I evaluated a professional ballerina from Germany who regrettably is having issues with recovery due to hip labrum surgery complications. In her case, she was diagnosed with CAM and pincer impingement and since having these bone spurs removed has never been able to get back to high level dancing and despite repairing the labrum, like many patients her post-op MRIs still show a torn labrum. Are these hip labrum surgery complications rare or common? In her case, there were all sorts of reasons why nobody should have ever removed the bone spurs in her hip.

Hip arthroscopy rates have exploded over the last decade. Despite that, we still have little high level evidence that these procedures work. One of the more common procedures is to “fix” the labrum and remove bone spurs from the hip in a procedure that is usually called a labral reconstruction or repair. However, we have good evidence that at least one bone spur type (pincer deformity) forms to protect the joint cartilage, so removing it isn’t a good idea. So why are surgeons removing it? Your guess is as good as mine.

Our ballet dancer not only had a labral tear but was also diagnosed with a tear in the one of the main stabilizing ligaments for the hip-ligamentum teres. She also has congenitally loose ligaments, so this woman began her surgical journey prone to instability. Given that the bone spurs formed to try and solve that instability, removing them only guaranteed that she would have an even more unstable hip. In addition, she had other issues as well that went unidentified, as the average orthopedic surgeon just isn’t going to take the time to look at the rest of the equation in the low back, knee, and ankle. However, for a ballet dancer, having optimum function in all of these areas is critical.

In her back, she has a lumbar disc bulge and tear at L4-L5 and L5-S1 (the two lowest discs) which are irritating nerves and causing the muscles in her right leg to operate at much less than 100% efficiency. For a dancer this is a huge issue. She also has a lax ACL ligament in the knee and lax ankle ligaments due to past injuries, all leading to more wear and tear on these joints and the need to use active muscle power to stabilize these areas, which is very fatiguing for someone operating at the level of stage ballet. All of this was invisible to the orthopedic surgeon who treated her hip, which happens all too often. All of it can be treated with injections without more surgery.

The upshot? We’re seeing more and more patients who never fully recover from hip labrum surgery. Despite the explosion in the number of these surgeries being performed, we have no high level evidence that they work well. In this woman’s case, removing the bone spurs around the hip just made for an unstable hip. Hopefully we can help her with precise injection of her own stem cells. At the minimum, we can help many of her myriad instability issues in the leg and the irritated nerves in the back, all of which are as important for a dancer as what’s happening in the hip!

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    comments

    Marylin Donato says

    When I was 11, I ran carrying glass soda bottles from the store. I tripped on a large crack in sidewalk, the pop bottles fell from my grasp, broke on the sidewalk, and I fell on top of the broken glass. My hip was cut badly. This was 1947 and the only repair done to my hip was some stitching. I grew until I was 15. There was a shortness in my hip and I walked from then on with a limp. My spine curved sideways to accomadate the limp. I did ballet and became a national synchronized swimming winner in my teens. I am now almost 80. I have great pain in both knees and cannot stand for long from pelvic pain. I am just wondering if stem cell therapy could regenerate what was cut in my hip and improve the degenerative disc in my spine.

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    Regenexx Team says

    Marilyn,
    That's an amazing story and a fairly complex situation. The fact that the injured hip resulted in a shorter leg suggests that there may have been injury to the growth plate at the top of the femur as well as the hip. The knee issues and pelvic pain could be originating from the DDD in your back and treating that may help the other symptoms. Stem cells would not recreate structure in your hip lost 68 years ago, but could help with pain and function. But to get from "could" or "may" would need a candidacy evaluation which is a phone call with one of Physicians and ultimately an exam. There is a Regenexx Candidate Form on the right side of this page: http://www.regenexx.com/. Please let us know if we can be of further assistance, Marilyn.

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    Carl Robinson says

    I am wondering if putting in spacers and lengthening the femur would help a little as well?

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    Regenexx Team says

    Carl,
    Thanks for your comment. An interesting idea very much in line with the structural paradigm of orthopedics. However, since the goal was accomplished with just injections of her own platelets and stem cells, the risks and complications of that type of surgery are thankfully, unnecessary.

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    Diana Carnes says

    After the injections is it advisable to rest and stay off the hip for a period of time, or is healing better promoted with movement and constant exercise? I have had two PRP injections and they do not seem to have improved my hip, but i did not rest afterward. Could that have affected my recuperation and internal healing process? Going soon for a set of three in three weeks and want to give the injections every chance of working!

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    Regenexx Team says

    Diana,
    We generally recommend a bit of both initially but it would depend on specifically what in the hip was treated. Were these Regenexx injections?

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    joseph Mastrianni says

    May have hip problem ,hip replace suggested no promise I can walk without a walker, or problem may be my back ,after MRI of back and hip with no pain doctors are not sure if it is a hip or back problem ,i have to us a walker for support
    I can walk about 8 to 10 steps without a walker ,again problem is I have no pain to ID my problem back or hip ?

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    Regenexx Team says

    Joesph,
    This dilemma is a common problem. In many cases it's both back and hip as cause and effect. Unfortunately without an exam by someone who has the skills to diagnose the problem, there is not a way to know. If you would like us to take a look at the MRI's and set up a phone consultation, please fill out the Regenexx candidate form on this page, http://www.regenexx.com Sometimes there are no other options other that a joint replacement, but a joint replacement is a big surgery with matching risks and complications, and sadly too many are performed without medical basis.

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    About the Author

    Chris Centeno

    Christopher J. Centeno, M.D. is an international expert and specialist in regenerative medicine and the clinical use of mesenchymal stem cells in orthopedics. He is board certified in physical medicine as well as rehabilitation and in pain management through The American Board of Physical Medicine and Rehabilitation.…

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