Postoperative Hip Bracing After Hip Arthroscopy
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|First Posted : October 22, 2020Last Update Posted : May 23, 2022|
|Femoroacetabular Impingement SyndromeAcetabular Labral Tear||Device: Hip brace||Not Applicable|
- Patient age 14-60 on date of surgery
- Patient seen at the institution for the study
- Patient scheduled to undergo arthroscopic osteoplasty and labral repair for femoroacetabular impingement syndrome.
- Any patient anyone who cannot follow up in person in clinic for the 6-week postoperative visit.
- Any patient with planned iliopsoas tendon release for tendonitis at the time of surgery, or who undergoes iliopsoas tendon release on the day of surgery .
- Non-English speaking patients .
Information from the National Library of Medicine
Please refer to this study by its ClinicalTrials.gov identifier : NCT04599296
Pain Management After Labrum Repair
To control pain, your doctor will administer a local anesthetic injection at the end of the procedure. You will also receive a prescription for pain medications. Application of ice is recommended for pain and swelling. Following the procedure, you are advised to use crutches for 2 weeks for safety and stability, although weight bearing is allowed as tolerated. You should avoid hyperextending or hyperflexing the hip or any movement that causes hip pain. Mild range of motion exercises such as stationary bike riding is recommended from the day following surgery to prevent stiffness. A hip brace is recommended for use at night to hold the hip in a safe position. You should follow up with your doctor within a week and will then begin a physical therapy program to improve strength and flexibility of the hip joint. Thanks to the surgery for hip being minimally invasive a full recovery usually takes about 12 weeks.
Risk Factors For A Hip Labral Tear Or Strain
- Overuse people who play sports that require repetitive twisting and pivoting are at a higher risk of suffering from a labral tear or strain.
- Structural abnormalities people who were born with hip abnormalities are at higher risk for a hip labral tear or strain.
- Pre-existing hip conditions people who have other hip issues, such as femoroacetabular impingement, are at higher risk from suffering from a labral tear.
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How Is A Hip Labral Tear Diagnosed
Labral tears can be difficult to diagnose because many hip injuries cause similar symptoms. Theyre often misdiagnosed for groin strains, according to the Hospital for Special Surgery.
To make a diagnosis, a sports medicine doctor or orthopedist will perform a physical exam and consider your symptoms. They may put your hip in certain positions to see if you experience pain or clicking.
If they suspect your labrum might be torn, they will order imaging of your hip. Imaging techniques include:
- X-ray. An X-ray can help identify signs of arthritis and structural concerns in your hip.
- Magnetic resonance imaging . An MRI uses electromagnetic fields to create images of your body. It can help a doctor identify atypical structures or tears in the soft tissue in your hip, including your labrum.
- Magnetic resonance arthrogram . An MRA is a special type of MRI that requires a healthcare professional to inject a dye into your hip joint. The images created by an MRA highlight or contrast the hip cartilage and joint space from the rest of the bones. In a 2017 study including 50 people, an MRI detected labral tears in 28 people while an MRA detected tears in 38 of them.
Recovery From A Hip Labral Tear Or Strain
Management of symptoms is the first priority in the recovery process after a labral tear. Patients who follow the rehabilitation plan completely are more likely to get back to their normal activities most quickly.
If the pain comes back during rehab, you may be pushing too much, too soon. You should work with your physician and physical therapist to modify the physical therapy plan and gradually strengthen the muscles around the hip.
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What Is Hip Arthroscopy
Hip arthroscopy is a minimally invasive hip surgery using a small camera called an arthroscope.
A special type of boot applies traction to your foot, which separates the ball and socket of the hip joint. The open joint, also called joint distraction, allows a surgeon to introduce the arthroscope into your joint. Your healthcare provider also injects fluid or air into your hip with the help of X-ray guidance.
Once they confirm the proper placement of the arthroscope, the surgical team will make anywhere from two to four small incisions on the side of your hip. Each typically measures around 5 to 10 millimeters in length. Through these tiny portals, your medical professional passes the instruments and arthroscope into your joint. They can then visualize your hip joint, find the problem and proceed appropriately.
Consider Hip Arthroscopy Surgery With Mufaddal Gombera Md
If you have additional questions, you can come to our office at any time to discuss them. We’ll do our very best to answer your questions over the phone as well. Our website has a great deal of information on it, as well as surgical animations. Feel free to visit our hip arthroscopy recovery blog as well, which contains lots of helpful information.
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What If It Is Painful
If you experience pain due to the brace call your doctor, as the brace itself should not be painful.
You may experience pain as a result from the injury, be it a dislocation, microfracture or surgery.
Your doctor will review complications related to pain and inflammation . They will also likely prescribe you medications like Motrin or Norco for pain management for after surgery.
Treatment For Minor Tears
Your labrum is what protects the femoral head and the acetabulum in the hips ball-and-socket joint. Treating a minor tear can start off conservatively with rest, medication, or ice. While nonsurgical treatment wont fix or heal the hip labrum it is a good place to start to lessen your pain and swelling.
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Causes Of A Hip Labral Tear
There are a variety of causes that can contribute to a labral injury, including trauma from a fall or motor vehicle accident, pinching in the hip between the pelvic bone and femur, and excessive force on the joint.
One common mechanism of injury for a hip labral tear is an overwhelming rotational force.
This typically occurs in athletes that perform repetitive motions such as kicking, jumping, or even a golf swing. Injury can occur acutely or across a long span of time in a degenerative fashion. Muscular imbalances can also be a culprit in the development of labral tears. Often, weakness is present in the gluteal muscles, and over time these imbalances can lead to improper load distribution on the hip joint and labrum.
Those most at risk for developing labral tears are athletes, elders, and overweight or obese patients. Athletes are subject to traumatic sports injuries and repetitive microtrauma, thus increasing their susceptibility to hip injuries. Elders are at risk due to developing weaknesses and degeneration that occurs in the strong tissues that make up the hip joint. People that are overweight or obese place excess load and stress on the hip joints, which can expedite degeneration and overload the hip structure.
How Much Does Hip Arthroscopy Surgery Cost
The cost of hip arthroscopy surgery depends on various factors. Estimates range from about $4,000 to a little over $8,000. Talking with your insurance provider is the best way to get an accurate estimate. The final cost will depend on variables including your insurance coverage, your deductible and your out-of-pocket maximum. The price will include the anesthesia, imaging, lab tests, surgery and hospital stay. You might receive separate bills from each of these providers.
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What Does It Look Like
A hip abduction brace has two harder pieces, each lined with a cushy pad. The two harder pieces are placed on the outside of your waist and on your thigh. Those two pieces are connected by an arm that has a small joint on itself, this too is positioned on the outside. The small joint is what will need to be adjusted to a certain angle prescribed by your physician. Each of the harder pieces has a strap on it, which is how it stays on your body. One strap will go around your waist, and the other around your thigh. This type of brace is worn on the outside of your clothing.
Other Nonoperative Treatments For Hip Labral Repair
Injections are one nonoperative option to repair labral damage. However, there are a number of other treatments Dr. Warner may consider.
- NSAIDS . Over-the-counter pain medications can be used to control pain, says Dr. Warner.
- Physical therapy. Therapy is definitely helpful, he continues. In fact, theres a strong recent study addressing the success of treating labral tears in young patients under age 22. With physical therapy alone, nearly 70 percent of those patients were able to avoid surgery, resolve their symptoms, and return to their normal level of activity. An additional 12 percent also got an injection and were able to avoid surgery as well. Theres increasing data showing that with the right kind of therapy and activity modifications, you can lessen symptoms and help people avoid surgery.
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Hot & Cold Application
A hip labral tear can hurt! Applying cold and heat can help soothe that pain making daily activities more bearable. Cold therapy with the use of an ice pack or another source works by numbing pain and reducing swelling. The cold interrupts the pain signal to minimize pain. It also constricts the blood vessels within the area, this discourages fluid build-up that leads to swelling.
Recovery After Hip Labrum Repair
Arthroscopic surgery is typically an outpatient procedure, which means you can go home the same day. After your hip labrum repair, you will be able to return to low-impact activities such as walking almost immediately. Your surgeon will refer you to a physical therapist to start exercising your hip to restore your range of motion and strengthen the joint.
If your job is in a low-activity environment, such as an office job, you may be able to return to work in one to two weeks after your hip labral tear surgery. If your job puts significant stress on the hip, you can work with your physical therapists to determine a safe return date or discuss job modifications with your employer to allow you to ease back into work as you recover.
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What Is Hip Dysplasia
Hip dysplasia, or a shallow acetabulum , can increase the stress on the acetabular cartilage and labrum with regular or increased activities. With a shallow socket, some of the force that would normally be placed on the socket is transferred to the labrum, which can lead to a labral tear. In cases of mild or borderline dysplasia, repairing the labrum can relieve the painful symptoms within the hip with arthroscopy. However, it does not deepen the socket. A shallow socket can increase the risk of developing osteoarthritis in the hip. The goal of a hip arthroscopy would be relieving the current painful symptoms in the hip. It will not eliminate the risk of developing arthritis. In cases of advanced dysplasia, larger reconstructive surgeries is an option to increase the coverage.
Hip dysplasia and hip impingement are opposite ends of a spectrum . Please check with me if you are unsure about your underlying diagnosis.
Hip Labral Tear Causes
Hip labral tears can happen to anyone. Hip labrum can tear suddenly, as a result of an impact, or gradually. Causes typically include:
- Repetitive hip motions and hip overuse
- Traumatic hip injuries
- Regular wear and tear of the hip
- Deformities of the hip joint, such as hip dysplasia and abnormal bone shape that leads to hip impingement, can increase stress on the labrum.
- Degenerative conditions such as osteoarthritis. The relationship between osteoarthritis and hip labral tears goes both ways: The erosion of cartilage caused by arthritis can contribute to a labral tear, and a labral tear can make you more likely to develop arthritis years later.
Causes of hip labral tears may vary depending on the location of the tear. Anterior hip labral tears are usually caused by repetitive movements common in sports such as ballet, golf, football or hockey. Posterior hip labral tears are usually caused by traumatic injuries such as falls, accidents or high-impact sports injuries.
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What Is A Hip Labral Tear
Labral tears occur at a structure located in the hip joint known as the labrum. The hip is a large ball and socket joint, composed of the pelvic bone and the femur. The labrum is a thick band of cartilage that rims the hip socket of the pelvic bone, deepening the joint and providing stability and structure. Important functions of the hip socket and labrum include shock absorption, stabilization, and strength. A tear can develop at any point along the donut of cartilage, most commonly in the front.
The degree of tear can vary from slight fraying to a fully displaced fragment. Historically, labral tears were often misdiagnosed. Due to the prevalence of advanced imaging, it is becoming apparent that labral tears comprise a large portion of patients suffering from hip pain. Though imaging is needed to absolutely confirm the presence of a labral tear, it is by no means necessary in order to begin non-invasive treatment such as exercise therapy.
Hip Labral Tear Surgery
If your hip labral tear is severe, or if you are still in pain after trying nonsurgical options, your doctor may recommend surgery. The most common surgery to repair hip labral tears is arthroscopic surgery. During this procedure, an orthopaedic surgeon makes several small incisions to access the hip. With the help of a special camera device called an arthroscope, the surgeon locates the labral tear and uses surgical tools to repair it.
Repairing a hip labral tear may involve removing frayed pieces of labrum, stitching the tear back together or using tissues from other parts of the body to replace a missing piece of labrum.
If your labral tear was caused by a hip impingement, the surgeon will address it by reshaping the bones of your hip joint so they glide smoothly.
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What Is Femoroacetabular Impingement
FAI is a condition affecting the hip joint and is characterized by abnormal contact between the femoral head and the rim of the acetabulum leading to damage to the articular cartilage in the acetabulum, or to the labrum of the hip, or both. The labrum is a ring of cartilage that surrounds the acetabulum. Damage to the labrum and/or articular cartilage will likely cause pain. An abnormality in the shape of the femoral head or acetabulum, or both, may cause FAI. Activities that involve recurrent hip motion can increase the frequency of this abnormal contact.
FAI can affect all age groups from the early teens to throughout adult life, and is being increasingly recognized as one of the predisposing factors for osteoarthritis of the hip. While hip arthroscopy may reduce the chance of developing osteoarthritis, it does not eliminate it. Arthroscopic hip surgery can be used to reshape the socket and/or the femoral head to prevent femoral acetabular impingement and aims to decrease the risk of developing osteoarthritis, as well relieving current painful symptoms.
What If I Need To Wash The Brace
If you need to wash the brace , you can remove the pads of the brace and wash them. Dont forget to look carefully at how they were positioned on the brace before removing themmaybe even snap a photo on your phone so you can remember how to reassemble it later.
The pads can be washed by hand in warm water and a mild detergent rinse well and lay flat to dry. Plastic and other hard parts of the brace can be wiped with a damp cloth.
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Hip Unloader Brace: The Potential Is There But Conclusions And Implications Tbd
by Ryan Paul | Oct 13, 2021
Can a Hip Brace Improve Short-Term Hip-Related Quality of Life for People With Femoroacetabular Impingement and Acetabular Labral Tears: An Exploratory Randomized Trial
Eyles JP, Murphy NJ, Virk S, Spiers L, Molnar R, ODonnell J, Singh P, Tran P, Randhawa S, OSullivan M, Hunter DJ. Clin J Sport Med. Publish online 8 Sep 2021.
Patients with femoroacetabular impingement syndrome or a hip labral tear had improved hip-related quality of life, symptoms, and function by wearing a hip unloader brace for 6 weeks. However, participants reported low adherence and poor satisfaction with comfort and effectiveness.
Patients with FAIS or a labral tear often experience pain in adduction, internal rotation, and flexion. While avoiding these impingement positions may help reduce pain, observation studies of one hip brace failed to find benefit. However, we need randomized clinical trials to determine if other hip braces improve quality of life and decrease pain for patients with FAIS or a labral tear.
The authors sought to determine whether providing the novel hip brace along with standard conservative care improved hip-related quality of life, hip symptoms and function, participation restrictions, acceptability and tolerability, and adverse events, relative to providing standard conservative care without the hip brace.