Hip Labral Tear x 3 after 2 surgical repairs

Bones, joints and muscles
1

My first hip labral tear was due to a specific injury in February of 2010.  We did the MRI, the tear was visible, I received two cortisone injections into my hip and followed a PT regimen until we decided it was not working and went ahead with the operation in October of 2010.  I was 21 years old. Surgery consisted of sutures into the labrum to close the tear and debridement of the femoral head. 

In 2014 I was pregnant with my second child when I was diagnosed with SPD (symphysis pubis dysfunction). Basically, I had excruciating pain in my right hip (same hip that was operated on) that was unexplained by anything else.  The pain was so severe I was physically unable to walk or put the slightest bit of weight on my legs.  Because I was pregnant, we were unable to run any additional tests to see what the source of pain was so I was given this diagnosis, a script for pain meds, a cortisone injection, a SI Belt, and another PT regimen. After delivery, the pain subsided and I was able to continue life as normal.

In the summer of 2016 I was training for a 5K when my right hip pain returned.  I followed up with my surgeon who did an MRI and was unable to find a “visual tear.”  I received another cortisone injection, and started PT yet again.  The cortisone injection gave me relief for less than 3 weeks. After 5 months of PT, I had no noticeable improvement in pain levels but did increase my range of motion.  A week before returning to my surgeon for a recheck, I was at PT doing a hip flexor stretch (kneeling on the left knee and leaning in to my right hip) when the pain became so excruciating I was in tears.  I was unable to put weight on my right leg and ended up leaving PT on crutches. The following week, when I returned to my surgeon he suggested a second labral repair.  He explained that it was entirely likely that a tear was the source of my pain but was unable to be seen on imaging.  At this point I was unable to drive to and from work without being in tears from pain. 

In February of 2017 I had my second labral repair.  This repair consisted of sutures in the labrum, 4 anchors into the femoral head, and osteoplasty.  My surgeon debated on an allograft repair but decided during surgery not to use this technique.  I had a fairly easy recovery, was back to walking two miles a day by April with minimal to no pain at all in my hip. 

Last Friday as I was leaving work, I slipped on a wet floor and basically did the splits (I never actually fell to the ground, but my right foot slipped out).  I felt a pop in my right hip and immediate pain but the pain was not horrible.  Due to other circumstances, I was required to go to a walk-in clinic for immediate care where they did an x-ray and assured there was no bone displacement but to follow up with my surgeon for additional care.  My pain steadily increased throughout that night and the following weekend.  I went to my surgeon the following Monday as the pain had intensified without relief and my ROM had severely suffered.  My surgeon said that the way I described falling, the location and type of pain I described, and my decreased ROM was fairly indicative of a labral tear (yes…NUMBER THREE), however since my surgery was barely three months ago he absolutely would not operate again.  Since he refuses to operate he says there is no point in doing any further testing to see if there is an actual tear or not because his treatment will remain the same.  He said we will treat as a non-operative labral repair and follow up in two weeks to see where we stand.  I am back at physical therapy on stage 1 of the labral tear program and have been instructed to use crutches (non-weight bearing) for 2 weeks when we reevaluate.  Given my history with cortisone shots not providing much relief, I don’t see the point in even trying that.  I was given narcotics for pain tolerance which at this point is not providing much relief.  I am unable to sit for extended periods, drive, stand, etc. and sleep for any extended period of time is proving to be a challenge. 

Has anyone had experience with multiple labral repairs, specifically less than a year apart?  At this point, should I try to get a second opinion?  Any advice, experiences, or encouragement would be much appreciated. 

2

Hi Thaton3girl, firstly I'm really sorry to hear of all the pain you've been through.

Unfortunately I have never had a labral tear, but it was only very recently that it was ruled out as I also suffer with chronic hip pain.

I'm still undiagnosed, but I was sent away from PT last year as the pain is intermittent. I also had cortisone injections in both hips to no avail and have just been prescribed liquid morphine for the pain.

I hope you get sorted out soon. I know all too well how difficult it is to live with the kind of pain you're describing, can't sit or stand for too long etc. IMHO it wouldn't hurt to get a second opinion, I had three arthrograms before they ruled out any labrum damage.

All the best - Greyf0x

3

Yes since I was 16 (I am now 24) I have had a total of 5 labrum tears and a total of 5 arthroscopic surgeries all of which are possible. I constantly had pain even after and it would just gradually increased and I'm at a point now that I am in sever pain and only had my last surgery 2014 so I went to get another opinion when I just had a new scan show a tear. I saw Dr. Ernest Sink at HSS and was told I have hip dysplasia and will be getting PAO surgery to correct it. I definitely recommend seeing a specialist in hip preservation and hip dysplasia. Hope for the best.

4

August of this year is my surgery.

5

Thank you for the well wishes. I'm sorry to hear about your tough time as well.

I have been going to my surgeon for many years and have always just trusted his recommendations and have never questioned anything. I guess after this second surgery I kind of has the "I'm not invincible" realization and that if I don't get this taken care of, I very well may be dealing with this hip pain for the rest of my life. (A terrifying thought as I have two young children.)

This last time is a work comp injury and I'm really worried about the lack of coverage as well and am still trying to wrap my brain around everything. A week ago, I was well on my way to recovery with almost no pain and another hip injury never even crossed my mind.

6

Wow!!! I am so sorry you have had to go through that! Were all of your surgeries performed by the same surgeon? What was the shortest time lapse between your repairs?

I'm wondering if a third repair would actually do any good or just further weaken the labrum and hip in general. Before my second surgery my surgeon told me he would not do a third repair and my next surgery would be a replacement...but neither of us planned for that need to be only three months after my second surgery.

7

Also...with any of your labral tears did you have visible swelling in your leg and foot? My right foot and toes are swollen and darker red. And I also have a large red area on my upper thigh and around my hip. I did not experience this with either previous injury but am assuming it's probably just inflammation from the newest injury.

8

Nope Dr. Sink at HSS is my 4th Surgeon. And I had a ton of swelling still do in my knees as well and heat. My 3rd surgeon told me the same thing but then I found Dr. Sink and his PAO surgery for hip dysplasia and I have a strong feeling you suffer from that and if that initial cause goes I corrected it can lead to a TOHR early on in life and more arthroscopic surgeries will only weaken the joint. I won't even be 100 percent because I've weakened the joint so much but I'm hoping for most of my life back. Will see how this goes and if doing the left is worth it.

9

My guess was the reason he said he wouldn't operate is that it would weaken the joint too much. I go back next week and have tons of questions for him. How long did you go in between your surgeries?

I'm also thinking maybe the increased pain this time around could just be how close it was to my repair. Hopefully I will have more answers soon!

10

I realize this thread is older, but I'm curious to know what happened. I had my first labral tear after giving birth to my daughter following intense diastsis symphasis pubis through the second half of pregnancy. I have an automimmune disease that causes chronic pain, so having a sore hip postpartem didn't seem that weird, and I didn't seek treatment. Fast forward two years, my rheumatologist put me on new meds and my joint pain throughout my body was substantially relieved - except in my left hip. I was referred to an orthopedic surgeon. After a dye contrast MRI, the labral tear was confirmed, as well as FAI. I had surgery in November 2018. Recocery was HARD. 10 weeks on crutches. 5 months of PT. Then in April 2019, I tripped over my daughter, and landed weirdly on my left foot, twisted hard at the hip. I felt it go. Hurt instantly. I had a follow up appointment in May 2019, and my surgeon thought we'd try meloxocam for a month to teduce swelling and pain, hoping it was just irritated. One month turned into 5 months, and by October 2019, it still wasn't better, and I couldn't stay on the meloxocam any longer. Another dye contrast MRI and another surgery in November 2019. The second time, my recovery was super fast and easy. I was cruising the counter tops without crutches by a week out. 4 months of PT, but I didn't get to finish because of the pandemic, but I was fine with that and doing well. Until yesterday. I slipped on wet leaves on our deck. I didn't fall, just an awkward flailing to catch my balance, and my left leg went shooting out at an uncomfortable angle. It hurt my hip a bit, but not a ton. I took some ibuprofen later in the evening for the pain, but it didn't help much. Today when I woke up, it was a little worse. It's gradually gotten worse throughout the day, and now it's evening and I can barely put any weight on it. It's constantly painful, even laying in bed. I called my surgeon and he's giving me a 5 day course of steroids and a month of meloxocam. I'm really worried about needing yet another surgery.

11

2 Labral tears.. so far! Omg am I thankful for finding this post. I know I'm late to the party but I am really down in the dumps and apparently in the same cycle you were. Pain started October 2017. Took 2 years of physios, osteopaths, chiropractors etc. until I found a great orthopedic Dr who diagnosed with MRI my labral tear and hip impingement from lunging in hockey. I was given 1x cortisone injection in Oct 2018 to last until my first surgery in March 2019 (I had just turned 17), which consisted of debridement, anchoring the tear, shaving down the bone growth and stapling a loose cartilage. Slow but positive recovery and by June 2019 I was given the green light to start my running recovery i.e. start small jogging sessions on the treadmill and build up. Then same month I happened to be playing charity football with disabled children and swung my left leg up fast and high to kick away a ball. Once I brought it down there was sharp pain and I knew I had done something. Another MRI confirmed another tear. End of August 2019 called for another arthroscopy, this time similar surgery however I had burst blood vessels that needed cleaning up. This surgery is when everything went downhill. I was in excruciating pain compared to the 1st, morphine and fentanyl not even taking the edge off. Ambulances needing to come to my house post-op a couple times. Pain did not subside at all after 6 weeks still, so back to my surgeon he suggested another cortisone injection and whilst giving it to me under general anaesthetic, did a manipulation procedure to check my movement was ok - which it was. However this recovery was extremely difficult and I only started light exercises again Jan/Feb 2020. Slow recovery, never getting to jogging level, only basic exercises for the next year until another burst of random pain in Sep 2020 causing a series of 3x cortisone injections. One end of Sep, which after a week caused excruciating pain, so then another MRI (showed nothing) then 2x injections one at top of hip and one further down the ITB in Oct 2020 leaving me on crutches/wheelchair for a few weeks. Ever since my pain has been there but only flares up here and there, my recovery is very slow e.g. walking an extra 0.5 miles every 2 weeks, still can't cycle/swim/run/walk too far. But I have been positive and have seen the slow improvements.

However... since 26th April out of nowhere I have had pain every single day, and the past 10 days it is getting significantly worse. I saw my surgeon yesterday but I'm not sure what he can do now (yes I am now an expert on hip injury solutions haha). MRI will show nothing I assume, cortisone injections are not fixing the problem, and apparently a hip replacement is not the solution right now (even though I'll inevitably need one in the future). Each time I visit my surgeon I see more and more concern in his eye (which is rare for surgeons as you must know, who remain very factual/unemotional). He has suggested an MRI, but I really am losing faith. And am starting to think that maybe I need to start accepting that the rest of my life or at least a large part of it will consist of pain to my hip rather than climbing Mt Everest or hiking the Great Wall of China?

Anyway, it is a little concerning seeing that you're in the same boat, but at the same time so relieving to know someone is going through a similar thing that not many people may understand!!! So glad I found this post.

12

Hi there

its so nice to find others like me, my surgeon is Dr Kelly at HSS apparently the best according to many and he repaired by left labral tear in feb 2020 right before the covid pandamic. I am also a type 1 diabetic so my healing is slow. i did PT and still doing PT and my left hip is still in pain infect worse off. i had an MRI/ x ray and everything looked normal however i know its hard to detect tears. Was told i had delayed recovery as i did PT remotely and to get in person PT. 5 months later, still no better off and wake up each night in pain. it hurts when i work out, after long walks and it still very bruised in the grown. the pain radiates all over my sacrum now. I know something is not right and pushing to see my doc again. i hear plasma injections are the way to go so will enquire about that. i wonder how i re-tore it or maybe i have scar tissue or something else going on. i am dreading a second surgery. sending good vibes to all of you and you are not alone.

13

Hi all, an update that may help others. I did a CT scan to check why I'm still in pain after 2 hip arthoscopies (3 and 4 years ago). It showed a problem with my bone rotation between my knee and ankle, where i should be walking with my feet outwards because my tibia and fibula are at a 40 degree outwards angle - I supposedly 'overcorrect' this problem subconsciously, by walking with my toes pointed straight. Apparently these rotational problems, can also be between hip and knee, can cause the labral tear in the first place. I underwent derotational surgery (tibial osteotomy) in July. Idea is that if the rotational problem is fixed, there is less pressure put on my hip when walking incline or carrying a heavy load for example, and over recovery my hip pain should disappear.

Sadly, it is 6 months later and I am still experiencing hip pain, (and now ankle pain whoops)... but thought this might be something helpful for others to check. It is usually diagnosed in children, but one of you may be overcorrecting a structural problem.