Hip Surgery - Labral Tear/Impingement

[S1969]

@stargzng386

You really need another Doctor that’s completely ridiculous, not to mention you can’t see a labral tear on x-ray either.

Oh well, I’m not upset with him; he’s not a surgeon, he’s a sports doctor and he’s been my sports doctor for some years. I don’t want surgery yet if I don’t need it…so I’m willing to see how the PRP works and if it doesn’t, then we’ll consider other options.

I’m hoping to be able to still run; I haven’t tried in 2 weeks because I played pickleball and it’s been sore since then…so I’m not quite yet at the point where I’m ready for surgery. I just want to have a plan.

@stargzng386

I know multiple people who are so much better off after a hip replacement and wish they had done it sooner. The recovery for a hip replacement is easier than the labral tear surgery. I’m basically going to wait until I have additional arthritis and push for a replacement.

That’s basically what he told me - labral tear surgery isn’t easy to begin with, and would not be successful for me anyway. He said “the next surgery you get will be the full replacement; no one is going to do anything to repair your hip” - it’s just a question of when.

@Simkie

There is not. Go get another opinion.

One of the reasons I’d rather not get one now is if I can run with PRP but can’t run with a replacement. I have heard conflicting statements about running. Sports med doc says “it’s not recommended” but other people have said “no restrictions.” But, the average hip replacement recipient isn’t a runner anyway, so maybe there is no need to say “you can’t run half marathons” but “you can run after your dog in the backyard.”

What do you think about running?

[Simkie]

There are a ton of different approaches and types of implants, so a blanket statement probably doesn’t apply.

A quick Google turns up this:

https://www.hss.edu/article_running-after-hip-replacement.asp

So I don’t think replacement automatically equals no running.

The reason your doctor isn’t keen on ordering an MRI is it just doesn’t matter. If there’s advanced arthritis, the state of the labrum is immaterial. The advanced arthritis means there’s no point in repairing the labrum. If arthritis is advanced enough to be clear on film, you don’t really gain any further info about the articular cartilage with MRI. You could assess for glute tendon tears, but it doesn’t sound like you’re really reporting that kind of pain.

PRP isn’t a terrible thing to try, especially if you’re looking to delay replacement. Have you done hyaluronic acid injection? That may be a better place to start, and insurance may actually cover it. Steroid injection is also often nicely effective.

But it sounds like you’ve not seen a surgeon yet. I would really strongly encourage it, rather than listen to your sports med doc about surgery. Even if your goal isn’t surgery right at this moment, understand what your options are, and what that future looks like. Get that info from the expert in replacement, not from a guy who doesn’t fully understand the landscape.

[stargzng386]

@S1969

What do you think about running?

I would ask the best surgeon you can find what they think about running after a hip replacement. They are the ones with the knowledge and experience to answer that. A second opinion is not discounting your current doctor, it shouldn’t be scary and should be something that everyone does with most big health issues.

PRP may help BUT it’s short term and will have to be repeated. Not a human but my dog has hip dysplasia and PRP lasts 4 months for her. I also am in the small minority where anything injected into my hip made my pain significantly worse because of the bony impingement. We started with steroids just to confirm the source of my pain but it was SO freaking painful during the injection, after the injection and for months until basically the steroid wasn’t there anymore. The hip surgeon apologized but said about 10% with hip issues experience that with injections. So I am not eligible for any future injection.

[S1969]

@Simkie

The reason your doctor isn’t keen on ordering an MRI is it just doesn’t matter. If there’s advanced arthritis, the state of the labrum is immaterial. The advanced arthritis means there’s no point in repairing the labrum. If arthritis is advanced enough to be clear on film, you don’t really gain any further info about the articular cartilage with MRI. You could assess for glute tendon tears, but it doesn’t sound like you’re really reporting that kind of pain.

That’s what I gathered. I can see why it wouldn’t make any difference to see more now. It won’t change anything.

@Simkie

But it sounds like you’ve not seen a surgeon yet. I would really strongly encourage it, rather than listen to your sports med doc about surgery. Even if your goal isn’t surgery right at this moment, understand what your options are, and what that future looks like. Get that info from the expert in replacement, not from a guy who doesn’t fully understand the landscape.

I haven’t seen a surgeon, but he’s a sports med doctor who works at a big ortho practice, so I think he probably does understand the landscape…just hoping I have time before he needs to hand me off to surgeons. Of course it won’t hurt to have a consult.

@Simkie

PRP isn’t a terrible thing to try, especially if you’re looking to delay replacement. Have you done hyaluronic acid injection? That may be a better place to start, and insurance may actually cover it. Steroid injection is also often nicely effective.

Steroid injection is on the list as well; he’s a fan of PRP for a lot of things because they won’t delay your own potential to continue to heal like steroids. I’ll have to look into HA injection; he did mention there were other options if PRP doesn’t work - not sure if this was one of them.

@stargzng386

PRP may help BUT it’s short term and will have to be repeated. Not a human but my dog has hip dysplasia and PRP lasts 4 months for her. I also am in the small minority where anything injected into my hip made my pain significantly worse because of the bony impingement. We started with steroids just to confirm the source of my pain but it was SO freaking painful during the injection, after the injection and for months until basically the steroid wasn’t there anymore. The hip surgeon apologized but said about 10% with hip issues experience that with injections. So I am not eligible for any future injection.

Yes, we’ll have to see how long it lasts. He sees good results for arthritis - I think part of the question is what you’re describing - how much of my pain is labrum tear and how much is arthritis. Sorry that your experience has been so bad.

[SpicyPRE]

My labrum was shredded in January of 2024. I tried injections and wish that I would have gone directly to surgery. The 1st injection was miraculous, the second lasted roughly 24 hours. Waiting 3 months for the steroid to clear so that I was eligible for surgery was horrific.

I am now 5 months post replacement surgery and if I were a runner, I could absolutely run.

I will second what @Simkie said, you absolutely need an MRI. There is so much in your hip that an xray will not show and you need a full picture of what is happening. Proceeding with injections without knowing the full picture is a waste of $$, IMO. Injections will help with inflammation but with a torn labrum you will not have relief for long.

[S1969]

@SpicyPRE

I am now 5 months post replacement surgery and if I were a runner, I could absolutely run.

Meaning, your doctor would allow it? Or you feel like you could?
The sports med doc is a triathlete, which is why I actually go to him. Half of his caseload are athletes who don’t want to be told not to do things. But he said it “isn’t advised” and followed immediately with “but you can ride your bike as much as you want - that’s actually really good for it too!”

[SpicyPRE]

I was released at 12 weeks with no restrictions. I would speak with a surgeon who specializes in joint replacement for athletes and get their opinion. As a rider, it was critical to me to get a surgeon who understood my life and could ensure that I could return to it.

[Simkie]

@S1969

I haven’t seen a surgeon, but he’s a sports med doctor who works at a big ortho practice, so I think he probably does understand the landscape…just hoping I have time before he needs to hand me off to surgeons. Of course it won’t hurt to have a consult.

I’m sure he’s really good at what he does, but since he’s not a surgeon doing hip replacement, he’s not up on the ins and outs and current research and newer tech–as you’ve experienced with his not quite accurate info about hip replacement.

I’ve definitely ridden the orthopedic merry go round, and if there’s any one thing I’ve really learned…go see the expert on whatever. Surgery? Go see the surgeon. Preferably a couple, and the absolute best ones you can find. Pain management? Go see the best physiatrist. (I have THREE, and see them for different aspects of care.) Regenerative medicine like PRP? Find the specialist, someone who’s really passionate, rather than someone doing a little on the side. Focus and passion really matters.

Progressing from steroid to HA to PRP to stem cell is not unreasonable. It goes from cheap (and insurance covers) to expensive (and insurance doesn’t cover.) I like PRP a lot and have had success, but it’s def not where I’d start, because it is expensive, and the post procedure discomfort can really be zero fun. The nsaid washout prior & post can also be kind of limiting.

But do go get some additional opinions. Go see Su, the doc who wrote that running article on the HSS site! If you want a personal HSS recommendation, go see Nawabi. While I’ve only seen him for arthroscopic stuff, he does do replacement, and he’s fantastic. Go see them both and get the low down from the experts.

[JB]

@S1969

He did not seem to think an MRI would be useful but others keep saying I should have one.

I agree with your Dr. If you’ve got arthritis as the cause of the tear, then fixing the tear is wasted time money and pain. My Dr said the exact same thing - no point in an MRI to see the state of the labrum because it doesn’t matter . The arthritis was bad enough that the only real fix was replacing it all, which includes replacing the lining

@S1969

Hip replacement is in my future…not sure when. I’m getting PRP next month to see if it helps.

Honestly, it depends on the stage and details of the arthritis. Bone on bone, big spurs causing the impingement, nothing is going to help that other than a THR.

@S1969

I suspect the significant pain I’m in now is the labrum tear, because it’s sharp and in response to specific movement/direction.

Don’t assume it’s the labrum. Mine was very sharp (buckling my leg) and in response to certain movements, because it was bone on bone with big spurs

@S1969

The doctor said “maybe try to get 5 more years” but that’s not going to be ok if this is how it feels. Not sure if there is a reason to wait…?

IMVHO, get the THR scheduled as soon as you can reasonable take enough down time (with support for things you CANNOT do for a period of time. It’s only going to get worse, and IME, when it gets to the point you’re at now, it starts accelerating in the decline… 5 years? No.

And worse, the longer you keep compensating, and increase the level and type of compensation, the harder recovery from surgery is going to be.

@stargzng386

Do not downplay your pain or how it affects your life. It’s easier as a woman to try and be tough and soften the description of your pain. Stick to facts. Pain prevents me from doing x, y, z, have a list prepared. Pain affects me x amount of time in my day.

THIS. Screw the xrays, pain and movement don’t read xrays. The PT I originally went to said he had a patient with 2 bad knees based on xrays. The knee that should have crippled her didn’t hurt, the “good” knee was crippling her.

@stargzng386

I’m basically going to wait until I have additional arthritis and push for a replacement.

May I ask why you’re not pushing for a THR now? See my comment above - the longer you compensate, the worse things get and at a faster rate, and makes recover harder

@S1969

One of the reasons I’d rather not get one now is if I can run with PRP but can’t run with a replacement. I have heard conflicting statements about running. Sports med doc says “it’s not recommended” but other people have said “no restrictions.” But, the average hip replacement recipient isn’t a runner anyway, so maybe there is no need to say “you can’t run half marathons” but “you can run after your dog in the backyard.”

There’s more to consider than just having a THR. A LOT of THR-ers start running again because they WERE runners. It’s a matter of how willing you are to shorten the lifespan of your implant. The average now is about 35 years (if they’re using modern implants). If you’re 50 and don’t mind a replacement at 70, then run. If you’re 65 and don’t expect to be running when you’re 80, then run! If running is 2-3 miles a few times a week run.

BUT, I would 100% wait until the implant is fully integrated into the bone before running again

I would schedule an appointment with an actual hip surgeon, one who only does that, one who’s been around with 1000s of replacements. At least get more information from someone who’s seen 100s of situations just like yours

[Kyrabee]

@Simkie

the post procedure discomfort can really be zero fun

No shit….I was not aware of how painful it would be. It probably didn’t help that I drove across the state for it and had to get back in the car and drive 5 hr home without being able to take the Percocet the doctor prescribed….should have been a clue. I have had LOTS of ortho surgery and I would rate the post PRP pain right up there with surgical incisional pain. I had 2 hip tendons and the joint treated. The joint PRP didn’t hurt at all but that soft tissue . It took a good 3 weeks before things started going in the right direction. I had a positive response to the PRP and physical therapy for about a year.

The arthritis continued to advance. I had a THR (anterior approach) in January. Unfortunately it didn’t help the tendon issue but I was back to riding and exercising 6 weeks post-op with a very nice pain free joint. Caveat…I am not and never have been a runner. I am older (69) but had my right hip replaced at 58. It may need revision at some point in the future but I was pretty unable to function (walk) without it. Labrum was shredded (surgeons words). Left hip (most recent) labrum had multiple calcified tears…those aren’t going to be fixed any other way than replacement.

[stargzng386]

@JB

May I ask why you’re not pushing for a THR now? See my comment above - the longer you compensate, the worse things get and at a faster rate, and makes recover harder

Unfortunately with no arthritis on x-ray or MRI my insurance won’t cover a hip replacement. I’m also just under 40 so again insurance isn’t going to even think about covering it until I’m older or have arthritis. Insurance will cover the arthroscopic labral repaid and grinding down of bone on bone.

[S1969]

@Kyrabee

The joint PRP didn’t hurt at all but that soft tissue .

Yes I have heard that about PRP for soft tissue; a good friend was on crutches for a couple of days. And, it was 4+ weeks of rehab, which I would not have with the joint injection.

@JB

IMVHO, get the THR scheduled as soon as you can reasonable take enough down time (with support for things you CANNOT do for a period of time. It’s only going to get worse, and IME, when it gets to the point you’re at now, it starts accelerating in the decline… 5 years? No.

And worse, the longer you keep compensating, and increase the level and type of compensation, the harder recovery from surgery is going to be.

Yeah, this is the question I’ll need to have answered because the left hip is about 5 years behind, so I’ll be looking at surgery for that one as well eventually. I don’t see me being able to go 5 more years, but this is fairly recent new pain. And, again, not sure if it’s the bone or the labrum (or both). I ran 2 weeks ago and it wasn’t too bad. I haven’t tried since then (that damn pickleball game!) but have been riding my bike which is no issue at all. So I can see why my dr. is willing to say “maybe you’ll get 5 years” because I still sound pretty active…it will definitely depend on whether this recent issue is permanent or gets better.

[Simkie]

@stargzng386

Unfortunately with no arthritis on x-ray or MRI my insurance won’t cover a hip replacement.

Not just insurance–it would be awfully tough to find a surgeon willing to replace a hip with zero indication of arthritis, especially when no preservation procedures have been attempted. JB’s whole thing of “just get a hip replacement” like you can order what you want off a menu is misinformed.

It sounds like you’re doing all the right things! That’s hopefully that you’re doing so much better. A lot of labral tears absolutely can be managed without surgery. I hope it “sticks”!

Labral repair does have better success than 70%, though, if you do get to that point. I think the only report of 30% failure is White. Everyone else reports FAR less failure. Just don’t use White, lol

[JB]

@stargzng386

Unfortunately with no arthritis on x-ray or MRI

Ahhh,I forgot you’re the OP on this with no arthritis

@Simkie

JB’s whole thing of “just get a hip replacement” like you can order what you want off a menu is misinformed.

See above - NOWHERE did I imply “order what you want off a menu” I simply forgot she’s the OP with no visible arthritis

[stargzng386]

Super easy to mix up and a fair question!!

[JB]

@S1969

I don’t see me being able to go 5 more years, but this is fairly recent new pain.

FWIW, I went from “this is weird, feels like soft tissue, feels like a strained ligament or tendon” which had gone on for maybe 2 years, to “ok this is ridiculous, the knife-stabbing pain here and there is new I need to go to a PT” to “please hurry up get my surgery scheduled” in about 6 months.

By the time surgery came, I was on hands and knees most of the time going up our stairs, and hadn’t been able to go for a walk or bike ride with DH and the dog for a few months. Oddly enough I could still (carefully) do all my leg and cardio workouts, which I did even the day before surgery. But for workouts, I could control what I was and wasn’t doing so could avoid things that hurt too much.

Surgery was 13 months ago, and I’d asked my surgeon his thoughts on when my other hip (which has “age appropriate arthritis” might go, and he guesstimated maybe 5 years. Now, I’m starting to feel things that were in my first hip just a couple of years ago, so we’ll see. Meaning - take “5 years behind” with a grain of salt. My brother’s surgeon told him the same thing, and 2 years later he had his 2nd hip done.

[S1969]

Yeah…that’s what I’m afraid is happening. What you’re saying about workouts tracks pretty well. My dr. did say that the left hip being “5 years behind” will probably not stay that way, because it will get worse faster if I’m compensating. But maybe I’ll get lucky. I have a significant bone spur on the right hip but none on the left (yet). That’s what I thought was the culprit causing the sharp pains but torn labrum might be the real cause.

I’m not afraid to get the replacement surgery, but I don’t really feel quite ready yet. However, I don’t want to wait until it’s unbearable either. I understand there is a sequence of varying types of injections I could get but they are just ways to get through it until the surgery.

[JB]

I totally get it. I was really against surgery as well, until my body said “yeah, this isn’t working…” It’s really just something you have to work through given the facts, what your body is allowing you to do, whether you to try some alternatives first, etc. Good luck! <3

[Simkie]

@S1969

I’m not afraid to get the replacement surgery, but I don’t really feel quite ready yet. However, I don’t want to wait until it’s unbearable either. I understand there is a sequence of varying types of injections I could get but they are just ways to get through it until the surgery.

It’s really reasonable to work through your more conservative management options! It’s totally okay to do that. The goal with anything is to get you comfortable so you can lead the life you want. If injections can do that, awesome! If injections can do that for a little while, then you step up to a different type of injection that does it, awesome! If you work through your conservative options, and they don’t work–big bummer–but if doing that helps you feel more comfortable about surgery, that’s STILL awesome.

There is no single right path. It’s okay to see how conservative stuff goes, if you want to do that, even if you know you’ll eventually wind up at replacement. Injections are useful for many, even if to “just” delay the need for surgery until you’re more ready.

But you don’t need to accept suffering for a certain amount of time–that would be bullshit. Do what you need to keep living your life the way you want. THAT should always be the goal!

[stargzng386]

It’s really interesting how your brain switch can go can’t do this anymore. I’m the OP and at the beginning of my saga I had a total breakdown, got my back stuff figured out, then the hip issues and what they tried mad it worse so I was 100% surgery now. Fix it I don’t care. With work leave I would have had to wait until 2025 and in that wait the pain subsided. My back pain is also virtually nonexistent. For the first time in my entire adulthood I’m living with minor pain that’s not 100% of the time chronic. It’s incredibly freeing. So then my brain switched to can’t do surgery, can’t willingly put myself through more pain. Now if I get back to where little tasks are impossible then I’d swap back. It’s all a personal decision. I do think really talking with a good surgeon and getting all of the imaging helped me make a very informed decision. The surgeon even said her goal was not to have to do surgery but to work through all of the other options first.

To S1969 my right labral tear is massive on MRI and I have a moderate left tear as well. The left causes zero pain. The right one is the one that hurts. I will say for me, it has never ever been a sharp pain. It’s is a dull throbbing pain that creeps up and down very slowly. I wonder if there’s a bony process adding to your sharp pain.