Hip Labral Tears Decoded: Is Surgery the Answer?
My hip labral tear journey began in 2011...
It started with back and hip pain in the gym. That pain persisted and led me down a rabbit hole of medical appointments, research, and uncertainty.
Over 5 years, I saw over 30 specialists and spent over $26,000 trying to heal my hips.
Fortunately, I ultimately did fix my hips WITHOUT surgery.
Fourteen years later, I have no pain or movement problems whatsoever.
But guess what?
I still have the labral tear and bony “abnormalities” in my hip.
Like me, many of you are wondering about YOUR hip labral tears and the scary prospect of surgery. Is surgery right? Is it wrong? Will it prevent or CAUSE more problems down the road?
These are the same questions I grappled with.
This article aims to guide you in decoding the mystery of hip labral tears and surgery. It sheds light on what the science says and what you can do to feel better now.
Understanding Hip Labral Tears: Pain or No Pain?
The labrum is a rubbery ring of cartilage that acts as a cushion and stabilizer for your hip joint, aiding in its smooth movement and supporting the joint structure.
When this labrum is torn, theoretically, it should cause discomfort and a range of symptoms such as sharp pain, a catching or locking sensation in the hip joint, stiffness, or limited range of motion.
These symptoms can impact daily activities, leading many to seek medical advice, often considering surgery as a solution.
The confounding aspect of labral tears, however, is that not all labral tears result in pain or noticeable problems.
This is where the situation becomes complex. Some individuals with labral tears might be asymptomatic, meaning they experience no pain or mobility issues.
This phenomenon raises significant questions about the approach to treatment.
Should an asymptomatic or mildly symptomatic patient undergo surgery?
What are the risks versus benefits?
And how do you even know if you have a labral tear in the first place?
MRI's for Labral Tears: "Donuts of Truth"?
One of the main ways people discover they have a hip labral tear is with seemingly advanced or sophisticated medical imaging.
While these machines (like MRI and MRA) give us some information, they are NOT "circles of certainty" or "donuts of truth."
For example, many studies have shown little to no correlation between labral tears seen on an MRI and pain or disability!
In one pioneering study, researchers studied people with asymptomatic hips (meaning their hips had no problems or pain).
The scientists wanted to examine the relationship between hip labral tears and hip pain. To their surprise, they found that the majority (73%) of the subjects had some abnormality or labral tear BUT no pain or problems.
In another study in 2019 titled "Acetabular Labral Tears Are Common in Asymptomatic Contralateral Hips With Femoroacetabular Impingement," the authors discovered that 43% of people with no hip pain or hip problems had labral tears in that hip.
In the author's own words:
"We suggest that the decision to perform...labral surgery in patients with FAI should be made cautiously considering the relatively high prevalence of labral tears in asymptomatic hips and the low chance of development of symptoms."
These studies show that 43-73% of the people in these studies had bony abnormalities and labral tears on an MRI but no problems.
The bottom line is this: MRIs are NOT "circles of certainty" or "donuts of truth."
Surgery for Hip Labral Tears: Success Rates
Okay, now you understand that “bad results” on an MRI machine don’t necessarily mean that that is the source of your pain.
However, some may still pray that surgery will be the “magic wand” to fix everything.
After all, Doctors dangle these surgeries in front of us, and the lure of the quick fix is enticing…
But what is “fixed?” And does “fixed” mean the same thing to the Doctor as it does for me or you?
For me, “fixed” means "I feel good again and can return to normal activities. Period."
But for surgeons, success is often defined as arbitrary “20-point increases” on a questionnaire or “Everything looks good on your MRI… so the surgery was a success!”
Given these dubious definitions of “fixed” or “success,” I’d think long and hard before letting a surgeon cut me open and start stitching things together willy-nilly.
With that said, let’s look at the science of labral tear surgery success rates.
One of the most popular “treatments” for hip labral tears in the last decade has been labral debridement (or labrectomy), in which a surgeon goes into your hip and cuts away the “loose” bits of your labrum.
Unfortunately (but unsurprisingly), removing pieces of labrum doesn’t help. It increases instability. So, it’s not surprising that a study on the results of labrectomy cited poor results for debridements or labrectomies.
In the author's words:
“Isolated arthroscopic labral debridement for hip labral tears had 45 % combined poor results when strictly defining failure as repeat surgery or abnormal hip rating.”
In plain English, labral debridement gave bad results for about half the people, and many were recommended another surgery when the 1st one failed.
The other surgical option for a labral tear is refixation, where the “damaged” labrum pieces are reattached. There’s some evidence that refixation may be better than debridement or labrectomy. (In other words, stapling it back on may be better than cutting it off.) However, the authors were uncertain whether the reported improvements resulted from surgery.
The last surgical option to treat your hip labral tear is arthroscopic hip surgery.
One of my mentors, who helped me fix my hips without surgery, struggled through 5 of these failed surgeries before he got to a place of relative normality.
In these surgeries, doctors perform the procedure if you have “abnormal” bone shapes like cam, pincer, or mixed morphology. These are often called the bone shapes of femoroacetabular impingement or FAI.
The goal of this FAI surgery is to “correct” the bony abnormalities that theoretically caused the labrum to tear. This is accomplished by shaving your bones and cutting or stitching up your labrum.
Unfortunately, we already learned that many people with hip labral tears don’t have hip pain, AND the same is true for FAI bone shapes.
So, next time you hear your doctor talking about the benefits of surgery, remember:
- The Doctor's definition of success and your definition of success might be wildly different. So proceed with caution.
- Studies show that labral tears and bad bone shapes aren’t necessarily the source of your pain. So think more wholistically.
- The success rates for these surgeries are disappointing and vary widely.
But what else?
What else should we consider if we are trying to understand whether surgery is appropriate for us?
How about the experience of other people who already had the surgery!
Surgery for Hip Labral Tears: Real Patient Stories
The cool thing about the internet is that people get surgery and then blog about it!
This is helpful because they share ALL their experiences (the good, the bad, and the ugly).
I hunted down a few of these blogs and will summarize the results here.
- One blog is Stephanie’s experience 1 year after getting surgery for a hip labral tear. Full blog. Here are a few highlights:
“Did the surgery work? Yes and no. It’s hard to blanket say the surgery was great and life-changing because, honestly, there have been struggles, pain, and setbacks.”
“I am s]till dealing with residual tightness one year after surgery.”
“I am experiencing sharp hip pain at random. I'm not sure if it’s muscular tightness, something pinching inside the joint again, or arthritis. But it is concerning to have gone through this process and still have sharp pain."
- Another blog is about Sarah Jane’s experience 1 year after getting surgery for a hip labral tear. Full blog. She says:
“I have noticed that my surgery hip gets tighter much easier when I do glute exercises and stuff, so I have to keep working on the knots in that hip.”
“The aching in my hip joint if I sit too much has improved, but I’m still quite tight in my inner thigh muscles. I have some adhesions and things I need to keep working on from surgery.”
“I still have discomfort when I try to do a knee-to-chest stretch with that hip, so I’m not sure if that will always be there or I just need to work on improving that mobility somehow. I guess I need to ask the nurse about something at my surgeon’s office.”
- And finally, we have Annette’s experience 1-2 years after getting surgery for a hip labral tear. Full blog. In her own words:
“Eleven months in, I. . . got another cortisone injection. Like the first injection I had gotten before the surgery, it just upset my hip joint even more.”
“I could not sit without pain until 14 months postop.
- “Would I do the surgery again? Honestly, I don’t know.
As someone who has a labral tear but decided NOT to get surgery, I’m struck by a crucial pattern when I read these stories: The pattern is – none of these people seem to be jumping with joy and singing the praises of surgery!
At best, they say: “Well, I guess I had to get it because it probably would have got worse.”
Not exactly a glowing review!
Of course, this isn’t to say that surgery is never warranted for anyone, but it does make you think long and hard about whether you’ve fully maxed out the nonsurgical options before going for the last resort.
TSR Method: Your Roadmap to Hip Health
There is another option beyond surgery and beyond traditional physical therapy. It’s called the TSR Method.
I developed this method by struggling with my own FAI, labral tears, and bone cysts, and it’s been working for thousands of people worldwide since 2015. This science-backed approach has produced hundreds of success stories since we started.
You can watch dozens and dozens of these real stories from real people on our website.
👉 If you want to heal your hips and get your life back without surgery, check out TheFAIFix.com for our “do-it-yourself” hip program powered by the TSR system.
👉 And, if you want personalized, 1-on-1 help implementing the TSR system, book a free, 1-on-1 call with me to see if you qualify for our VIP mentorship program.
I hope this video and article have decoded the surgery mystery for hip labral tears. And, as always, please remember: You’re just 1 step away from building, or rebuilding, your perfect body.