On Friday the 25th of October I had the pleasure of joining Mr Tao Shan Lim in his operating theatre for the morning to observe a range of surgical procedures. Mr Tao Shan Lim specialises in Arthroscopic Hip procedures and is Western Australia’s most experienced surgeon performing arthroscopic hip labral repairs among other specialties and talents. Mr Lim is one of only a handful of surgeons in Western Australia to perform hip arthroscopies for labral repairs, so it was a pleasure to be able to witness one of these procedures firsthand.
At this point, a lot of you reading may be completely lost and thinking, ‘what on earth is the labrum?’. The Acetabular (hip) Labrum is a ring of cartilage that runs around the inside of the hip socket (acetabulum), increasing its depth and supporting the femoral head. A labral tear is a common injury and is often the result of repetitive stress during high impact sports, acute trauma, or occasionally can be the result of structural abnormalities within the hip joint causing wear and tear. Labral tears are quite often the cause of hip and groin pain and other symptoms such as locking, clicking, and instability, however, most minor labral tears can be completely asymptomatic. The process of diagnosing a labral tear can be quite tricky as many other conditions of the hip can cause similar symptoms, the diagnostic process may include investigations including MRI’s and X-Rays along with physical examinations to test the hip joint integrity. According to Dr Lim, once scans and testing reveal a labral tear, the best method to determine if the tear is the cause of the symptoms is to have the patient undertake an ultrasound guided anaesthetic injection. If symptoms are resolved following this injection, it is a positive indicator that the labrum is the cause of the symptoms and surgical intervention would be beneficial.
In a case where surgical intervention is recommended, an arthroscopic procedure is considered the best possible approach and depending on the type of labral injury, either a repair or debridement may be required. The advantages of hip arthroscopy over the traditional open hip surgery include:
- Smaller incisions
- Minimal trauma to surrounding ligaments, muscles, and tissues
- Less pain
- Faster recovery
- Lower infection rate
- Less scarring
- Earlier mobilisation
- Shorter hospital stays
In terms of exercise rehabilitation, the recovery timeline from an arthroscopic labral repair is much shorter in comparison to open hip surgery and in most cases, patients can resume most of their normal Activities of Daily Living (ADL’s) and moderate physical activity within 8-12 weeks post-operatively. This is however highly dependent on a multitude of factors that can impact the recovery timeline including the severity of the tear, the type of repair completed, the age of the patient, and any co-morbidities such as obesity, diabetes and smoking status.
The most important factor in recovery from an arthroscopic labral repair is to commence Physiotherapy immediately post-operatively, followed by the commencement of a structured and supervised exercise rehabilitation programme under the guidance of an Accredited Exercise Physiologist (AEP) from approximately week 4-6 onwards. The exercise rehabilitation programme should be specifically targeted to improve the functional status of the hip along with gradually integrating exercises that promote increased tolerances for ADL’s, work tasks and recreational or sporting activities. The exercise rehabilitation programme needs to be highly specific and individualised, with the treating AEP working in harmony with the treating Physiotherapist, Surgeon and any other stakeholders involved to ensure the best possible outcome is achieved.
If you would like more advice on post-operative management for labral repairs, head to absolutebalance.com.au or come into our clinic and make an appointment to see one of our AEPs.
Alixe Marion (BSc – Exercise Physiology)
Senior Accredited Exercise Physiologist
Andrew Wolff, M. (2019). Hip Labrum Repair Surgery: Issues to Consider. Retrieved 28 October 2019, from https://www.sports-health.com/treatment/hip-injury-treatment/hip-labrum-repair-surgery-issues-consider