The concept that hip labrum tears cause pain is relatively new in medicine. Despite that, the number of arthroscopic hip surgeries to treat hip labrum tears and impingement have exploded in the past five years. Have physicians become too zealous? A patient I evaluated in clinic yesterday is an example of what we see more and more-an MRI of the hip that showed a labral tear which was assumed to be the cause of her pain. However, for my patient, the surgeon clearly operated on a phantom.

“MRI hysteria” is a regular occurrence. This happens when an MRI of some body part that hurts shows some abnormality and the patient believes that this is “smoking-gun” evidence of the cause of their pain. This belief is prevalent despite scientific evidence that it’s unlikely that the abnormality is causing their pain. One example is a knee meniscus tear in a middle-aged person with new-onset knee pain. Studies indicate it’s unlikely that the meniscus tear is causing the patient’s knee pain, but many thousands of patients still undergo operations every month for a meniscus tear. While some doctors have begun to get the memo on meniscus tears, the surgical community operating on hip labrum tears seems to be using MRI findings with wild abandon to support their practice.

The labrum is the fibrous lip around the hip socket where the leg bone (femur) attaches. It’s an important stabilizer of the hip, but just like the meniscus spacer in the knee, tears here are common in patients without hip pain. In fact, recent studies have shown no association between hip labral tears as seen on MRI and hip pain.

Think about that for a second. We have research that shows that patients without hip pain have labral tears and patients with hip pain have no more tears in that structure than patients who have no pain. Huh? Why then are we operating on hip labral tears that are seen on MRI based a cursory physical exam and a short discussion with the patient? If the hip labrum tear isn’t causing the hip pain, isn’t the surgery unnecessary? The following patient provides a great example of what the all-too-common medical practice of operating on a phantom.

The patient is a middle aged woman who was a runner and loved high-level exercise. A few years back she began to notice pain and aching in her thigh, and eventually pain in the back and side of the hip as well. As this became more disabling, she had to decrease her exercise. Ultimately she sought help from an orthopedic surgeon who ordered an MRI arthrogram of her hip. That image showed a labral tear, but regrettably little else about her symptoms was convincing for primary hip pain, which usually is located in the deep groin. Given that the MRI image also showed “impingement syndrome,” surgery to “repair” the labral tear and reconstruct the labrum, was performed. The patient’s pain never lessened one bit. Following that, the patient visited a doctor who questioned the need for the surgery. He injected her hip with a numbing agent. If the surgery failed and the hip was the problem, this should take away most of her pain. Since the numbing shot didn’t reduce the patient’s pain, it’s obvious that her hip joint isn’t causing the hip pain. The patient had undergone surgery with all its risks, and this never changed the pain because the wrong area was treated. What was causing this patient’s hip pain? A comprehensive exam revealed it to be located in her lower back.

Operating on problems that aren’t causing pain might seem like a rarity, but every week patients undergo hip, knee, or shoulder surgery that provides no relief from their pain. This is happening because doctors are treating up to 40 patients a day, relying on cursory exams and a firm belief that the MRI findings alone give accurate assessment of the cause of pain. If you suffer from pain in the hip, knee, or shoulder, don’t buy the quick explanation for the cause of your pain, and don’t let a surgeon operate based only on MRI findings.

“Hip Tear Surgery Didn’t Work” first appeared as a post on the Regenexx blog.

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