Hip Labrum Surgery: Is It the Right Treatment?

Orthopedic surgeons have become better at understanding sources of pain, and technology has increased our ability to diagnose conditions that previously went undetected. One source of hip and groin pain that is being diagnosed much more commonly is called a hip labral tear.

The hip labrum is a ring of cartilage that surrounds the socket of the ball-and-socket hip joint. Often likened to a meniscus tear of the knee joint, a hip labrum tear may be a source of pain and discomfort in the hip joint.

As we have gained a better understanding of the anatomy of the hip joint, and technology such as magnetic resonance imaging (MRI) has improved our ability to see abnormalities, we have identified more specific sources of pain around the hip. One structure that is often identified as a source of hip pain is the labrum of the hip.

Man with his hand on his hip experiencing pain
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The Hip Labrum

The hip joint is a ball and socket joint at the junction of the top of the thigh bone and the pelvis. Unlike other ball and socket joints such as the shoulder, the hip has a very deep and stable socket.

The labrum is a cuff of cartilage that makes a ring around the edge of the hip socket. This helps to deepen the socket, while also being flexible (unlike the bone of the socket) to allow for some movement.

The hip labrum, like other types of cartilage, tends to have problems healing from injury. The cartilage tissue lacks a good blood supply and therefore does not have a capacity to heal after damage has occurred.

Once the labrum has been damaged, it tends to show signs of damage that may not repair over time.

Hip Labrum Tears

When the labrum of the hip joint is damaged, people generally refer to this damage as a "tear of the labrum." Despite using this language to describe just about any injury to the hip labrum, hip labral tears come in a variety of shapes, sizes, and types.

Not every labral tear is the same, and the treatment of labral tears can differ significantly. Furthermore, patients come in many types with different expectations for recovery and different interest levels in various treatments.

Most importantly, labral tears are often seen in the setting of other damage to the hip joint including arthritis and bone spurs. A labral tear in the setting of arthritis of the hip is nothing like a labral tear as an isolated injury.

When surgery is considered for a hip labral tear, the most common way to address this is through arthroscopic treatment. The first arthroscopic hip surgeries took place in the 1980s and it has become a routinely performed surgical procedure today.

Between 1999 and 2009, arthroscopic surgery of the hip joint increased 18-fold, with a 365% increase between 2004 and 2009.

Hip Arthroscopy

Arthroscopic hip surgery is an outpatient surgical procedure that is often performed under general anesthesia. Your surgeon places a small television camera with an attached light source into the hip joint, and through a separate small incision can place instruments to address hip labral tears.

Standard treatments to address a hip labral tear are either to repair, trim out the torn portion, or in some cases reconstruct the labrum. The decision of how to address the tear usually depends on factors including the tear type and location.

Arthroscopic hip surgery is not without potential risks. These risks include problems like infection, persistent pain, and nerve or blood vessel injury. When considering any surgical treatment, it is important to weigh the risks and the benefits of surgery.

So the question then becomes, is surgical treatment better or worse than nonsurgical treatment? Because we know that labral tears do not tend to heal, many people are under the presumption that if they want the pain to be addressed, a surgical procedure is their only option. But is that actually the case?

Results of Surgical Treatment

A number of studies have reported good short-term results following arthroscopic hip surgery. Most of these studies find that people who undergo hip arthroscopy have good pain relief in the months and years to follow surgical treatment.

Especially in patients who do not have any signs of arthritis, these results tend to hold up well over time, and people are satisfied with their treatment. This evidence certainly supports the consideration of surgical treatment, but only a few studies have actually compared if surgical treatment is better than nonsurgical treatment.

One study of about 100 military recruits who had hip labral tears randomly assigned them to either get surgery or nonsurgical treatment. Two years after treatment was completed, there was no significant difference between the groups of individuals treated surgically versus those treated nonsurgically.

That is not to say that everyone got better, it just means that an approximately equal number of patients got better with nonsurgical treatment as with surgical treatment. However, 70% of the patients who didn't have surgery ended up undergoing surgery later.

Labral Tears After Age 40

There has also been controversy regarding the treatment of patients over the age of 40 who have labral tears. These patients must be approached very cautiously when considering hip arthroscopy.

While there are some situations where middle-aged people can find good pain relief with arthroscopic hip surgery, many do not have improvements with this type of surgery.

Studies have shown that people over the age of 40 have a higher rate of progressive arthritis of the hip joint, and the labral tear is likely an early sign of arthritis in the hip. Almost 20% of these patients ultimately end up having hip replacement surgery within a year and a half of undergoing arthroscopic hip surgery.

As is the case with many emerging surgical procedures, hip arthroscopy included, orthopedic surgeons are continually improving the understanding of which patients are most likely to benefit, and which are not, from surgical intervention.

It is clear that not every individual who has a hip labral tear needs arthroscopic hip surgery. In fact, nonsurgical treatment in many cases may be just as effective, and sometimes even more effective, than surgical intervention. Working to define which patients are most likely to benefit is an ongoing process.

It is clear that in almost all situations nonsurgical treatment should be attempted first and patients over the age of 40 should be considered very cautiously for a surgical treatment.

A Word From Verywell

Arthroscopic hip surgery undoubtedly plays an important role in the treatment of hip labral injuries. That said, many patients can find equally effective treatment with nonsurgical treatment. In almost all scenarios, nonsurgical treatment should be attempted before considering arthroscopic surgery.

Studies have shown that when nonsurgical and surgical treatment are compared, the results are not too different between these groups; both treatments tend to lead to an improvement in symptoms. There are situations when nonsurgical treatments are ineffective, and surgery can be considered.

The ideal candidate for surgical treatment is under the age of 40 years old and does not have signs of arthritis in their hip joint.

Frequently Asked Questions

  • What happens if you don't fix a torn hip labrum?

    It depends. Surgery is not always required or recommended for a labrum tear. A person’s age, the extent of the injury, and overall hip health are factors to consider. 

    Surgery is not typically recommended for people ages 40 and up. This is because a hip labrum tear is often an early sign of arthritis. If you have osteoarthritis, a hip replacement may be needed in the future.

    In addition, other treatments, including physical therapy, may be equally as effective as surgery for a minor tear.

  • How long does it take to recover from hip labrum surgery?

    It can take several months to fully return to normal after hip labrum take surgery. You can expect to walk with crutches for the first week or two. After that, at least six weeks of physical therapy will be needed to help restore strength and flexibility. 

    On average, it takes about six months to fully recover after hip labral tear surgery. Some people recover in as little as three months, while others take longer to heal. As long as there aren't any complications or other problems with the hip joint, you should be fully recovered within nine months.

  • What activities should you avoid after hip arthroscopy?

    In the immediate aftermath of hip labrum arthroscopy, you will not be able to put any weight on the leg for the first week or so. Other things to watch out for:

    • Avoid sitting on low, soft surfaces as they may be difficult to get up from.
    • Don't sit cross-legged or with your ankle resting on your knee.
    • Do not lift the leg straight up or pivot over the leg that was operated on. 

    Once you start physical therapy, it will still be a while until you are able to exercise independently. You will need to avoid high-impact activities like jumping or running for at least 12 weeks—and not until your physical therapist or surgeon approves it.

9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. Stanford Health Care. Hip labral tear.

  3. American Academy of Orthopaedic Surgeons. Osteoarthritis of the hip.

  4. Gwathmey FW, Jones KS, Thomas byrd JW. Revision hip arthroscopy: findings and outcomes. J Hip Preserv Surg. 2017;4(4):318-323. doi:10.1093/jhps/hnx014

  5. American Academy of Orthopaedic Surgeons. Hip arthroscopy.

  6. Menge TJ, Briggs KK, Dornan GJ, Mcnamara SC, Philippon MJ. Survivorship and outcomes 10 years following hip arthroscopy for femoroacetabular impingement: labral debridement compared with labral repair. J Bone Joint Surg Am. 2017;99(12):997-1004. doi:10.2106/JBJS.16.01060

  7. Mansell NS, Rhon DI, Meyer J, Slevin JM, Marchant BG. Arthroscopic surgery or physical therapy for patients with femoroacetabular impingement syndrome: a randomized controlled trial with 2-year follow-up. Am J Sports Med. 2018;46(6):1306-1314. doi:10.1177/0363546517751912

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  9. Meftah M, Rodriguez JA, Panagopoulos G, Alexiades MM. Long-term results of arthroscopic labral debridement: predictors of outcomesOrthopedics. 2011;34(10):e588-e592. doi:10.3928/01477447-20110826-04

Additional Reading
  • Horner NS, Ekhtiari S, Simunovic N, Safran MR, Philippon MJ, Ayeni OR. "Hip Arthroscopy in Patients Age 40 or Older: A Systematic Review" Arthroscopy. 2017 Feb;33(2):464-475.e3.

By Jonathan Cluett, MD
Jonathan Cluett, MD, is board-certified in orthopedic surgery. He served as assistant team physician to Chivas USA (Major League Soccer) and the United States men's and women's national soccer teams.