Treatment
of hip labral tears are a fairly new (and controversial) topic in the
world of orthopedics. Somewhere between 20-50% of hip and groin pain in adults
is caused by hip labral tears. The current conversation mostly revolves around the
balance between invasiveness and recovery time. In my opinion, the procedure is
dependent on the patient.
I
am in a unique position in which I can compare both methods from personal
experience. In September of 2018, I underwent an arthroscopic hip labral repair
for an acute anterior labral tear in my right hip, in which the surgeon first
shaved off the bone spurs on my femoral head and then reattached my labrum to
my acetabulum. I was cleared to play 7 months later.
In
June 2019, I was diagnosed with a similar labral tear in my left hip. This time
I consulted a doctor that specialized in non-surgical orthopedic techniques. He
suggested a platelet-rich plasma injection that would hopefully kickstart my
own body's healing process. Although it wouldn't heal my labrum entirely, the
injection would ease my symptoms enough to allow me to play through the season.
During
the outpatient procedure, I first had blood drawn from my arm which was
centrifuged to isolate the plasma. The medical assistant then added calcium
chloride to initiate the release of growth factors
from the platelets, and then that solution was injected directly into my hip joint
using ultrasound imaging. The whole process took less than an hour, and I
walked out of the appointment with no assistance (albeit a slight limp). I
was cleared to play 6 weeks later.
At first, the pain improved. This relief unfortunately only
lasted a few weeks until my symptoms returned in full force. So, I am meeting
with my surgeon soon to schedule my second hip surgery to repair my labrum once
and for all.
Between
the two procedures, my outcome was better
after hip arthroscopy. However, I trust the evidence that there are instances
in which PRP has been very successful. I wish I had been one of those for whom PRP
could have been a miracle cure, but I have full confidence that I will have the
same success in my left hip after arthroscopic labral repair as I had in my
right hip.
Kraeutler, M. J., Garabekyan, T., & Mei-Dan, O. (2016). The use of platelet-rich plasma to augment conservative and surgical treatment of hip and pelvic disorders. Muscles, ligaments and tendons journal, 6(3), 410–419. doi:10.11138/mltj/2016.6.3.410
A friend of mine recently had both of her hips done via this surgery you describe and her recovery looked pretty painful. I had never heard of this non invasive procedure before, and find it pretty promising, but maybe not for tears as bad as yours? I read that PRP is for tissue regeneration, but if a muscle is torn I don't think that enough regeneration can take place quickly enough to "heal" you. I'm sure it also depends on the muscle, but considering the human body and the force put on the hips, the labral provides stability to the hip joint thus providing stability to your entire stance. Given you already had the invasive surgery once, I can't blame you for trying out another option before deciding to go back under the knife for the other side. And you did feel better, until you absolutely didn't, which is promising for people who maybe have less strenuous tears or tears that aren't affecting the stability of major bone structures.
ReplyDeleteThank you for your share and experience. Are you playing soccer or volleyball? I naturally assumed soccer, but my friend who had both her hips done is a volleyball player, both which require much squatting and movement which can really aggravate those muscles and joints.
Ya I think it might be a great option for people who just want to ease pain in their daily lives. I play volleyball, and I think that is why it didn't really work for me. I put a lot of stress on my hips by jumping and twisting so much every day. If I didn't play sports, I think I might have been happy with PRP! The goal was not really to heal it completely, but to really just reduce inflammation, which would have maybe kept my labrum from being pinched every time I go into flexion. I'm definitely looking forward to how this procedure develops in the future though!
DeleteAs a person who has also torn their labrum (shoulder not hip) I can relate to some of the struggles associated with the surgical repair. However, a hip repair is much more severe, and I can imagine a much more difficult recovery. The idea of PRP had me really intrigued. Although, I have never had a PRP injection I have had a cortisone shot in my back my freshman year of high school. I received this shot after breaking my back and still had pain associated with it even after the break was healed.
ReplyDeleteThe doctor recommended a cortisone shot to help reduce inflammation. A cortisone shot works by injecting corticosteroids that mimic the effects of hormones produced naturally by the adrenal glands. It is said that this injection can aid in the reduction of swelling as well as decrease pain. I guess I never realized how similar the two injections were, one was using platelets and other artificial hormones. Similar to your case, the injection seemed to have no positive affect on me. In fact, it had the opposite effect, it triggered severe reactions.
After receiving the shot, I found out I was allergic to the corticosteroids, prednisone. This caused me to react with vomiting, tingling sensations in my limbs as well a condition called Red Man Syndrome. So not only was my back still in pain, but I was also cascaded with many secondary reactions. I would have to agree with your statement and have surgery rather than synthetic injections which seem to have no real benefit.
References:
Prednisone and other corticosteroids: Balance the risks and benefits. (2019, October 9). Retrieved October 11, 2019, from https://www.mayoclinic.org/steroids/art-20045692.
Yikes, sounds scary!! That's one positive thing about PRP, it's all products that have been derived from your own body, so that would definitely decrease the odds of having some bad reaction to it! It's interesting that it didn't reduce your pain either, that was another thing that I was considering to get me through season. I decided against it because it wouldn't help my healing process at all, just mask pain. I also had the thought that maybe the pain was something I didn't want to mask entirely, just in case I was making my injury a lot worse without realizing it! Maybe it wouldn't have worked at all though!
DeleteThis is a very interesting post. The person who nannies for me has a husband who is waiting for hip surgery. They administered a shot of corticosteroids to ease his symptoms, but then they said they had to wait months to schedule the surgery because he just had this shot. It was extremely frustrating to them because if he had known that taking the shot would delay his surgery, they wouldn't have done it. My question here is this: can this method be used as a way to mitigate pain while a person is waiting for hip surgery? If they are using the patient's own platelets, there might not be any contraindications and it might temporarily relieve discomfort. Corticosteroids are also used to temporarily relieve pain, so maybe this would be another option?
ReplyDeleteBishop, S. (December 2012). Before hip replacement, consider all options for treating hip arthritis. Retrieved from https://newsnetwork.mayoclinic.org/discussion/before-hip-replacement-consider-all-options-for-treating-hip-arthritis/
That's really interesting that now he has to delay surgery! That sounds terrible, PRP had no impact on my surgery timeline. Of course, if it had worked I wouldn't want to have surgery until I was in pain again, but if I had wanted to do surgery even sooner it wouldn't have been an issue. I considered a cortisone injection, but I was worried that by masking the pain with no intent for healing I might have done more damage and not realized it. I think for some, PRP would be effective at reducing symptoms before surgery, if surgery was a year or two away. The unfortunate thing about PRP is that it does not have an immediate effect. It takes between 4-8 weeks before symptoms start to abate, if they ever do. Not only that, but it is not covered by insurance because it is still considered experimental, so it can be expensive. If someone was planning on having surgery anyways, I'm not sure it's something I would consider.
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