THR for labral tearing, no arthritis?

[HipBossGal]

Hi

I've been lurking here on/off for a while. What a great resource!

I really want to know if there are/have been others on the same path. My situation seems somewhat unique.

I developed hip pain 7 yrs ago. Started as deep achiness & butt pain. Left. I'd been working a lot, thought: exercise! Stretch! I did, and it just got worse. Hurt like hell every time I rose from standing.

Then one day I woke up with severe sciatica. Severe! Of course this led to a diagnosis of a disc problems & it was months for that to recover. But the whole time I kept saying: what about my hip? Was told that I was lucky it wasn't my hip haha.

Back got better (but now I was a delicate creature lol). Hip...worse. That catching pain got horrendous & an MRI diagnosed labral tear. Scope in July 2012. Easy, successful in that the catching pain was gone. But I've had few pain free periods since.

Several cortisone injections. 50/50 results with those.

A year ago, newer, worse pain. MRI in September diagnosed another small tear. I have seen it on the slides & it's tiny. When I went for my 1st xrays in 3 years, I was sure I must now have arthritis. I don't have much "good joint space" "not a hip we would typically replace" are words I've heard. And yet, I'm heading for it.

Yes everything non-invasive helps a little. Ice. Pills. The NSAIDs bother me a lot now after I abused them in 2011/2012. I have to take an acid med with them.

I am 5-6 wks post PRP. Can't say it's helped, tho doc says give it 8 weeks. I've never taken painkillers & I don't want to. Prospect of taking pills rest of my life...not appealing. I could probably find someone to scope me again. But I'm 56 and a recurrent tearer: I'm not a great candidate.

It's been troubling me that I have a tear that's about the size, maybe, of a pencil eraser (if that!) Wreaking so much havoc & leading to replacement of the whole (decent) joint. Surgeon says it's like walking the rest of my life with a pebble in my shoe... Not gonna get better. May in fact get worse.

My pain is low to moderate but persistent. If I have to walk a lot however I'm in trouble. Gave up hiking & skiing. I have a lot of muscle imbalance from years of (probably) walking slightly funny. I do not have the catching pain now but don't want to wait for that! I am able to work & do basic stuff, range of motion fine. I do spinning. Pain varies, but I never have pain free. Disturbs my sleep often.

If I had arthritis, THR would be a no-brainer! Since I do not and it's only a tiny tear, a fear that I have is that I go through with the THR and it does not relieve my pain! And yet I pretty much know it will.

My scope in 2012 revealed a lot more than what showed on the MRI. Synovitis, a torn labrum there which was removed. I find myself wanting to ask the surgeon for pictures of the problem to validate the surgery.

Just wondering if there are others who traveled a similar path. I'm sure many others have had various doubts about whether or not THR is the right solution. I feel like I don't really have any options.

Thanks for listening
HipBossGal

 

[djklaugh]

@HipBossGal Welcome to BoneSmart! I'm not a medical person so I'm going to tag @Josephine who is both the Admin here and our orthopedic medical expert. She most likely can best address your concerns and questions. She is in the U.K. so it maybe a bit of time before she sees this. I'm sure there are others here who will chime in

 

[Josephine]

If I had arthritis, THR would be a no-brainer! Since I do not and it's only a tiny tear, a fear that I have is that I go through with the THR and it does not relieve my pain! And yet I pretty much know it will.
I'm sure many others have had various doubts about whether or not THR is the right solution. I feel like I don't really have any options.

HBG, you are outlining concerns and then answering them yourself! So I take it that your overall question is, should you or should you not have a hip replacement? Once you clear that out of the way for me, I can give you some observations!

I have a tear that's about the size, maybe, of a pencil eraser

This really isn't a god indicator - in my lifetime I have used erasers in a range that that starts from 65mm in length (bottom one!) so it doesn't tell me much!

But on a more serious note, since you have now suffered two labral tears, I would suggest that you must have some degree of arthritis in your hip joint and are therefore a good candidate for a replacement. I can also assure you that a replacement will resolve the pain you are experiencing completely. I suggest you read this to better inform yourself of the issue Femoro-Acetabular Impingement (FAI).

I would also say that in my career, I've known people have minimal evidence of arthritis yet be in excessive pain while others who have gross arthritic changes declare very little pain. A very strange phenomenon but proves that one cannot go on xray/MRI findings alone.

So I'm going to leave you with a scoring chart to help you assess your pain and see if it warrants surgery. The results are for you only so there will be no point in you recording them on this forum.

 

[HipBossGal]

Thank you @Josephine .

I know it's my call about THR; I was more wondering if anyone else here has had a similar experience.

Lol true on the eraser. Let's say a pea.

As for arthritis, docs have looked at my xrays in the past year and say they look remarkably good considering. My unaffected hip does look better, they say, but they've shown me nice bright white space in both hips. Good to know there isn't always a correlation between pain levels & degree of damage.

I have not been diagnosed with FAI. I have a very mild dysplasia but neither surgeon I've consulted with thinks that's the reason for the tearing.

Ultimately yes by any measure I have some limits & pain, not the worst, but unresolved for years. And I'm sick of dealing. So...most likely THR in the fall.

Thanks again

 

[Josephine]

Jolly good!

 

[MobileMel]

I am not medical, but I am suffering from a labral tear since early February 2018. I would say to go through with the replacement, especially before your pain worsens. My tear started out very painful, but I noticed about 4 weeks ago for about a couple of weeks, I felt that the pain was more bearable, persistent, but not as excruciating. I gained no extra mobility during this brief "respite". You mentioned that you have mild dysplasia, as do I. In my case, my surgeon told me the tears would just continue as the joint is not in the right position. Currently, the pain is at a new level. I am counting the hours until my new hip. I wouldn't wish anyone to wait until they got to this point if they could plan and avoid it. I was diagnosed with dyplasia of the left hip about 6 years ago, but I had to start from ground zero in February in searching for a surgeon who could help me with more complete imaging and diagnostics. This took months between consultations, so I just encourage anyone on the fence to have their plan in place before things take a turn for the worse. I was just diagnosed with Bilateral dysplasia, which really derailed me mentally, but I can guarantee that the when my right hip starts limiting me in anyway, I will be scheduling its replacement right away. I also had NO evidence of arthritis until my tear. Now I have moderate OA. Hope this helps.

 

[HipBossGal]

Thx @MobileMel

Yes my first tear went from bad to excruciating pretty quickly. This one, really has varied since arising about a year ago. But I'm aware if what can happen.
I'm right now awaiting the requisite time my Dr suggests to see if the PRP injection helps .Honestly maybe 5% improvement? Not enough.
I'm seeing the surgeon within a month and I believe I'll set a date.

 

[Bull76!]

I initially had a torn labrum, surgery resolved the pain and I was back to normal and active life, then 6 yrs later back even more pain and limited movement. Cortisone injections did nothing surgeon said I was too young for a THR. But would do the arthroscopic surgery as we have many options.

Turned out my hip and cartilage was in worse condition than the first one. Xrays didn't show this and an MRI showed some extra damage. I've been in pain since the last arthroscopic surgery, was advised pain mitigation. I got a second opinion which turned out to be my best course of action. Advised I needed a THR if I wanted rid of the pain and a normal life.

If you need a THR then get it, life is important, enjoy it when you can and not when someone else thinks you should.