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Panorama Orthopedics & Spine Center has been a trusted provider of orthopedic care in metro Denver for more than 70 years. With more than 30 orthopedic surgeons, we are one of the largest and most specialized orthopedic groups in the United States and are known as a leader in orthopedic care. We offer highly trained surgeons and
specialists in sports medicine, spine, joint replacement, orthopedic trauma, foot and ankle, hand and wrist and non-operative pain management. We are committed to excellence in everything we do. That’s why patients of all ages — from children to seniors — trust Panorama Orthopedics to help them get them back to doing the things they love.
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Student and patient of Dr. Patel

Hip Arthroscopy

When most people think about hip pain, they think of old age and arthritis, but hip pain can happen in younger, active people too.

Hip pain in younger people can be caused by a labral tear. Unfortunately, those who have this condition often go undiagnosed or misdiagnosed for an extended period of time. Individuals with a labral tear usually have pain in the front of the hip or groin, and often times they are diagnosed with a muscle pull or a groin strain that doesn’t get better with rest and anti-inflammatory medication.

Some young or middle-aged athletes may be predisposed to labral tears, based on the repetitive motion of their activity or sport, including: runners, tri-athletes, volleyball, soccer and hockey players as well as gymnasts and dancers. Labral tears are common; in fact, studies show that 67% of all teenage athletes have a labral tear and 93% of youth hockey players have a labral tear in the hip. Fortunately, not everyone with a labral tear has pain or symptoms that need treatment, but when young, active athletic individuals do have pain in the hip there is help available.

Some of the common symptoms of a labral tear can include:

  • Pain in the front of the hip or groin that gets worse with activity or motion
  • Decreased range of motion in one hip, when compared with the other
  • Pain often gets worse with sitting for long periods of time
  • A locking or catching sensation in the hip
  • Difficulty putting on socks or shoes
  • Pain that does not get better with physical therapy

Michaela's Story of Bi-lateral Labral Repair

What causes a Labral Tear?

The hip is a ball-and-socket joint, where the upper end of the femur (the ball) fits into the acetabulum (the socket), which is part of the pelvis. The labrum is fibrous tissue that lines the socket, protects the underlying cartilage, and provides a suction seal between the ball and socket joint.

Problems can arise when the ball and socket don’t fit together properly, leading to labral tears or cartilage damage in the hip joint. Femoroacetabular impingement or FAI as it is commonly called is often the culprit behind a labral tear.

This type of impingement happens when the ball doesn’t fit quite right in the socket and repetitive motion or extended motion in the hip joint causes the bone to bump or “impinge,” with the labrum pinched between the bones thereby causing a tear in the labrum.

Over time, if FAI is untreated, it exposes the cartilage in the hip joint to excessive wear and tear, which starts the process of arthritis as you age. Untreated hip pain caused by impingement or a labral tear can lead to arthritis, so it is important to address the underlying cause of hip pain. While it is important to note hip arthroscopy is not used to treat arthritis, it can be an important tool in preventing it.

Diagnosing Your Hip Pain

Diagnosing a labral tear can be quite difficult. On average, it takes individuals with this condition almost two years to get an accurate diagnosis. On their journey to find answers, they will usually see three or more providers before getting a definitive diagnosis of a labral tear and FAI.

Why does it take so long to get answers? The anatomy of the hip is complex and there are 27 different muscles that cross the hip joint. Individuals can have referred pain that originates in the lower back, spine or SI joint that radiates to the back of the hip also known as posterior pain, may have pain that is stemming from the spine. Pain on the outside of the hip, or lateral hip pain, can stem from muscle strains or bursitis. True hip pain that is coming from the hip joint, like in the instance of a labral tear, is typically felt in the front of the hip.

When active people have pain coming from inside the hip joint there are a number of things that we are able to do to accurately diagnose a labral tear and impingement. First, we are able to take x-rays that show unique views of the hip joint.  These views can highlight subtle bone abnormalities that would not otherwise be picked up on standard x-rays and can help diagnose FAI, which is the most common cause of a labral tear.

Because labral tears do not always show up on a standard MRI, we use a special type of imaging study called an MR Arthrogram to get a deeper look. With this, a numbing medication is injected into the hip along with a contrast/dye, then an MRI is performed.  This allows the doctor to see the detail of the structures within the hip, including the cartilage and the labrum.

Before  any type of surgical intervention would be recommended, the doctor would first use diagnostic injections to determine where the pain is coming from. By injecting the painful hip joint with a pain-relieving medication we are better able to tell where the pain is coming from.  If the patient experiences relief from the injection we can suspect the pain is coming from a labral tear inside the joint. If the pain does not resolve with an injection, however, it is likely that the pain is originating from outside the joint and further testing may be required. In either case, the doctor would initially attempt to treat hip pain without surgery first, usually with physical therapy, injections and anti-inflammatory medications.  If the patient does not get pain relief from these measures, surgical treatment may be necessary.

Meet Dr. Ellman

Dr Ellman on Labral Tears and FAI

The Panorama Difference - Surgical Expertise

Hip arthroscopy is a technically demanding field within orthopedic medicine. Doctors who are the best at diagnosing and treating hip pain in young, active individuals are those doctors who specialize specifically in hip arthroscopy. Because repetition breeds excellence, these are the doctors who have the best outcomes when treating patients with hip pain. Many orthopedic surgeons who specialize in sports medicine may dabble in performing an arthroscopic labral repair.

These doctors on average may perform a few of these surgeries a month or even a year. At Panorama Orthopedics & Spine Center, Dr. Ellman was trained in hip arthroscopy by one of the most prestigious and well knows experts in the field of hip arthroscopy, Dr. Marc Philippon, Director of Hip Research at the Steadman Philippon Research Institute in Vail, Colorado. Dr. Ellman is an expert in this area and performs hundreds of these surgeries a year.

Hip Arthroscopy - What to Expect

Your doctor may recommend hip arthroscopy if you have hip pain that has not responded to nonsurgical treatments, including rest, physical therapy, medications and injections.

Hip arthroscopy is a minimally invasive surgery. This means the entire procedure is completed with only two or three 1 cm incisions. This speeds the recovery time and minimizes any scarring. Through these small incisions, the doctor is able to reshape any bone to eliminate FAI and repair or reconstruct the labrum.

“My philosophy is to preserve your own tissue whenever possible, “says Dr. Michael Ellman. In greater than 90% of cases, Dr. Ellman is able to repair the patient’s torn labrum.

When the quality of the labrum is just not good enough for a repair, Dr. Ellman will remove the existing labrum and replace it with a new labrum to provide cushioning in the joint.

After surgery, you’ll be up and moving right away. Patients are usually on crutches for approximately three weeks following their procedure. The surgery has a very high success rate, and most people return to full activities, including athletics, within four to six months.

If you’ve suffered from ongoing hip pain that hasn’t responded to physical therapy or other treatments, you may be a good candidate for hip arthroscopy.

Hip Arthroscopy Team