Torn Labrum

You may have been told you have a torn labrum and that you need hip arthroscopy. We are firm believers in avoiding surgery first, which leads our patients to the pool. Patients have been asking us for sixteen years, "If I have a torn labrum, how is the pool going to make me better?"

There are two reasons:

1) Imagine the torn labrum is like a blister in the palm of your hand. If you clipped a hundred roses in your back yard, you hand would hurt and you would see that the skin is torn. What is the treatment? If you gently and carefully continue to clip roses, the blister will become a callus. That's how the pool exercises work on a torn labrum. The labral tear turns from sore, vulnerable tissue into protected, callus-like tissue.

2) Doing our pool program allows you to unload your weight and take the stress off your hip joint while you strengthen your muscles in an environment of weightlessness. As your muscles surrounding the hip joint become stronger and more able to stabilize your sore hip, they come better shock absorbers in preventing the stress from going through the joint. Nothing on land duplicates this. If you tried a muscle-strengthening program on land, you would be damaging the labrum further, but in the pool, you're unloading the joint at the same time you are placing resistance on the muscles.

After several months of the pool program, you will find that with every step you take, your muscles take more of the stress off the joint and fewer aggravating forces go through your hip. You may live happily-ever-after with an MRI that shows a labrum not exactly the way it was before, just as your hand with a callus will look different from normal skin. But if it doesn't hurt anymore, you're not doing any damage. So STOP! Consider our Win-Win situation of doing the pool program, making your pain go away, and staying ahead of the game.

However, if you pursue our pool program diligently for two or three months and your pain is still there, then you do need to go to a doctor who has experience with the highly technical nature of hip arthroscopy. It's a difficult procedure that requires lots of skill and training. This doesn't mean you must come to Los Angeles to see Dr. Klapper, but he asks that you do your research and choose a skilled surgeon who has done hundreds of these hip arthrocopies.

In recent years, we have seen the sequence of events become clearer in terms of the development of arthritis. Our MRI diagnostic tool has become a better "digital camera." We can now see inside the hip better earlier in the game and that has allowed us to differentiate between several hip labrum problems.

If you consider the labrum of the hip to be the equivalent of the meniscus of the knee, we can think of how that cushion can get stuck in between the ball and socket in extreme positions. The labrum can get caught or pinched, and thus the term impingement syndrome. There are only two anatomical reasons you can develop impingement syndrome because we have only two things to talk about when it comes to the hip: the ball and the socket. If the ball is shaped more like a mushroom head than a billiard ball, it doesn't fit as nicely in the socket. That is called the "cam" phenomenon where the ball is almost too big for the socket. It pinches the labrum and tears it. The second bony reason the labrum can tear is because the socket is too big compared to the ball. In that case, extremes of motion, such as kicking in front or to the side or rotating in certain ways can cause the edge of the socket to indent into the ball with the labrum stuck in between. That is called the "pincer" phenomenon. Today's MRI shows us the torn labrum, but now with our better analysis, we can say, "The labrum is torn. Is it a cam or a pincer problem?" Once we know that, we can treat the torn labrum correctly. It allows the surgeon to file down the bony bump that is the problem, either the bump coming from the ball side of the joint or the bump crushing the labrum from the socket side of the joint.

When the labrum is torn, this beautiful, rubbery cushion protecting the cartilage of the ball and socket joint begins to act like a piece of sandpaper wedged in between and it starts speeding up the process or arthritis. A labral tear can actually cause the delamination of the cartilage - that is, it can cause the cartilage to "unglue" itself off of the bone. Yet with arthroscopy, we can clean away the torn labrum or surgically repair it through two small puncture sites. At the same time we can file down the bony bump, the beginnings of a bone spur that may have caused the labral tear in the first place. This may postpone or completely prevent the need for a hip replacement for a lifetime. This is why Dr. Klapper is so interested in continuing to pioneer hip arthroscopy procedures.

Ten years ago, we used the scope merely to clean up labral tears. Now we have learned why the labrum is torn and we know we must fix the reason the labrum was torn by filing down the bump on the bone so another tear will not occur.

Heal Your Hips

Heal Your Hips: How to Prevent Hip Surgery - and What to Do If You Need It

by Robert Klapper, M.D. and Lynda Huey.

The first comprehensive guide to hip health. Avoid injury, prevent deterioration, work out in water and on land, and decide among the entire range of nonsurgical and surgical options.

(John Wiley & Sons, Inc., 1999.) 224 pages, 85 photographs and drawings.