Hip Labrum Repair

[RooTheDay]

(Yes, I know we’ve had this thread before, but not for a bit.)

After losing a season to, in order, Mare being lame, me choosing to get my ankle fixed from a previous injury, and Mare being neuro, I’ve learned that I’ve ripped the crap out of my hip labrum. Possibly this is due to two years of limping, possibly this is due to doing all my cardio one-legged in an attempt to stay fit, possibly something completely different, but it doesn’t matter: it is what it is. There are both anterior and posterior tears and two opinions have confirmed that I need surgery. So Mare is getting an all-expenses-paid-by-me vacation to Florida and I’m scheduled for mid-January.

A few questions:

• How soon were you back in the tack after a labral repair?
• Any suggestions on things that were helpful in decreasing that time, or in general? I’m still hoping for a 2024 season.
• Did you do or consider doing BMAC as part of the surgery, and if so, are you glad you did? (It would be a chunk of money out of pocket but it’s not undoable.)

Any additional thoughts on pertinent topics are also welcome, of course.

[Foxglove]

OP -this is one of those questions that I think should not be asked on the WWW seeking information from people who have no medical background and have never seen your MRI, CAT Scan, or radiographs. Instead of posting here, ask your doctor. With something like this I would also ask a second doctor. I would use the WWW to research the doctors --see the number of cases they are treating each year, reviews, etc.

I had both knees replaced at the same time, a hip replacement, and two shoulder repairs over the past 10 years. Each time I asked my doctor those questions before surgery; and then I saw a second doctor for a second opinion (in all cases it was the same as the first). My kiddo is an OR nurse and knew all the surgeons in our small area --she recommended one over the others. The only time I met him, he was arrogant and unpleasant. However, he is the top surgeon in his field --so I went with him. I am fine. 100% pain and arthritis free. ASK your SURGEON about your down time and prognosis.

[RooTheDay]

@Foxglove

OP -this is one of those questions that I think should not be asked on the WWW seeking information from people who have no medical background and have never seen your MRI, CAT Scan, or radiographs. Instead of posting here, ask your doctor. With something like this I would also ask a second doctor. I would use the WWW to research the doctors --see the number of cases they are treating each year, reviews, etc.

I do appreciate your concern and your time in posting! That said, please rest assured that (as someone who is also associated with the medical-industrial complex), I did the things you suggest long ago. When it comes to both talking to one’s surgical team/getting multiple opinions and also asking for the personal experiences of other athletes in your sport, I’m a big fan of “why not both.”

[Alterration]

@RooTheDay

• How soon were you back in the tack after a labral repair?
• Any suggestions on things that were helpful in decreasing that time, or in general? I’m still hoping for a 2024 season.
• Did you do or consider doing BMAC as part of the surgery, and if so, are you glad you did? (It would be a chunk of money out of pocket but it’s not undoable.)

• I was back in the tack 3 months after surgery. This probably wasn’t wise as I could have used more strength before I got back up there.

• Strength train before you ride. Make sure you’re strong BEFORE surgery.

• No

I’m still on the fence about my surgery. It doesn’t seem to have really fixed anything but I think I have something weird going on in my lower back/pelvis that I think is causing the hip issues. I wish I’d have gone straight for replacement, that way I could at least eliminate that issue as now I have OA and impingement in one of the hips again (I did not go for another MRI, just the xray so I have no idea if I’m torn again). Hope this helps.

[wtxhunter]

This response is SPOT ON! I was back in the saddle at 6 months and really should not have. Get strong first. Stay on top of rehabbing and never stop the exercises. It’s a life long journey.

[RooTheDay]

@Alterration

I’m still on the fence about my surgery. It doesn’t seem to have really fixed anything but I think I have something weird going on in my lower back/pelvis that I think is causing the hip issues. I wish I’d have gone straight for replacement, that way I could at least eliminate that issue as now I have OA and impingement in one of the hips again (I did not go for another MRI, just the xray so I have no idea if I’m torn again). Hope this helps.

Thank you! You were one of the folks I’d seen post about this before, and that I was hoping would reply (also @Laurierace and @Simkie if they have time, though Simkie has already been super helpful in DM!)

How long ago did you have surgery? Did you do both hips? What makes you say you could have used more strength?

[starrunner]

I think I was back in the saddle two months in but my labrum was shredded and beyond repair. It was just removed. The surgeon thought it was a FAI surgery but it turns out that the labrum was just wedged everywhere it shouldn’t have been.

I had no issues competing the season post surgery. To be honest, I still have pain with the hip but more scar tissue and more limited mobility than the other hip. However, I’m hypermobile so restricted ROM is most people’s normal.

My riding in general actually improved quite a bit post surgery just because the deep pain was gone.

But ymmv. I went with the arrogant, well known surgeon and I don’t have regrets that way.

[TheBestCompanions]

@RooTheDay

• How soon were you back in the tack after a labral repair?
• Any suggestions on things that were helpful in decreasing that time, or in general? I’m still hoping for a 2024 season.
• Did you do or consider doing BMAC as part of the surgery, and if so, are you glad you did? (It would be a chunk of money out of pocket but it’s not undoable.)

I’ll preface this by saying pretty young - early 30s, so it went very smooth. I had the repair on my left hip, with femoroacetabular impingement correction. My right is also torn, but not painful so I’m not planning on fixing it (until it / if it becomes painful).

I was back in the saddle (cleared by the surgeon) six weeks after surgery.

Things that helped - do ALL of the PT exercises the maximum number of times a day allowed; stay on crutches for longer than you think for every day movement (work, store, etc) but build strength back up with PT and very regulated, careful movement. I came off crutches at 3.5 weeks and was in the saddle 2.5 weeks after that. I think it was because I was so careful up until then.

I had surgery in February of 2023 and competed this summer. Actually even got all 6 scores for my bronze medal this summer - so no slouch of a season either!

I didn’t do BMAC. I wasn’t even offered it. I would totally and completely do the surgery again and highly recommend anyone get it done who needs it. I went from constant, horribly achy pain to better than before. I think the impingement was really affecting my riding.

[Laurierace]

I don’t even know what BMAC is so I assume I didn’t have that any of the three times I had the labrum
repair surgery. I would say it probably was about 3 months until I was back on a horse on average. I learned that I wasn’t ready to get on until I could lift my leg up over the seat of the exercise bike at PT. Whether it was the right or left hip that had been repaired the lifting over was definitely the key milestone. Best of luck to you!

[Simkie]

I would pursue more than two opinions, and at least one from a surgeon who does mainly periacetabular osteotomy.

I would exhaust conservative measures before considering surgery.

I would insist on an intra articular anesthesic injection to confirm the pain generator is within the joint.

I would not consider BMAC unless a regenerative medicine specialist weighed in on the hospital’s protocol and deemed it worthwhile.

This is a long, onerous recovery. Things don’t always go well, and there’s no undo button if you’re unhappy with your results.

I was not permitted to ride until six months post op. Patient compliance to the rehab protocol is an important factor in success.

[Alterration]

I had my first hip (left) done in June 2020 and my second (right) January 2021. The reason I would say to be very strong is that my surgeon didn’t want me weightbearing at all for like 9 weeks. You would be surprised as to how much strength you can lose in 9 weeks, especially if you’re over 40. It was a very arduous recovery with a lot of PT. What I’m hearing is that a replacement is actually easier.

I felt like my surgeon had done a lot of old people hips and not a lot of athletic hips. I also felt a little like they didn’t take enough time in diagnosing what was mechanically wrong with me. I don’t walk correctly and you can see that on camera. Clearly something is wrong with all of those muscles that a few leg raises isn’t going to fix.

[RooTheDay]

First off, I really appreciate everyone sharing their experiences here. This has been both a useful and heartening resource for me; in the spirit of hopefully helping someone else, I’ll post a few updates to this thread about my own experiences recovering.

I’m currently three days post-op. My surgeon kept me overnight, but it was totally unnecessary; I was off of narcotic pain medications day of surgery and cleared to leave by PT in the PACU thanks to my previously-established crutching skills from my ankle surgery. I had surgery four hours from my home, which was why I didn’t fight the overnight stay harder, but I think I would next time; I absolutely could have gone home same-day even with the drive.

I had mostly decided not to do BMAC (bone marrow aspirate concentrate, basically PRP on steroids) due to the out-of-pocket cost, but my surgeon ultimately was very convinced that it would be beneficial for me due to my mild arthritis (my other opinion didn’t think there was arthritis present), and I saw some improvement in recovery time in the literature, which is important to me since I’m still hoping to have a 2024 season. Surgeon quoted that 70% of his patient population fitting my profile were very happy with their results without it, and that he got an additional 15% in the context of those who did; I ultimately decided to play those odds and sprung for it.

My surgeon has told me to expect to be on crutches for 4-6 weeks (though I am allowed 20% weight-bearing on the operative leg with said crutches, which is a big win over the ankle experience), that I can drive again at three weeks for automatic and six for stick, and to return to riding in three months. I generally heal quickly and expect/hope that I may be able to beat those timelines (though am committed to full compliance with whatever my care team ultimately feels is appropriate), which was supported by my first PT appointment today; he was very impressed with my strength and range of motion for three days post-op.

I was cleared to start doing the air bike for 15 minutes a day in addition to a small collection of additional exercises, all of which feels good. I’m also using an ice machine and a CPM machine. The ice machine does feel good, but I’m not sure that it’s super necessary. Since my range of motion is already so good (I am also hypermobile), I think I likely could have done without the CPM machine, but it certainly isn’t hurting.

Prior to surgery, my pain usually peaked at a 4, though I had a day when it was a 5 right before surgery when I was doing some last-hurrah athletic stuff. Since surgery, it has not gone over a 2, and right now, unmedicated except for the anti-bone-growth NSAID protocol, I have barely any pain at all. So so far, pretty good; we’ll see how things continue.

[wtxhunter]

Jingles for a speedy and successful recovery

[RooTheDay]

I’m bad at updating threads in a timely fashion, but at least I’m good at eventually updating.

Recovery has been awfully boring, with emphasis on both. The low point may have been giving myself mild rhabdo going hard on an upper-body circuit they gave me to try and keep me entertained at PT. I quit PT a few weeks after that because nothing useful was happening (I had already hit all the mobility/strength markers that I was allowed to do for the stage of recovery I was at; the PT folks agreed with my decision.)

At my six-week post-op, I made a list of 10+ potential activities on my phone for which I was requesting permission. After driving five hours and waiting 3+ hours after my appointment time (not unusual for this surgeon), I saw him for five minutes. I read him the list of activities and he said no to every one. Around the eighth one, he said, “You can keep asking but I’m gonna keep saying no.” He also told me that day that return to riding was two months from my six-week, rather than three months from surgery date. We had a pleasant and civil conversation about that, which ended in him saying, “Ultimately you can do whatever you want but if you don’t listen we’re going to wind up doing all this over again but worse.”

I listened. Angrily.

I did get cleared at the six-week to do as much biking and upper-body lifting as I wanted, so I started doing four or five hours a week on the air bike and benching.

22 Apr was my release date, but I had a different, unrelated surgery (yeah, it’s been a bit of a year) planned on that date, so I got on Mare on Sunday the 21st just to see what I was working with.

It is possible that Mare’s highest and best calling in life is not therapy pony, and also Mare is quite fat on spring grass. I had zero ROM and significant pain with or without stirrups in walk, trot, and canter. I got off after 20 minutes or so, put Mare away, and immediately emailed the surgeon to confirm that I was now blessed to do as much mobility work as I wanted with it, which he did ultimately confirm.

I’m not allowed to ride for two weeks because of the other procedure (until 6 May) so I’m going hard on the stretching. It’s not the most fun I’ve ever had but hopefully it works. I’m doing lots of traditional hip stretches but it’s hard to target the specific pain points/areas of catching through the range of motion necessary to ride; today I figured out that I can sit on my exercise ball in a vaguely horse-like fashion and move through the range of motion there, so hopefully that winds up working.

Aside from all of that, I’m happy with my outcome. The block did make my sciatica worse but I no longer have pain from the hip itself, and I’m used to managing the sciatica. We’ll see where things are once I’m allowed to ride again.

[TWH_Girl]

Glad you’re doing better! That stinks you had to have another surgery so soon afterwards. Stuff just piles on sometimes. Hope you heal up quickly!!

[wtxhunter]

Jingles!! Been there. You got this!!!

[forwardmarch]

For stretching mode, consider reformer Pilates if available near you. Especially if you can arrange a couple of private sessions, the reformer allows you to targets specific points in stretching through your range of motion. I found the pulley/spring mechanisms support limbs in a way that allows more relaxation into deep/difficult positions. Good luck!