Hip Labral Tear & FAI (Femoroacetabular Impingement)

What is a hip labral tear and FAI (femoracetabular impingement)?

Femoroacetabular Impingement (FAI) and a labral tear are both conditions related to the hip joint, and they often occur together, contributing to pain, discomfort, and reduced mobility.

Femoroacetabular Impingement (FAI)

FAI is a condition where abnormal contact between the femoral head (the ball-shaped part of the thigh bone) and the acetabulum (the hip socket) causes damage to the cartilage and labrum in the hip joint. There are two main types of FAI:

  1. Cam Impingement:

    • The femoral head is misshapen (not round), which causes it to rub against the acetabulum, leading to damage in the joint.

  2. Pincer Impingement:

    • The acetabulum is too deep or extends too far over the femoral head, causing excessive contact between the femoral head and the socket, which can pinch the labrum.

FAI can cause hip pain, stiffness, and reduced mobility, especially during activities that involve hip rotation, flexion, or deep bending (e.g., squatting, sitting for long periods, or certain sports). Over time, if left untreated, it may lead to further joint damage and increase the risk of developing hip arthritis.

Labral Tear

The labrum is a ring of cartilage that surrounds the acetabulum (hip socket) and helps to stabilise the femoral head (ball) inside the socket. It acts like a cushion and provides a seal that maintains the stability of the joint.

A labral tear occurs when this cartilage is damaged, often due to repeated stress, trauma, or abnormalities like FAI. The tear can be partial or complete, and it can involve any part of the labrum. Labral tears can cause pain, clicking, instability, and reduced range of motion in the hip.

How FAI and Labral Tears are Related

FAI is a common cause of labral tears in the hip joint. The abnormal bone contact caused by FAI can lead to excessive wear and tear on the labrum, eventually causing it to tear. In many cases, the two conditions occur together:

  • Cam Impingement can cause the femoral head to rub against the acetabulum, damaging the labrum over time.

  • Pincer Impingement can cause the acetabulum to pinch the labrum, leading to tears.

Symptoms of FAI and Labral Tear

  • Hip Pain: Typically felt in the groin area, but it can also radiate to the outer hip or thigh.

  • Stiffness: Difficulty moving the hip, especially with flexion (bending) or rotation.

  • Clicking or Catching Sensation: Some people experience a feeling of catching, locking, or popping in the hip joint.

  • Instability: The hip may feel weak or unstable, especially during physical activity or weight-bearing movements.

How is FAI and Labral Tear Diagnosed?

  • Physical Examination: Dr Collins will assess your hip joint's range of motion and check for pain patterns associated with FAI and labral tears.

  • Imaging Tests: X-rays are often used to look for bone abnormalities that might indicate FAI (e.g., cam or pincer deformities). MRI is often used to confirm a labral tear and assess the extent of damage to the labrum and cartilage. A CT scan may also be necessary.

How do you treat FAI and labral tear?

  1. Conservative Treatments:

    • Physical Therapy: Exercises to strengthen the muscles around the hip joint can help improve stability and reduce symptoms. It may also help improve joint range of motion and reduce stress on the labrum.

    • Medications: Anti-inflammatory drugs (NSAIDs) can help reduce pain and swelling.

    • Activity Modification: Avoiding activities that place strain on the hip (e.g., running, squatting) can provide relief.

Injections:

  • Corticosteroid Injections: These can provide temporary pain relief and reduce inflammation in the hip joint.

  • Hyaluronic Acid / PRP Injections: In some cases, these injections can help lubricate the joint and reduce pain, potentially reducing inflammation.

Surgical Treatment:

  • Hip Arthroscopy: minimally invasive surgery can be used to treat both FAI and labral tears. Dr Collins may reshape the bones to address FAI and repair or remove the damaged portion of the labrum. Often the preferred option for younger, active patients who have exhausted other non-operative treatment options.

  • Osteotomy: Periacetabular osteotomy (PAO) may be necessary in severe cases.

If treated early, both FAI and labral tears can be managed successfully with conservative measures and, in some cases, surgery. Without treatment, however, FAI can lead to further joint damage and increase the risk of developing hip osteoarthritis in the future.

If you experience persistent hip pain or other symptoms of FAI and/or a labral tear, it’s a good idea to consult with your healthcare provider team to discuss the best treatment plan for you. Dr Collins would be pleased to be apart of this team to help improve your quality of life.

Hip Procedures performed by Dr Collins

Hip Replacement

What is a Hip replacement?

A hip replacement, also known as hip arthroplasty, is a surgical procedure where a damaged or worn-out hip joint is replaced with an artificial joint (prosthesis). The hip joint is a ball-and-socket joint, where the femoral head (ball) fits into the acetabulum (socket) of the pelvis. In a hip replacement, the damaged components of the hip are removed and replaced with prosthetic parts made of metal, ceramic, or plastic. 

Dr Collins specialises in hip replacement surgery. 

Why might I need hip replacement Surgery?

If you’re suffering from chronic hip and/or groin pain that’s affecting your quality of life, an appointment with Dr Collins, a leading Melbourne hip specialist, is recommended to discuss if hip replacement surgery is right for you. 

If you’re unsure if you’re ‘ready’ for or ‘need’ a hip replacement, the ACHE tool can be helpful: https://www.achetool.com

Hip replacement surgery is an elective operation and the decision should be made by you in conjunction with your treating healthcare professionals including Dr Collins.

What are the different types of hip replacement surgery offered by Dr Collins?

Dr Collins specialises in:

  • Anterior hip replacement (Direct anterior approach)

  • Posterior hip replacement

  • Hip resurfacing

    • For younger, active patients with healthy bone structure, hip resurfacing can be a good option

  • Revision hip replacement

Where will I have my hip replacement surgery?

Dr Collins operates at multiple hospitals throughout Melbourne, he can discuss your preferences in person during your consultation.

What does a Hip Replacement involve?

A hip replacement procedure is typically performed under general anesthesia or spinal anesthesia (numbing from the waist down). It usually takes about 1 to 2 hours to complete. Here's what generally happens:

  1. Incision: The surgeon makes an incision over the hip to access the joint, Dr Collins’ preference is an anterior approach.

  2. Removal of Damaged Parts: The damaged femoral head (ball) and the worn-out acetabulum (socket) are removed. The femoral stem will be inserted into the femur (thigh bone), and the new acetabulum is placed into the pelvis.

  3. Placement of the Prosthesis: The surgeon will fit the artificial joint components into place and ensure they fit properly and move smoothly.

  4. Closure: The incision is closed with absorbable stitches, and the incision site is dressed.

What will the recovery be like after surgery?

You will walk in the same day as surgery, early mobilisation aides a good recovery and decreases complications/risks.

Recovery following a hip replacement is a particular area of interest to Dr Collins, and he endeavours to utilise the lastest technologies and techniques to optimise your recovery journey.

Anterior approach hip replacement has been shown to offer a faster recovery, nonetheless it is important to not over do it. As your pain improves, your body still needs to heal.

Dr Collins aims to manage your recovery and rehabilitation together. You will be provided with comprehensive information about your recovery, swelling management, pain management and rehabilitation. Dr Collins aims for a fast and safe recovery for you.

What are the risks and complications of hip replacement surgery?

As with any surgery, there are some risks and complications to be aware of, including:

  • Infection: Although rare, infections can occur at the surgical site or within the joint. The anterior approach has been shown to have a lower infection rate.

  • Blood Clots: Deep vein thrombosis (DVT) can occur, particularly in the legs. Blood thinners and early mobility can reduce the risk.

  • Dislocation: The new hip joint may dislocate, especially in the first few months after surgery. The anterior approach has a lower dislocation rate, and with use of technology the risk is decreased.

  • Leg length discrepancy – A lot of patients will have a small (millimetres) leg length discrepancy radiologically pre-operative and not notice if themselves, Dr Collins will discuss this with you prior to surgery. Lengthening or shortening the leg slightly may be apart of the surgical plan to improve your outcome. The use of technology helps Dr Collins avoid a clinically symptomatic/noticeable discrepancy.

  • Nerve or Blood Vessel Damage: In rare cases, nerves or blood vessels around the hip may be damaged during the procedure.

  • Thigh numbness – numbness to the lateral thigh is relatively common with a direct anterior approach incision, this is due to damage/injury to the superficial nerve supplying the skin (lateral femoral cutaneous nerve).

  • Implant Problems: The artificial joint may wear out or become loose over time, requiring revision surgery.

  • Stiffness or Limited Range of Motion: While rare, some patients may experience difficulty moving the hip joint fully after surgery.

  • Dissatisfaction or ongoing pain: All efforts are made to avoid this complication, nonetheless some patients still report ongoing pain and lack of satisfaction, this is often multi-factorial but can be due to other sources of referred pain (lumbar spine, sacroilliac joint or other), tendinopathic conditions and/or muscle weakness.

Prevention and prehabilitation is best – the fitter and stronger you are prior to your surgery, the safe and quicker your recovery will be. Dr Collins recommends a number of initiatives pre-operatively to optimise you for surgery.

How long do hip replacements last?

Modern hip replacements should last greater than 20 years in over 90% of patients, individual factors such as age, activity level and weight can impact this. Results from the Australian National Joint Replacement Registry show that one of the total hip replacement prostheses Dr Collins uses has a 95% chance of survival from revision after 15 years.

How long does hip replacement surgery take?

Generally takes between 1-2 hours.

What is a hip replacement made of?

The femoral (stem) and acetabulum (socket) metal components are made of a metal alloy (stainless steel alloy, titanium alloy), with a metal or ceramic femoral head (ball) and a very strong medical grade plastic (polyethylene) liner insert within the socket.

When can I drive?

4-6 weeks following your surgery. You need to be close to your pre-surgery mobility/function level, and feel safe and confident in your ability to drive. You need to be off strong pain relief, have a good range of motion of your knee and mobilising/walking well without gait aides.

Orthopaedic Surgeon Melbourne

Utilising the latest techniques and technology Kade aims to return you to your best as soon as possible with optimised recovery via a multi-disciplinary and multi-modal approach.