Labral Augmentation

What is Hip Labral Augmentation?

The hip joint is one of the body's largest weight-bearing joints and is the point where the thighbone (femur) and pelvis (acetabulum) join. It is a ball-and-socket joint in which the head of the femur forms the ball, and the pelvic acetabulum forms the socket. The labrum is a ring of strong fibrocartilaginous tissue lining around the socket of the hip joint that serves many functions where it acts as a shock absorber, lubricates the joint, and distributes the pressure equally. It holds the head of the femur in place and prevents the lateral and vertical movement of the femur head within the joint. It also deepens the acetabular cavity and offers stability against femoral head translation.

Hip labral augmentation is a surgery to treat hip labral tears. A labral augmentation surgery involves utilizing tissue from another area of the patient’s body (autograft) or a donor (allograft) and affixing it to the top of the native labrum to restore the suction seal. The blood supply of the native labrum is believed to help the graft heal postoperatively. The surgery helps to restore the function and anatomy of the hip in cases of a hypotrophic labrum and when, after a labral tear, the labrum is deemed insufficient to keep the suction seal.

Indications for Hip Labral Augmentation

Hip labral tears are the main indication of hip labral augmentation. A hip labral tear is a partial or complete rupture of the hip labrum, a ring of fibrous cartilaginous tissue that surrounds the socket of the hip joint. These tears are most commonly seen in athletes involved in high-impact sports such as ice hockey, soccer, and football and can also occur due to traumatic injury or degenerative conditions. 

Preparation for Hip Labral Augmentation

Preoperative preparation for hip labral augmentation may involve the following steps:

• A review of your medical history and a physical examination are performed by your doctor to check for any medical issues that need to be addressed prior to surgery.
• Depending on your medical history, social history, and age, you may need to obtain dental clearance and undergo tests such as blood work and imaging to help detect any abnormalities that could compromise the safety of the procedure.
• You will be asked if you have allergies to medications, anesthesia, or latex.
• You should inform your doctor of any medications, vitamins, or supplements that you are taking or any conditions you have such as heart or lung disease.
• You may be asked to avoid medications such as blood thinners, aspirin, or anti-inflammatories for a specific period prior to surgery.
• You should refrain from alcohol or tobacco at least a few days prior to the surgery and several weeks after as it can hinder the healing process.
• You should not consume any solids or liquids at least 8 hours prior to surgery.
• You need to arrange for someone to drive you home after surgery.
• A signed informed consent form will be obtained from you after the pros and cons of the surgery have been explained.

Procedure for Hip Labral Augmentation

Hip labral augmentation surgery is a minimally invasive procedure in which an arthroscope, a narrow tube with a tiny camera on the end, is used to assess and repair damage to the hip labrum. The surgery is performed with the patient under general, spinal, or local anesthesia.

Your surgeon will make 2 to 3 small incisions around the hip joint area. The arthroscope is inserted into the hip joint through one of the incisions to view the labral tear. The camera attached to the arthroscope displays the image of the joint on the monitor. A sterile solution will be pumped into the joint in order to have a clear view and room to work. Through the other incisions specially designed instruments are inserted. The native labrum is debrided until healthy tissue is noted with stable margins to assist in labrum-graft healing. After this, the remaining intact tissue volume is evaluated to ensure adequacy for maintaining the suction seal. An arthroscopic burr is utilized to create a healthy bleeding bony bed on the acetabulum in preparation for graft placement to assist in graft-to-bone healing. An iliotibial band (ITB) autograft or allograft is then placed over the native labrum/area of labral deficiency and secured to the labrum with sutures. Your surgeon will test to ensure the graft is of the correct size, and the suction seal is regained or restored. After the completion of the procedure, the arthroscope and instruments are removed and the incisions are closed.

Postoperative Care and Recovery

In general, postoperative care instructions and recovery after hip labral augmentation may involve the following:

• You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anesthetic reactions and monitor your vital signs as you recover.
• Most patients may need to stay in the hospital for a day or two before being discharged home.
• You may notice pain, swelling, and discomfort in the hip area. Pain and anti-inflammatory medications are provided as needed for comfort.
• Antibiotics are also prescribed to address the risk of surgery-related infection.
• You will be placed on assistive devices such as crutches with instructions on restricted weight-bearing for a specified period of time. You are encouraged to walk with assistance as frequently as possible to prevent blood clots.
• Instructions on surgical site care and bathing will be provided to keep the wound clean and dry.
• Refrain from strenuous activities for the first few months and lifting heavy weights for at least 6 months. A gradual increase in activities over a period of time is recommended.
• An individualized physical therapy protocol will be designed to help strengthen hip muscles and optimize hip function once you are off assistive devices.
• Most patients are able to resume their normal activities in 3 to 4 weeks after surgery; however, returning to sports or high-intensity activities may take at least 6 months or longer.
• You should refrain from driving until you are fully fit and receive your doctor’s consent.
• A periodic follow-up appointment will be scheduled to monitor your progress.

Risks and Complications

Hip labral augmentation surgery is a relatively safe procedure; however, as with any surgery, there are risks and complications that can occur, such as:

• Infection
• Bleeding
• Failure to obtain pain relief
• Damage to blood vessels
• Nerve damage
• Blood clots or deep vein thrombosis (DVT)
• Anesthetic/allergic reactions