Labral Hip Tear with Impingement

hotlum wrote:

I figured this, but it is always good to hear from someone who has had the procedure. IF I have to get the FAI and potential labrum clean-up, the surgeon has years of these procedures in his background. 

Yes! especially since it is a more rare procedure it is nice to see what people have to say about it. If you want to ask any questions about it shoot me a PM I can answer whatever you want!

I've been following this thread for a while ever since the pain in my hip and lower back got worse. I opted for surgery after consulting a doc who said that my tear was never going to get better, and would likely lead to my quitting surfing/climbing within a few years if I didn't get the cam impingement + tear repaired. 

When they opened me up, they found a few full-thickness lesions in my cartilage. I was all blown out, and there were patches of bone-on-bone. I am not a boulderer, and I have never really had an extended period of high-impact sports in my life. (Though I did downhill skateboard for a while in high school.) 

Doc said I was the worst he'd seen at my young age of 26. They seeded the areas with a few thin patches of fresh cartilage, and deemed me "fixed." It is now up to me to not screw it up while the cartilage heals. 

I had to be on crutches for 8 weeks, CPM machine for 8 hours per day. I'm now on week 11 or 12 post-surgery, and am progressing through my PT + rehab. Lots of stretching (I should probably do more) and getting back to light activity like stationary bike and recently snorkeling. 

I think mine was a fairly extreme case among those who didn't ultimately need a total replacement. Feel free to ask me anything or DM me if you're on the fence, but ultimately you should go to an orthopedic surgeon who specializes in (edit: this particular hip surgery) and preferably someone who has experience with a wide range of cases within FAI and labral repairs. There was little to no sign of my cartilage damage on any imaging done, and I was surfing an amazing day the day before surgery. I knew I was in pain, but I didn't know I was 10/10 "worst [the surgeon] had ever seen." 

Point is, don't wait for treatment if you have pain that is not going away. If I had waited another year or two, I would have likely needed a full replacement at 28 years old. Cortisone shots are often only masking the symptoms of the root cause, and are really intended for those who, for whatever reason, need to perform through a short period and have to just get by.

It was a year ago that I saw an orthopedic surgeon about my hip pain and he gave me the wonderful news that, "no matter what you do, you'll need new hips in 5 years." I got a second opinion with the same verdict and cried. A lot. Not just because I was in constant pain and it was having a major impact on my quality of life but also because I was too young to entertain the idea of a total hip replacement. That's something 60-80 year olds have, not someone in their 30s. At one point I was convinced that having total hip replacements would mean the end of climbing (ha, fat chance). My issues were: FAI, mild-moderate osteoarthritis, and torn labrums on both sides, not to mention shit range of motion. 

Fast forward a year and I'm just over 4 weeks post-op from total hip replacement #2 (holy shit). It's been 9 months since my first one and the differences are amazing. I don't have intense pain in my groin, I'm not waking up in the middle of the night in pain, I can actually open my hip and reach that hold waaaaaay out there without having to do some janky contortion moves with my body, I can keep my body closer to the wall...the list goes on. In fact, I finally sent my nemesis 5.11c that required a very precise foot placement. I couldn't do it before surgery cuz my foot kept popping, but now that I have this new ROM, I tried it again and this time I stuck the move and sent the route.

I'm still a few weeks out from being allowed to climb again, but I can't wait to see what happens! Overall, I second everyone who said not to wait to get yourself fixed. Living in pain isn't worth it. 

Cheers!

Adding to what Jordan R said since I've had both a labrum repair and hip replacement now. The recovery from the (direct anterior) hip replacement was remarkably faster than the arthroscopic labrum repair.  There was immediate pain relief. With the labrum repair, I had to retrain my hip stabilizers to get fine motor control back. With the hip replacement, I had only minor discomfort from swelling; I was hiking again with trekking poles in 2 days and doing up to 19 mile day hikes within 6 weeks.  Now I'm climbing again.

@A V I didn't end up using Nicolas Mast b/c his scheduler was procrastinating in getting insurance pre-approval, but a close friend with complicated hip anatomical issues had a successful double replacement with him.  I think the scheduler was reprimanded after I escalated it, since I received a written apology.  He's a competent surgeon, one of the few in the country very experienced with the direct anterior approach, and will work with people outside of insurance.  I ended up using a SLC-based surgeon that trained with Mast's mentor, and he spoke highly of Mast. There's some info on his site about cash options.  Good luck and sorry about the insurance situation.  The healthcare/insurance situation in the US is not optimal.  

p.s. Some of the orthopedic surgeons require a specific hip view for x-rays to properly size/configure the hardware. To avoid having to get another set ask first.

I had this same surgery (labral tear and impingement) and have recovered/ have no issues. If you have any questions feel free to PM me. The surgery was athroscopic (sp). I was on crutches for a few months with about 6-7 my months of PT. Went back to running that next summer (slowly) and now it works better than my right hip. 

Cheers and good luck 

Im a doctor and had FAI surgery 10yrs ago. Basically you should stop all high impact stuff, and movements that aggravate it. You are guaranteed  to develop OA and need a hip replacement at some point, which you want to delay as long as possible. The FAI might buy you 10yrs or so ( mine just started playing up again this year) Interestingly the evidence for surgery is quite equivocal, esp after 35 or so. Even physio / stretching doesnt seem to help , its a pretty nasty disease process and one that hasnt wasnt really recognised/treatable until after the 2000s with the advance in arthroscopic hip surgery. When you need a hip replacement , opt for the direct anterior approach. If in SLC , dr stephen Aoki is the guy for FAI and Chris Pelt UU for the direct ant approach

Mowgli Wogliwrote:

Im a doctor and had FAI surgery 10yrs ago. Basically you should stop all high impact stuff, and movements that aggravate it. You are guaranteed  to develop OA and need a hip replacement at some point, which you want to delay as long as possible. The FAI might buy you 10yrs or so ( mine just started playing up again this year) Interestingly the evidence for surgery is quite equivocal, esp after 35 or so. Even physio / stretching doesnt seem to help , its a pretty nasty disease process and one that hasnt wasnt really recognised/treatable until after the 2000s with the advance in arthroscopic hip surgery. When you need a hip replacement , opt for the direct anterior approach. If in SLC , dr stephen Aoki is the guy for FAI and Chris Pelt UU for the direct ant approach

Dan, do you mean anything high impact should be discontinued even after receiving what looks like "successful" surgery? I had a pretty good lesion in my cartilage, but was pretty gentle during the healing process, and have continued PT since surgery (now at about month #7). 

I've been undecided about bouldering, or anything that could lead to a ground fall. Doc advised against it, but I wasn't sure if that meant avoidance for life, or just during the year or two it would take to get cartilage back. I am definitely much more cognizant of the potential costs long-term: Do I really want to try to ollie that random gap? Do I really need to do this woodson problem right now as a boulder problem? Probably both, "No," even though I'm still 26.

hotlum wrote:

I'm at 3 months post operation... by all accounts the surgery was a success. I had the impingement addressed by shaving a bit of the femoral head at the impingement area, bone spurs removed, and large labrum tear repaired. All of the dysfunction in my glutes and hammys will take dedication to get back to normal, but the joint itself feels as fluid as ever.

At my 12 week post op with the suregon I was told that activities that require chronic hip flexion past 90° should be avoided as much as possible going forward. A high step here and there won't be the worst for it, but I definitely see more pure crack climbing in my future rather than Smith style vert sport. He said bouldering is basically off the table. 

I'll probably start climbing again at 4 months, but will be pretty easy on myself until I get my flexors strong again.

Interesting re:the part on limiting flexion. Is that for as long as you want to keep the hip working + minimize pain? I didn't get back to gym climbing (still TRing on plastic only) until about 7 months post-surgery.

I was just told to minimize impact going forward, so no bouldering. I'm still rebuilding my base of friends to climb with, since most of that network collapsed during the dispersion of everyone during the pandemic, combined with my inability to really participate over the better part of last year.

What did y’all’s hip labrum tears feel like? I have been experiencing intense pain in the groin after climbing. I’ve had an inguinal hernia before and this does not feel like that. The more I lift my leg at the hip especially with flexion or abduction or external rotation (outward rotation) the more it hurts. It hurts day to day but after climbing is when it really hurts. There is also a “catch” for lack of a better description. It feeels like something (tendon? Bone?) gets caught on something deep in the joint and catches for a moment before sliding past or releasing. That is intensely  painful and happen when I sleep most often. This has been progressing for 8+ months. I thought initially it was tendinitis in an inguinal tendon or a sports hernia, or actual inguinal hernia, but now I’m not so sure.

I've got an appointment this week to look at it, but it seems like it could be several things and maybe consistent with some descriptions of a hip labrum tear. It’s really been bumming me out because climbing really sets it off and makes it hurt the most of pretty much any activity I do.

csproulwrote:

What did y’all’s hip labrum tears feel like? I have been experiencing intense pain in the groin after climbing. I’ve had an inguinal hernia before and this does not feel like that. The more I lift my leg at the hip especially with flexion or abduction or external rotation (outward rotation) the more it hurts. It hurts day to day but after climbing is when it really hurts. There is also a “catch” for lack of a better description. It feeels like something (tendon? Bone?) gets caught on something deep in the joint and catches for a moment before sliding past or releasing. That is intensely  painful and happen when I sleep most often. This has been progressing for 8+ months. I thought initially it was tendinitis in an inguinal tendon or a sports hernia, or actual inguinal hernia, but now I’m not so sure.

Yep, that's the kind of pain I had when my labrums were shot. Kinda like something in my hip/groin area was "catching" when I was in a certain position and when I moved through it, it felt like it snapped free. That was extremely painful, but then the pressure (for lack of a better term) I felt in the joint would settle down. I think I know when I tore my left labrum...I was really cranking on a heel hook (which I almost never did because of the FAI and limited mobility in my hips) and suddenly had intense groin pain. It hurt like hell for days but eventually became a dull everyday ache. Activity (biking, climbing) caused the issue to flare up and then it would bother me for days and wake me up at night. Get to the doctor!

Sigh, doctor said a hip labrum tear is likely. He ordered an MRI, so I guess I’ll hopefully find out for sure after that happens.

Yes, I would avoid all high impact as much as possible, but I understand the Adrenalin rush might be needed for sanity , articular cartilage rarely grows back thou .(Avascular) Glut Medius gets turned off really easily so a good physio like the Uu ortho centre. (“Physio is for life”) Stretching doesn’t really help. 26 is well young to get it!  Surgery has better results the younger you are thou. Btw labral tears are mostly asymptomatic, it’s not like tearing a knee meniscus. 

csproulwrote:

Sigh, doctor said a hip labrum tear is likely. He ordered an MRI, so I guess I’ll hopefully find out for sure after that happens.

Well, it is a torn labrum. Unfortunately it is also accompanied by arthritis. The Dr told me that this makes labrum repair far less likely to relieve the symptoms, and that ultimately a hip replacement is probably in the cards…just a matter of when. He recommend trying cortisone shot to the hip joint and see if it gives enough relief to prolong things until I eventually need a hip replacement. Doesn’t seem like a great plan to me. I’ll probably try the cortisone shot while I get a second opinion on whether I should try labrum repair or go straight to a hip replacement.

I too have labrum tears (both sides) with arthritis and am now pushing 50.  I discussed with the doctors and they all agreed that, assuming an eventual hip replacement, there is generally no permanent damage done by postponing as long as pain allows.  This has been my general approach: carry less heavy haul bags (get a super strong partner!) and just keep grinding it to dust until the pain becomes unbearable..then replace the hips.  I've heard nothing but great things about the quality of modern hip replacements. 

Hi everyone,

I posted in this thread last year when my wife got hip arthroscopy on her left hip. It was really helpful hearing everyone's experiences. She's recovered relatively well though her other hip has started bothering her now too, as such she hasn't been that psyched to get back into climbing.

Unfortunately, I started having similar symptoms in both hips over the past few months. An initial xray revealed the classic "cam & pincer" structure and my MRI result, which I just got this morning, shows significant labral tearing and a bone cyst, which could be indicative of damage to the hard tissue underneath the labrum. The doctor said its likely that the damage occurred over a long period of time, which is interesting given that I've never had any problems in the past. Fortunately I'm still able to climb relatively pain free but given the potential damage to the hard tissue its something that I will probably get taken care of soon.

For those of you who have had this surgery, how was your return to climbing? What kind of time frame is realistic? Were you able to make a full-return or are there certain things you definitely can't do anymore? Any information would be much appreciated, trying to maintain some motivation. Thank you. 

Phil Awrote:

For those of you who have had this surgery, how was your return to climbing? What kind of time frame is realistic? Were you able to make a full-return or are there certain things you definitely can't do anymore? Any information would be much appreciated, trying to maintain some motivation. Thank you

I was doing extremely cautious outdoor TR at 6 weeks, with very limited internal rotation and high stepping. Schlepping a pack and climbing ice on TR with most of my hip function at 3 months (although ice climbing has more predictable/limited movement than rock). I didn’t start bouldering again until probably 7 months, and leading was about the same. Might have been possible to start earlier, but I was being conservative. 8 months til I did a big alpine day, but even 18 months later, I’m still having issues on real big enduro days.  

With 2 of my 3 labrum surgeries, I got almost full range of motion back. With my last surgery, I lost a meaningful amount of high-stepping and general mobility, but (as a middling climber) it hasn’t impacted my climbing that much. 

Hopefully not too drifting too much here. Lots of discussion of surgery above. I've got something going on in my left hip, but probably won't ever get an official diagnosis unless I'm completely crippled by it. Running up and down lots of vert for many years probably doesn't help... I get shooting pains when stemming hard or holding my legs at a funny angle for extended periods (driving, sitting), I've been doing light yoga for a few years with my wife to try and address this but now and again it can cause flair ups.

How has PT worked out for folks? Sounds like muscle balance is really crucial whether or not electing for surgery. 

I've been making a concentrated effort to strengthen glutes and carefully develop a bit more strength at end range in my hip. Anyone else have similar experience to share in this realm?

Alyssa Kwrote:

I was doing extremely cautious outdoor TR at 6 weeks, with very limited internal rotation and high stepping. Schlepping a pack and climbing ice on TR with most of my hip function at 3 months (although ice climbing has more predictable/limited movement than rock). I didn’t start bouldering again until probably 7 months, and leading was about the same. Might have been possible to start earlier, but I was being conservative. 8 months til I did a big alpine day, but even 18 months later, I’m still having issues on real big enduro days.  

With 2 of my 3 labrum surgeries, I got almost full range of motion back. With my last surgery, I lost a meaningful amount of high-stepping and general mobility, but (as a middling climber) it hasn’t impacted my climbing that much. 

Thanks Alyssa, thats encouraging to hear. I think my wife wasn't allowed to start walking for more than a mile until around 3 months, I'm glad you had a quicker recovery. They had to shave away part of the bone though so maybe that's made it more drawn out. May I ask what your diagnosis was?

Phil Awrote:

Thanks Alyssa, thats encouraging to hear. I think my wife wasn't allowed to start walking for more than a mile until around 3 months, I'm glad you had a quicker recovery. They had to shave away part of the bone though so maybe that's made it more drawn out. May I ask what your diagnosis was?

They shaved off some bone, but I don’t know how much — I guess I got off easy. I had the labrum repaired + capsular plication + cheilectomy. Diagnosed with the torn labrum, hip instability, and hip dysplasia. 

hotlum wrote:

In my case, I really stuck to the guidance given to me by the suregon and my PT. I did some easy TR at week 12 and the crux was the hike down to the main area at Smith. I was definitely sore at the end of the day... A week later I was TRing 5.9 and got a lead in on 5.8. Im at week 18 now and feel like I could push onto 5.10-, but the weather has been wet and I'm stuck behind a computer (hence all the MP time). Honestly, I think my mental is holding me back. I really don't want to push anything. 

I did have a little bone work done. The labrum had a straight forward repair as far as stitching it back together. No microfracture or introducing of cadaver soft tissue needed. Week 12 was the time given to me to pick back up on prior sporting activities at lower levels. I was told to wait until week 16 to do any type sport/activity specific training. Month 6 is when I should feel comfortable to go full bore. I don't think that is universal, that is just what my time frame is/was. 

Thanks for sharing. That's also an encouraging recovery time, though I'm sure it feels longer when you are the one going through it. From your posts it seems like we have a similar situation, the doctor says my hips have probably been messed up for a long time though for some reason they just started flaring up recently. Luckily climbing and hiking is still alright with some modified beta, thought the thought of potentially being "bone on bone" and messing it up more scares me.

And yeah, the mental crux of returning to sport after seems the most daunting to me, so I'm glad to hear you are back to leading. :)