Hip Labral Tear surgeon in the Boston area?

Ok, background:

My wife was involved in a serious vehicle accident (Chevy Tahoe flipped and rolled), 2 months after accident my wife gave birth. She constantly complained of pain and was in PT for over 2 years with multiple Corticosteroid injections using ultrasound.

Approx 8 months ago she was finally diagnosed with a significant labral tear. Since the diagnosis I have done an exorbitant amount of research on the matter.

#1 A Acetabular Labral Tear will NOT heal on it's own. Regardless of what any Dr will tell you. It is because of the location of the acetabular labrum. It is considered a very low blood flow area.

#2 All surgical procedures regarding a labral tear are relatively new (within the last 10 years).

#3 There are 2 types of procedures that are being completed. You will want to listen to your Dr. specifically in regards to how severe or significant the tear is to determine which surgical option they think is best for you. Please, do not take your Dr's word on the type of surgery he recommends. Do your own research.

#3 The 2 types of surgeries are a debridement and reconstruction.

A. Debridement involves removing a part of your labrum and smoothing it out.

B. Reconstruction involves repairing the tear with sutures and possibly having impingement done (re-anchoring it to the hip).

#4 The debridement has a mediocre success rate. It is approx 65% depending on study. (recovery time - IF successful - 2-3 months to full recovery)

#5 The reconstruction has a slightly higher success rate of 80-90% depending on the study, if performed by the right surgeon. However, the recovery process is significantly more - 9-12 months recovery due to the fact of where the labrum is located (low blood flow area - longer to heal).

Now it is time to decide which surgical option is best for you. Remember, you CANNOT have reconstruction surgery if you previously had a debridement. Why? Because when you have a debridement they surgically remove the tear and there isn't anything left to reconstruct. Remember, if you have a reconstruction first and it isn't successful, you can always have a debridement done in the future.

http://www.ishameetings.net/assets/isha/ISHA_2011_Labral_Reconstruction.pdf

http://www.western-ortho.com/WesternOrtho/media/WesternOrtho/Hip/Hip-FAI-talk-for-patients-10-31-11.pdf

Individuals who tell others not to have surgery are either 1. a chiropractor or 2. has no idea how painful and irritating hip pain is to someone who used to feel young, vibrant and athletic.

Thanks for the info William Scott. That is more than I got from my doctor. I had to look back at my notes from after the surgery. I had a "thermal" repair. The second link you provided from Dr. White is not positive about this type of repair. I had no stitches and the labrum didn't need to be reattached to the joint, maybe that is why I could start running three weeks post surgery. I did have a large tear, according to the doctor, and they were surprised at the minimal amount of arthritis I had as the way my hip functioned or didn't function started giving my lower back problems 30 years ago. The doctor also debrided a synovial impingement, which I guess was bunched up tissue. I could run on the hip quite early, but I was often left limping afterwards. It took about 1 1/2 years and now, all of a sudden, I am finally coming out of the woods. The last 3 weeks have been fantastic. For once I can run distance without limping afterwards and this week the muscles around my hip have loosened up even more and I can elongate my stride and go faster. My main problem after getting the surgery was to get rid of the multiple compensations my body thought up over the past 30 years to keep me running. My stride looks so much better and it is so much easier to run. I no longer have the pain and discomfort I used to have daily whether I ran or didn't run. At this point, I can't see why I can't run as well or better than I did prior to surgery (after I lose the weight gained and get some more miles in). I have not regretted the surgery one bit, although I hated getting so out of shape due to waiting almost a year with no running prior to the surgery and the slow transition back to full running.

Just a quick reply re: Dr. McCarthy, I brought up FAI when he reviewed my MRI and he got a bit heated actually...it seems he's not a proponent of it being a 'real'--or at least 'fixeable'--thing.

I'm having a hip arthroscopy on Friday. It's been 4+ years from initial injury to diagnosis and treatment. The unusual thing, in my case, is that my injuries started with the lower leg, first with knee pain, then with ankle pain. Dr. McCarthy believes these lower leg injuries are unrelated to the labrum tear but at the same time nothing I've pursued has led to any answers...and I'm talking visits with a neurologist, knee surgeon, podiatrist, osteopath, physiatrist, running gait specialist, multiple physical therapists, as well as an EMG, ultrasound, MRI on my knee, and treatments ranging from massage, rest and ice, chiropractic adjustments, taping the knee and ankle, cortisone in both the knee and L4/L5, and trigger point therapy. Long story short: I'm HOPEFUL (though not optimistic) that this surgery will cure my lower-leg symptoms. But at the same time I can't wait because my groin/glute/hip pain has gotten pretty bad.

Hope everyone who's had surgery and is recovering or post-recovery is doing well!

TDF, hope the surgery and recovery has come and gone by now. I'm going to California to have the surgery this winter but will be back in the Boston area for part of my rehab.

Wondering if anyone can recommend a physical therapist with surgery rehab experience for this in the Boston area? Thanks so much in advance!

Mike Reinold -- very good with shoulder, also great with hip. I'm recommending him because he will assess everything you do from head to foot and make ensure nothing is affecting the function/healing of your hip. I just saw him recently. However he does not see a large number of patients (works with a lot of MLB players). You can put in a request through his blog here. He will get back to you pretty quickly. Has a small clinic/gym in Needham, MA. He does take most forms of insurance.

http://www.mikereinold.com/work-with-mike-reinold

Thanks so much for the suggestion. I will get in touch. Unfortunately, will definitely need someone in the immediate Boston area (easily T accessible) so if anyone else has recommendations, I would really appreciate it!

49 yo male. FAI and torn labrum both hips. Daily pain and tightness. Cannot run. Cannot determine if pain is L5/s1 , SI or hip related. Had multiple cortisone injections in hipsocket, L5/si, facets , SI. each time felt great for 3 days only then back to full pain. Scott Martin MD and Brian Kelly both said my hip joint is in good shape (other than the labral tear) and there is no guarantee that surgery is going to resolve the issue since many labral tears are asymptomatic and I do have tough looking L5/S1. Still other surgeons tell me that at my age because of the FAI, if i do scope...i will be back in a few years later for full arthroplasty because recover from arthroplasty at 49 results in lots of scar tissue and accelerates deterioration of the joint capsule.

Great posts - Can those who have had the arthroscopy possibly reply back with your progress since your original posts? Is labral tear felt in groin or back ? thanks for any help you can offer

Hi Dante,

Define "tough looking" L5/S1. What did your MRI report indicate? Is there degeneration and/or a herniation of any level?You mentioned facets joints being a possible issue but did not indicate if they were noted as significant on an imaging report.

I don't think it's beneficial so try to compare your symptoms to other people who have had labral tears. That pain can present itself anywhere surrounding the hip joint depending on the location. 95% of labral tears are anterosuperior in nautre, but people complain of a wide variety of symptoms (or lack of). You could definitely have referred back pain, others experience none and it is more localized to the groin area. Some have instability while others have chronic tightness/stiffness. You may or may not have clicking/popping/catching/etc. It is truly difficult to diagnose.

It sounds like Kelly assessed your bone structure. I will assume he had you get a CT scan. If he thinks you look good I would take his word for it.

My suggestion would be to ask if he might refer you to another physician at HSS, Dr. James Wyss. He is a physiatrist who has an amazing background in sports medicine and spine pathology. Dr. Kelly knows him fairly well. I would ask his opinion if he thinks it might be beneficial for you to have a consult with Wyss and see if he can help you differentiate between the hip and the back and if so, help set you up with some therapy ideas or a plan of care to help you progress more than you are doing at the moment.

http://www.hss.edu/physicians_wyss-james.asp

Since this was my original post from a few years ago. I had hip arthroscopy to repair a labral tear 3 years ago when I was 52. I only had the tear fixed and don't know if I have FAI or if I have other mechanical or hip problems, but that whole left side is really wonky (femoral anteversion, tibial torsion, anterior pelvic tilt, and earlier this year was told slight dysplasia in that hip). I can't imagine I was born with all those things off on just one side of my body, so I guess that there is a lot of compensations going on to work around something (who knows what originally). I have been told all sorts of stuff and every doctor has a different opinion, and none I have met have really cared beyond their own specialty. I always felt it primarily in my lower back on that left side (30 years of pain and discomfort that I ran through) and then the SI joint until my hip became really unstable and then unusable so that I finally needed surgery when I could no longer run. I can run now but the muscles around my joint get stiff and I end up limping afterwards. Three years post surgery I can move that femur around pretty good in my joint, and strangely it is just running that I can't do, but I am still undoing years of compensations and hope to get back to running eventually, but have kept it very limited in the past 6 months after pushing myself too much post surgery. If I don't run, I feel much better than I have in many years. Instead of running the past 6 months, I have been riding an ElliptiGO and love it. No pain at all and I can work out as hard and as long as I desire!

Hello, I also had a labral repair with Dr Martin one year ago. It's way too long of a story and way too many symptoms to list here. It's been extremely difficult physically and mentally. Some days I don't think I'll ever be able to even walk normally and without pain again. I used to run and strength train regularly. Now I dread standing up and walking. I'm a nurse and still haven't returned to work. How are you doing at this point? If you're up for it I'd like to talk with you but I'm not sure how to get in contact without posting personal information on the web.

Hey Dante, I'm really sorry to hear about your pain! I can definitely understand and I hope you are able to find a solution soon :) First, some brief background info.

25yr, female. Tore quad playing soccer, also had hip/ groin pain from injury. After three years and still severe hip pain present, I had various diagnostic testing and imaging done. Turns out in addition to the quad tear, I had FAI impingement (CAM) and a labral tear, which was initially difficult to differentiate this pain separately from my quad. I had surgery at Boston Children's with Dr. Yen three weeks ago. He is not only an incredible surgeon, but has a terrific bedside manner that I have never before seen from a surgeon. Also, Children's has one of the best sports medicine/ ortho programs in the world.

As to my progress so far: The first week was tough. I was pretty much confined to bed and a CPM machine for 8hrs a day. However, since then, I've been going to PT and can definitely see an improvement as the weeks pass. I was told 4-6 mths recovery, possibly up to a year (but my surgery consisted of an osteoplasty, labral repair with anchors and fixing some additional cartilage). A lot of my pain was located around the groin and greater trochanter, but definitely deep in the joint. Decreased ROM, grinding and popping were also all present. To me, there was no doubt about having surgery. I had been in PT for two years, had cortisone injections and greatly altered my lifestyle (no soccer, running..etc) all to no avail. There was also no chance in hell that I was going to live the rest of my life unable to participate in sports, let alone walk over a mile without pain. Also, no matter what anyone might say, a torn labrum will usually not heal itself; it will only get worse and cause more damage.

Although I did not have an arthroplasty, if I did not have this surgery, I would have needed one in the not so distant future. Heck, my doctor said I might still need one later in life because of some irreversible damage, but fixing these problems is giving me (hopefully) decades with a pain free hip. As people before me have mentioned, if you do choose to have the surgery, two big factors leading to high success rates are to strengthen your hip as much as possible beforehand and to take rehab VERY seriously afterwards. Also to note, even my doctor said there was no guarantee surgery would stop the pain...I think legally they say this to cover their butts.

If you or anyone else have any questions, I'd love to help! I also want to mention that I know first hand of a few quack doctors in the area that said I had none of the medically blatantly obvious above problems, so if you plan to have hip surgery in Boston, stick to Children's, MGH, Brigham and BIDMC. This is a serious surgery and you don't want to put your health in the hands of an ortho surgeon who can't tell the difference between an open fracture and a sprain.

Saw your posts on Dr. Scott Martin and your surgery. Would love to connect with you! I'm a patient of his and he is now doing a study on PT vs. hip arthroscopy on patients over 40. He wants me to participate. I'm 44 and have bilateral tears with impindgement and early OA.

Are you open to connecting on this?

Thanks! Jennifer

Jerrykat7- would love to connect!!!

My daughter was just diagnosed with torn cartilage in her hip. She is 15 and runs x-country and track. We have an appointment with Dr. Travis Matheney from Children's. Has anyone seen him?

Dr. Diane English is tied in with the Boston College athletics medical team

617-254-1247

Saw her for my left knee probs. (fully resolved)

Scott Martin "REPAIRS" the torn labrum. Others dissect and cut it off, meaning you never run again.

Make sure you ask if they try to repair first.

Personally, I would only trust Scott as he is the only one I have not heard horror stories about (sorry those who like McCarthy).

Martin is at the Brigham and repaired my hip. In my opinion, did a good job and I am back running the same amounts as before. No pain/discomfort in my hip at all.

Thanks Been Through It for your knowledgeable response! I know I'm YEARS late but going through the same thing :( I'm devastated but trying to find positive outcomes to aid my decision/will to have surgery.

Have you since returned to running? Successfully? As strong as before injury?

I'm thinking it will be worth any pain and lengthy recovery if I can just run marathons pain free again.

Also, I'm looking for BOSTON surgeon. I've heard great things about Dr Martin but I think I have read he doesn't prescribe PT? Did u do PT? If so, where?

Thank you!!!!!!! Anything helps at this desperate stage in looking for answers!

Hey Check the doctors

Thanks for your advice. Dr. Martin is definitely on my list! Would u mind a few questions? Every surgeon is different!

Did you have labral repair with anchors ? Did you have FAI repair?

Did you do PT? (His website doesn't include PT instructions)

What was timeline for recovery? (Crutches? Start running? Return to preinjury running?)

Thanks so much!!!!