Labrum tear in mild hip dysplasia
Labrum lesion in mild hip dysplasia. How should we treat this young, 20 years old girl with rigth hip pain. On x-ray mild dysplasia.
RMN revealed labrum lesion without Cam. Which treatment is considered the correct one?
- femur osteotomy: varisation of proximal femur
- suture of the labrum lesion
- suture of the labrum lesion with shelf arthroplasty
Functional x-ray in abduction and intrarotation showed good hip containment.
- PAO (periacetabular osteotomy) to improve coverage of the femoral head: the dysplasia is of low degree, only mild. PAO seems an exagerated treatment in this case
- Suture of the labrum lesion: arthroscopic or mini-open treatment with refixation of the lesioned labrum. Is this an adeguate treatment? The dysplasia is at the origin of the mechanical stress due to the reduced femoral head coverage. Suture of the labrum doesn't correct this undercoverage and the next labrum rupture is to be expected. If labrum refixation lasts for many years (someone is saying 10 years?) it could be an option. Maybe labrum refixation with Albee-shelf arthroplasty could resolve also the mechanical stress. Could you report experience in this procedure?
- Femoral osteotomy does not resolve the undercoverage of the femoral head but was an experienced technique in the past in mild hip dysplasia. The forces acting on the femoral head were directed more medial protecting the labrum from mechanical stress.
We opted for the femoral osteotomy because of the mild dysplasia and perfect containment of the femoral head after functional x-rays in abduction and internal rotation. This position was reproduced with the osteotomy. Maybe association with contemporary labrum repair could be an option.
Intertrochanteric femoral varisation osteotomy was executed without labrum refixation.
The patient presented immediate pain relief after surgery.