Hip Labral Repair Rehabilitation: What To Expect

The hip labrum is a cartilaginous ring that extends around the outside of the hip socket as seen in the illustration below. Hip labral tears manifest as sharp, nagging pain deep in the hip or the groin areas. Pain associated with a hip labral tear may also refer down the thigh towards the knee. Car accidents and chronic repetitive stress imposed from years of sports or yoga are often root causes of hip labral tears. Women appear to be much more susceptible to this type of injury.

Hip labral surgery is a comparatively new orthopedic procedure that seeks to repair the labrum and thus stabilize the hip socket. This type of surgery is becoming less invasive from year to year: the patients that we see now have very small surgical scars and fewer post-operative precautions.

Precautions & Expectations in Regards to Hip Labral Repair Surgeries

1. Almost all post-operative labral repair patients are “non-weight bearing” for a minimum of two weeks following the surgery. Patients use crutches during this time frame. In terms of rehabilitation, I ask patients to lie flat on a bed or on the floor for a period of time each day that he or she is using crutches. The purpose of this is to allow the hip flexor muscles to relax into a neutral position, as suspending one’s leg while using crutches does require prolonged flexion of the hip.

2. Swelling in the hip area is an inevitable effect of surgery and causes the surrounding muscles to “shut down.” Isometric exercises are typically started shortly after surgery in order to minimize the negative effects of swelling. The gluteus maximus, gluteus medius, hip adductors, and hip flexors can all be trained gently through isometric exercise. There are many resources on the Internet that can lead you in the right direction in terms of isometric exercise instruction.

3. Pain in the lower back and pelvis following labral repair surgery is common because of muscular imbalance. The spine in general does not handle asymmetry well: if one leg cannot accept weight well for a prolonged period of time, the lower back and pelvis are loaded too heavily from the stronger side. In order to minimize this effect, in rehabilitation we encourage the patient to work on idealizing the mobility of the lower back and pelvis through a series of exercises. It also goes without saying that the sooner the patient regains his or her strength and weight bearing capacity on the surgical side, the better the lower back and pelvis will feel.

We have two (2) exercises on our “media” tab under the abdominal section: “pelvic clock” and “pelvic control” are good ideas in terms of restoring lower back and pelvic alignment. The password to get into the exercises is “patient.”

4. Healing from this surgery generally takes a long time! It is not uncommon for patients to experience discomfort six months after the fact. The important thing to remember is that if you notice positive differences from week to week (or month to month), you are going in the right direction! We will typically ask patients to record the distance that they can walk before pain sets in and then use this as a baseline for comparison.

5. With hip and knee surgery in particular, people have the long-term tendency to develop habits that keep them from maintaining full weight and strength through the leg. Avoid crossing your surgical leg over the uninvolved leg when seated, and when standing, force yourself to bear your weight equally through both legs. The body will often unconsciously try to default over to the non-surgical side because it has learned to do so. Initial post-surgical weight bearing precautions are a necessary evil: people need to re-teach their bodies to accept weight equally, and this may takes months of practice.

Discussion

  1. Lauren says

    Hi- I had a mini open FAO surgery 10 days ago to address a labral tear, impingement and to remove a cyst that had developed. I developed some femoral nerve issues following surgery and have no feeling down the whole leg on the inside. I was told to wear a large brace that locks my knee and that I was weight bearing as tolerated. I did not feel the need for crutches so I did not use them. Yesterday while I did not have the brace locked, I took a hard fall and landed on my knee on the post op side. I was wondering if this could have possibly caused the labrum to tear again since it was a pretty hard fall 10 days post surgery.

    Thanks

    • says

      Lauren two thoughts here:

      1. The big bulky brace might actually be placing pressure on the femoral nerve. Have the doc check it to make sure that it is not digging in to your thigh
      2. You certainly should see the doc in regards to the fall you had. A compressing motion may not have torn the labrum, but it would inflame the joint quite a bit. Better to have the doc look at it.

  2. Marco says

    I got an FAI surgery on my left hip 13 days ago. I was feeling much better already but must have over extended myself a bit. I only did a light walk (6 minutes) and the next day walked 3 blocks. I hobbled across the sidewalk too fast. I’m crippled now. What is the likelihood this pain is a retorn labrum? I’m praying it’s just inflammation from a bit of overuse. How easy is it for sutures to be retorn? The doc said I could walk without crutches if the pain was fine. Apparently not. Any thoughts are helpful.

    • says

      Typically these post-ops are on crutches for at least a few weeks. You certainly irritated the joint, but it usually takes something more like a fall to jar an anchor loose. You should see the doc and have it assessed. No appreciable weight bearing in the mean time, use the crutches.

  3. Maxine says

    I had open surgery for tendon pulled away from bone in right hip, scar is 8 inches. Dr told me he drilled 2 small holes in hip pulled tendon through and tied down. Two of my bursa were inflamed Dr. said he cleaned them up, not sure what that meant. I used crutches for 6 weeks. I use a cane now. It’s been 3 months now. I get achy pain in my hip area after walking for 20 minutes. I wake up with achy pain, usually goes away after I get up. I went to the movies last night, it was 2 hours long, I got up this morning and my hip is achy and tight feeling sometimes feels like a pinching feeling. Is this normal, since my surgery has been 3 months?

    • says

      Maxine that sounds like a considerable surgery. 3 months is not that long, so I would certainly expect soreness etc. for a few more months to come. Make sure that you are sticking to a gentle strengthening routine, preferably under the supervision of a PT or the doc. It sounds like you still need to strengthen the gluteus maximus and medius among other things.

  4. Cynthia says

    I have bilateral Avascular Necrosis of the femoral heads (early stage 2 pre-collapse), as well as tearing of the Labrum only in the symptomatic hip. I have been advised by a THR surgeon to hold off on having the painful hip replaced until I can’t take it he pain any longer. I’m almost certain my pain is from the tear and wonder if I would be a candidate for an arthroscopic repair of the Labrum (or is concurrent AVN a contradiction)? Thanks so very much…not sure which way to turn!

    • says

      Ugh. It seems like it would be a waste of a surgery for the labrum if the femoral head were to go in to full AVN at some stage. You would probably be better off having the THA, hopefully that would take care of both issues at one time.

      I think that vascular compromise (AVN) would make the labral surgery more difficult to recover from, not to mention an increase risk of causing the AVN to advance.

      It never hurts to get a second opinion from an orthopedist who deals with hips on a regular basis.

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