Comparing Hip Labrum Surgery and Prolotherapy

Danielle.Steilen.ProlotherapistDanielle R. Steilen-Matias, MMS, PA-C

The hip labrum is an important ring of cartilage that holds the femoral head, or top of the thigh bone, securely within the hip anatomy. It also serves as a cushion and shock absorber to protect the hip and thigh bones. Damage or  degeneration to the labrum causes pain, hip instability and bone overgrowth in attempt to stabilize the area.

Hip labrum injury and labral tears

Hip labrum injury and labral tears can be caused by a sudden, specific injury or with repetitive motions that cause “wear and tear.” Patients come into our office with varying degrees of hip pain and may also describe a pain deep in the groin.

The patient with hip pain suspected to the hip labrum may also describe a clicking, popping or a locking sensation in the hip. While they may describe more symptoms, one thing they all seek is hip labrum pain relief and a return of hip function and stability.

Simply a patient seeking hip labrum injury treatment can research two options. A non-surgical option and a surgical option. Almost all patients start with the “conservative” non-surgical path, most of them end up on the surgical table.

Why does conservative treatments lead to surgical options? The easy answer is the conservative treatments were not effective for the patient. But conservative treatments are a broad term to describe many options. Perhaps the patient and his/her health care provider did not seek a broader selection of options and did not select the correct conservative treatment. We will cover these options below.

Labral hip tears are grouped into four classifications

Hip labral tear treatment – traditional conservative options lead to surgery

The labrum has a poor blood supply, which makes a tear or injury difficult to treat with conservative approaches. The poor blood supply to the labral area also makes for recovery after hip labrum surgery at best challenging.

Conservative approaches include

While physical therapy can help the surrounding muscles, it does not promote repair to the the labrum or prevent further instability of the hip joint. Consequently, labral tear cases are quickly referred to surgeons for potential  surgery to try and repair or remove the damaged tissue. The surgical prognosis is often guarded as to whether the patient/athlete would be able to return fully to his or her work or sport, especially if labral tissue is removed.

Hip labral tear surgery. Are staples stabilizers?

It should be obvious that we are not big fans of surgery. If you take the hip meniscus or the hip labral tissue out you are taking out tissue that the body needs for stability. The surgery will leave the patient less stable. Some patients believe the titanium staples used in these surgeries will provide the stability and support they need for their hips.

The labrum is a very pliable tissue. Simply tacking it in place will restrict all the movement the hip was designed to do.

One of the main questions we are often asked is what are hip labral tear surgery success rates?

Let’s let the research answer and let’s take a very positive surgical study, in fact here is what the conclusion of a 2016 study in the American Journal of Sports Medicine states:

“Primary hip arthroscopy for all procedures performed in aggregate had excellent clinical outcomes and patient satisfaction scores at short-term follow-up in this study. More studies must be conducted to determine the definition of a successful outcome. There was a 6.1% minor complication rate, which was consistent with previous studies. Patients should be counseled regarding the potential progression of degenerative change leading to arthroplasty as well as the potential for revision surgery..”

Excellent clinical results included:

During this research study period between April 2008 and October 2011, data were collected on all patients who underwent primary hip arthroscopy. A total of 595 patients were included in the study.

The researchers of this study were right to point out: More studies must be conducted to determine the definition of a successful outcome.

This research should concern patients thinking of a surgery for removal of their hip labrum

If the above research was not enough, listen to what doctors at the Rizzoli Orthopaedic Institute in Italy published in the medical journal Hip International:

In their research the Italian researchers wanted to examine the  kinematic behavior of the hip joint (how the hip moved) with particular interest in the contribution of the periarticular soft tissues (tendons, ligaments, labral tissue) to hip stability. In essence to examine what happens to the hip when  the acetabular labrum is damaged and then surgical repaired.

The study showed that after hip labrum surgery, the hip no longer acts as a ball-and-socket joint (meaning it is unstable and unsupportive for the rest of the body) and the femoral head anatomical displacement is strongly affected by the removal of periarticular soft tissues, labral repair as well as labrectomy.(4)

If the labrum is not there the hip bone “floats” and causes hip instability which can lead to a further degeneration of the hip which will lead to hip replacement.

Another study: Concerns about hip labrum MRI and surgical recommendation

If the above research was not enough, listen to what doctors at the David Geffen School of Medicine at UCLA wrote in the medical journal Skeletal radiology. This should concern patients over the age of 50 who had a MRI or MRA for suspected hip labral tears and were recommended to surgery.

Basically the surgeons wanted to do hip labrum surgery, and are seeking and MRA (A more advanced imaging than MRI where contrast is used), to justify the surgery.

The radiologists of this study said this:

In other words, in patients over 50 advanced imaging and surgery is not supported.

Please see our article Options and alternatives to hip preserving arthroscopic surgery

Labrum-Repair-CMThis is may be why patients often question hip labral tear surgery success rates. For many surgery is not the answer they hoped for. This is why new surgical procedures are being sought.

In a recent study published in Clinical orthopaedics and related research from doctors at the University Hospitals of Geneva and University of Geneva, concern is expressed that there does not appear to be options for patients showing degenerative labrum hip tear symptoms: painful, torn, irreparable, or completely ossified (calcified) acetabular labrum short of reconstruction with grafts.

What is being suggested here is that there was a thought that if you shaved away the damaged labrum tissue that regeneration of the acetabular labrum was possible. But studies are inconclusive and one study says it does not happen.

The Geneva team concluded: “Resection (removal) of a non-repairable acetabular labrum does not stimulate regrowth of tissue. . . patients who underwent this procedure had neither results in regrowth nor the restoration of consistently high hip function.”(5)

Doctors at The Ottawa Hospital in Canada found similar findings in their research published in The Journal of bone and joint surgery. They too cast a harsh light on hip labral procedures in patients over 45:

Surgeons discuss saving the hip labrum

Doctors at the Ohio State University Wexner Medical Center say in their research in the Sports medicine and arthroscopy review: that the techniques utilized for the management of articular cartilage and hip labral injuries during hip preservation surgery have changed dramatically because doctors need to figure out a way to preserve the hip labrum so as to achieve the goal of providing labral treatment that restores native functions of the labrum to allow for more normal biomechanical function.(7)

In 2009, Dr. Megan M. Groh of the Physical Medicine & Rehabilitation, Mount Sinai Hospital, New York. conducted a comprehensive review of hip labral tears that pointed out  that hip surgeries that remove or debride the hip labrum are taking away from the vital function of the labrum and indeed motion of the hip. Writing in the Current Reviews in Musculoskeletal Medicine:

For a review of the various hip surgery techniques including chondroplasty, debridement and microfracture our article Treating Degenerative Hip Disease.

It all comes back to saving the hip labrum, as documented by the research

Research out of Wake Forest University School of Medicine published in the Journal of hip preservation surgery suggests that an awareness of how biomaterials, among them stem cells would make the future of hip arthroscopy exciting. Cartilage injuries can be managed with a higher level restorative techniques. These cartilage restoration techniques have evolved rapidly as well, and may include the use of scaffolds, allograft cartilage cells, and other stem-cell-related procedures.(9)

Prolotherapy for Hip Labrum Tears

In our own research, Prolotherapy for hip labral tears was curative in 54% of the patients (no pain at all after Prolotherapy) and overall relieved 80-85% of their pain, which in our experience will end up much better than surgical procedures, because the hip is now stable.

Regenerative Injection Therapy (Prolotherapy) for Hip Labrum Lesions: Rationale and Retrospective Study

Ross Hauser MD of Caring Medical and Rehabilitation Services and Amos Z. Orlofsky, Ph.D of Albert Einstein College of Medicine published the above study in The Open Rehabilitation Journal research describing the effectiveness of Prolotherapy for hip labral tear and groin pain. The study concluded Prolotherapy for acetabular labral tear appears to be a safe and potentially effective treatment.

Here are learning points from that research:

A Retrospective Study on Hackett-Hemwall Dextrose Prolotherapy for Chronic Hip Pain at an Outpatient Charity Clinic in Rural Illinois

In this research published in the Journal of Prolotherapy,  Prolotherapy was found to provide connective tissue growth responses and provide clinical benefit with low risks in musculoskeletal conditions. Further, Prolotherapy can be a cost-effective alternative to surgery for patients with hip pain and labral tear.10

We examined Sixty-one patients, representing 94 hips, who had been in pain an average of 63 months We treated these patients quarterly with dextrose Prolotherapy.

This included a subset of 20 patients who were told by their medical doctor(s) that there were no other treatment options for their pain and a subset of eight patients who were told by their doctor(s) that surgery was their only option.

Patients were contacted an average of 19 months following their last Prolotherapy session and asked questions regarding their levels of pain, physical and psychological symptoms and activities of daily living, before and after their last Prolotherapy treatment.

Results:

We concluded: “Prolotherapy used on patients who presented with over five years of unresolved hip pain were shown in this retrospective pilot study to improve their quality of life even 19 months subsequent from their last Prolotherapy session.

The 61 patients with 94 hips treated reported significantly less pain, stiffness, crunching sensation, disability, depressed and anxious thoughts, medication and other pain therapy usage, as well as improved walking ability, range of motion, sleep, exercise ability, and activities of daily living. This included patients who were told there were no other treatment options for their pain or that surgery was their only option. The results confirm that Prolotherapy is a treatment that should be highly considered for people suffering with chronic hip pain.”(11)

If you have questions about Hip Labrum Surgery, You can get help and information from our Caring Medical staff

1 Krych AJ, Griffith TB, Hudgens JL, Kuzma SA, Sierra RJ, Levy BA.Limited therapeutic benefits of intra-articular cortisone injection for patients with femoro-acetabular impingement and labral tear. Knee Surg Sports Traumatol Arthrosc. 2014 Apr;22(4):750-5. doi: 10.1007/s00167-014-2862-3. Epub 2014 Feb 1. [Google Scholar]

2 Gupta A, Redmond JM, Stake CE, Dunne KF, Domb BG. Does primary hip arthroscopy result in improved clinical outcomes? 2-year clinical follow-up on a mixed group of 738 consecutive primary hip arthroscopies performed at a high-volume referral center. The American journal of sports medicine. 2016 Jan;44(1):74-82. [Google Scholar]

3 Zaffagnini S, Signorelli C, Bonanzinga T, Lopomo N, Raggi F, Di Sarsina TR, Grassi A, Marcheggiani Muccioli GM, Marcacci M. Soft tissues contribution to hip joint kinematics and biomechanics. Hip Int. 2016 May 14;26 Suppl 1:23-7. doi: 10.5301/hipint.5000407. Epub 2016 May 12. [Google Scholar]

4. Jayakar R, Merz A, Plotkin B, Wang D, Seeger L, Hame SL. Magnetic resonance arthrography and the prevalence of acetabular labral tears in patients 50 years of age and older. Skeletal Radiol. 2016 Apr 20. [Google Scholar]

5 Miozzari HH, Celia M, Clark JM, Werlen S, Naal FD, Nötzli HP. No Regeneration of the Human Acetabular Labrum After Excision to Bone. Clin Orthop Relat Res. 2015 Apr;473(4):1349-57. doi: 10.1007/s11999-014-4021-z. [Google Scholar]

Wilkin G, March G, Beaulé PE. Arthroscopic Acetabular Labral Debridement in Patients Forty-five Years of Age or Older Has Minimal Benefit for Pain and Function. J Bone Joint Surg Am. 2014 Jan 15;96(2):113-8. doi: 10.2106/JBJS.L.01710. [Google Scholar]

7. Salata MJ, Vasileff WK. Management of Labral and Chondral Disease in Hip Preservation Surgery. Sports Med Arthrosc. 2015 Dec;23(4):200-4. [Google Scholar]

8. Groh MM, Herrara J. A comprehensive review of hip labral tears. Curr Rev Musculoskelet Med. 2009 June; 2(2): 105–117. [Google Scholar]

9. Stubbs AJ, Howse EA, Mannava S. Tissue engineering and the future of hip cartilage, labrum and ligamentum teres. Journal of Hip Preservation Surgery. 2016;3(1):23-29. doi:10.1093/jhps/hnv051. [Google Scholar]

10. Hauser R, Orlofsky A. Regenerative injection therapy (prolotherapy) for hip labrum lesions: rationale and retrospective study. The Open Rehabilitation Journal. 2013 Oct 18;6(1). [Google Scholar]

11. Hauser R, Hauser M, A Retrospective Study on Hackett-Hemwall Dextrose Prolotherapy for Chronic Hip Pain at an Outpatient Charity Clinic in Rural Illinois. Journal of Prolotherapy. 2009;2:76-88. [Google Scholar]

 

Our Facebook Reviews
Our Facebook Reviews
Celebrating 25 years of Prolotherapy! Are you a good Prolotherapy candidate?
How Can We Help You?
First Name:
Last Name:
Phone:
Email:
Question:

Enter code:
captcha

SEARCH
for your symptoms

Prolotherapy, an alternative to surgery

Were you recommended SURGERY?
Get a 2nd opinion now!

WHY TO AVOID:
★ ★ ★ ★ ★We pride ourselves on 5-Star Patient Service!Come see why patients travel from all
over the world to visit our clinics.
Current Patients
Become a New Patient

Chicagoland Office
715 Lake St., Suite 600
Oak Park, IL 60301
(708) 393-8266 Phone
(855) 779-1950 Fax
Southwest Florida Office
9738 Commerce Center Ct.
Fort Myers, FL 33908
(239) 303-4069 Phone
(855) 779-1950 Fax Fort Myers, FL Office
We are an out-of-network provider.
© 2017 | All Rights Reserved | Disclaimer
National Prolotherapy Centers specializing in Comprehensive Prolotherapy,
Stem Cell Therapy, and Platelet Rich Plasma.

Meet our Prolotherapy Doctors and check out our Prolotherapy research.