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Let's summarize and talk about the

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treatment of labral pathology in the hip.

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You've got to exercise caution on

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how you word the injury to any labral

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or fibrocartilaginous pathology.

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You know from doing MRI of the knee that

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most patients over age 50 are going to

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have some component of labral degeneration

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or meniscal degeneration or tear.

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These are often cleavage tears.

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In the hip, the same thing occurs.

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Signal increases in conspicuity

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and frequency as one ages.

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And that signal may then

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degenerate into a chronic tear.

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Most labral tears are chronic.

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And most of these tears can be treated

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conservatively through physical therapy.

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MRI has made the diagnosis of labral

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tears possible without having to use

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invasive diagnostic means arthroscopically.

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Physical therapists will perform an examination

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to determine range of motion in the hip

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and develop a care plan according to the

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patient's symptoms and the MRI findings.

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Now, young individuals who have a sudden acute

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catastrophic injury, such as falling on a flexed

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knee in slight rotation, often with people

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falling on top of them, would be one example.

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How you can drive the femoral

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head up and shear off the labrum.

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Most labral treatments involve

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repair, arthroscopically.

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Occasionally there's debridement and

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very rarely is there labral resection.

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Our surgical colleagues have gotten

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better and better at doing this

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with minimally invasive therapy.

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Most patients who have labral

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tears will have pain, especially

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when standing, but also clicking.

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Frequently, their flexibility and

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range of motion is inhibited.

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This is improved by physical therapy.

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Range of motion is also substantively

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inhibited in patients who have impingement,

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especially younger people with CAM type

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impingement and bump cyst complexes.

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Patients that have pincer type impingement,

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they have generalized arthritis and they're

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in so much pain, it's kind of hard to

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assess their range of motion, but their

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range of motion is decreased as well.

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A hip wrap can be used in

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patients with external rotation.

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It's kind of like an ace bandage that goes

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around the hip. And the hip is externally

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rotated to give the patient a healing period.

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And sometimes this is just a temporizing

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measure until the patient goes to surgery.

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But if surgery is necessary, as stated,

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it is now performed primarily using the

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arthroscope rather than an open procedure.

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In cases with bone deformities, it may be

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necessary to do more than just a repair,

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more than just a debridement of the labrum.

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You may have to do a femoroplasty,

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where you actually resect an area of

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asphericity at the bump cyst complex.

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We're learning more and more now that people

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with hip abnormalities, impingements, etc.,

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are often born with an abnormality

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that's very subtle, and then

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progressively impacts the labral status.

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In other words, developmental dysplasia of

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the hip may present in a 15, 20, 30, 40, and

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even 50-year-old with severe osteoarthritis.

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So, DDH, DDH. Developmental dysplasia of

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the hip has now increased in frequency

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as a diagnosis presenting in adults.

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That is my summary of treatment.