How long should a patient with a history of left hip labral tear repair remain nonweightbearing (NWB) after a fall?

Weight Bearing After Hip Labral Tear Repair Following a Fall

Patients with a history of hip labral tear repair should be allowed to weightbear as tolerated following a fall, with appropriate use of assistive devices like crutches if needed for comfort.

Assessment and Initial Management

When a patient with a history of hip labral tear repair presents after a fall, proper evaluation is essential:

• Perform a thorough hip examination, noting particularly:

  • Pain with internal and external rotation (suggests intra-articular pathology) 1
  • Presence of a limp or positive Trendelenburg sign 2
  • Positive impingement sign (present in 95% of labral tear cases) 2

• Obtain appropriate imaging:

  • Plain radiographs of the hip and pelvis as initial imaging 1
  • If radiographs are negative but clinical suspicion remains high, proceed to MRI 1
  • MRI without contrast is the gold standard for detecting occult fractures and soft tissue injuries 1

Weight Bearing Recommendations

The American Academy of Orthopaedic Surgeons (AAOS) guidelines provide clear direction on weight bearing after hip injuries:

• For patients with hip fractures treated surgically, immediate full weight bearing to tolerance after surgery is recommended (limited strength of evidence, limited strength option) 3
• For patients with suspected labral injuries without fracture, weight bearing as tolerated with crutches is appropriate 1

Rehabilitation Timeline

The rehabilitation process should follow a structured approach:

• Initial phase (0-2 weeks):

  • Weight bearing as tolerated with assistive devices as needed for comfort 1
  • Monitor for worsening symptoms and instruct patients to return immediately if pain increases 1

• Intermediate phase (2-6 weeks):

  • Use of a protective device that allows mobilization by 2-4 weeks 3
  • Begin gentle range of motion exercises while limiting extreme hip positions 1

• Advanced phase (6+ weeks):

  • Progressive strengthening and functional exercises 1
  • Sport-specific training can begin after appropriate healing (typically 3-6 months) 4

Special Considerations

• If MRI reveals a fracture, weight bearing recommendations may change based on fracture type and location 3
• For cartilage defect procedures (such as microfracture), 6 weeks or more of non-weight bearing may be necessary 5
• Patients with posterior labral pathology more often complain of pain rather than instability 6

Monitoring and Follow-up

• Regular follow-up is essential to ensure proper healing
• Return for care and re-evaluation if discomfort does not abate or worsens 3
• Consider advanced imaging if symptoms persist despite appropriate management 1

Common Pitfalls to Avoid

1. Delaying MRI when radiographs are negative but clinical suspicion for injury is high
2. Imposing unnecessary weight bearing restrictions that may lead to deconditioning
3. Failing to recognize the "sports hip triad" (labral tear, adductor strain, and rectus strain) in athletes 7
4. Overlooking the possibility of occult fractures or re-tears that may require surgical intervention

By following these evidence-based guidelines, patients can achieve optimal outcomes while minimizing complications and unnecessary activity restrictions.