Failed Hip Arthroscopy

The hip labrum is a ring of cartilage that surrounds the hip socket, providing stability to the joint. The hip labrum plays an important role in maintaining normal hip function. It functions to tighten the seal between the bones for joint stability, allows for a wide range of motion, and helps to maintain the alignment between the bones.   A hip labral tear occurs when this cartilage is damaged or torn, often due to a hip injury, degeneration, or FAI. This tear can lead to a range of symptoms, including hip labrum pain (groin pain), clicking or catching sensations, and a decreased range of motion.

The hip capsule is a crucial anatomical structure that provides stability, protection, and lubrication to the hip joint, enabling smooth and controlled movement of the leg while also preventing excessive motion and potential injuries. The hip capsule, also known as the acetabular capsule, is a fibrous, ligamentous structure that surrounds and stabilizes the hip joint. It consists of strong connective tissue and ligaments that form a capsule-like structure around the ball-and-socket joint of the hip. The functions of the hip capsule include:

Joint Stability

The hip capsule plays a crucial role in maintaining the stability of the hip joint. It helps keep the head of the femur securely within the socket of the acetabulum. This stability is important for weight-bearing, movement, and activities such as walking, running, and jumping.

Lubrication and Nutrition

The synovial membrane lining the inside of the hip capsule produces synovial fluid. This fluid lubricates the joint, reducing friction between the articulating surfaces and ensuring smooth movement. It also provides essential nutrients to the cartilage within the joint, helping to maintain its health.

Joint Protection

The capsule acts as a protective barrier for the hip joint, helping to shield it from external forces and injuries.

Limiting Excessive Movement

While allowing for a wide range of motion, the hip capsule also limits excessive movement of the joint, preventing dislocations and maintaining joint integrity.

Proprioception

The ligaments within the hip capsule contain sensory receptors known as proprioceptors. These receptors provide feedback to the nervous system about the position and movement of the hip joint. This information helps with balance, coordination, and posture.

Re-injury to the hip labrum or hip capsule following hip arthroscopy can occur for a variety of reasons. Most commonly, patients may recall a trauma or injury in which the operative leg was forced into either an extreme degree of extension or external rotation. Additionally, failed hip arthroscopy can occur due to the presence of pre-existing risk factors such as hyper-laxity (Ehlers Danlos syndrome), untreated hip dysplasia, osteoarthritis, or a degenerative labrum.

Symptoms of a failed hip arthroscopy include:

• Intermittent deep groin pain or ache (most common)
• Pain at the outside of the hip joint
• Sharp stabbing pain when twisting, turning, or squatting, such as when getting in or out of a car or a chair.
• A dull ache from prolonged sitting or walking
• A sensation of catching, clicking, or locking in the hip joint during movement
• Instability of the hip joint
• Stiffness and reduced flexibility in the hip joint
• Limping

During your consultation with Dr. Jorge Chahla, a Chicago sports medicine surgeon and FAI specialist, your medical and surgical history, FAI symptoms, and past injuries will be reviewed. It is highly recommended to bring all records from your previous FAI surgery, including the operative report, any surgical photos, and any subsequent imaging, to your consultation with Dr. Chahla, as this information can be very helpful in the diagnostic process.

Physical Exam

He will conduct a physical examination checking range of motion including flexion, adduction, and rotation to diagnose your hip impingement. The hip impingement test will also be performed during your physical exam. This is a test in which Dr. Chahla will ask you to bring your knee to your chest while Dr. Chahla rotates the knee in toward the opposite shoulder (FADIR [flexion, adduction, and internal rotation]). If the hip impingement test causes pain, you likely have a hip labral tear.  A comprehensive physical exam is key to determine the cause of your hip pain.

Imaging

Diagnostic imaging is necessary to definitively diagnose FAI and a hip labral tear.  X-rays will reveal abnormally shaped bones, and an MRI will reveal damage to the soft tissue, such as a re-tear of the labrum or an injury to the hip capsule. A CT scan may be necessary to further evaluate details about the shape of the bones, location of abnormal bone growth, and the rotation of the bones that may have contributed to the re-injury.

Hip Injection

An intra-articular hip injection can help to confirm the diagnosis of a failed hip arthroscopy. This injection will be performed in the office at the time of your office visit under ultrasound guidance. If the majority of your pain goes away, even temporarily, following the injection, then it confirms that the source of the pain is due to a possible re-tear of the labrum or capsular injury.