What is the management of paralabral cysts in the hip?

Management of Paralabral Cysts in the Hip

Ultrasound-guided aspiration followed by arthroscopic labral repair is the recommended approach for symptomatic paralabral cysts of the hip. 1, 2

Diagnostic Approach

• MR arthrography is the gold standard for confirming labral tears and associated cysts, with direct intra-articular injection of dilute gadolinium solution providing reliable diagnosis 3, 4
• Ultrasound can be used to localize fluid collections such as paralabral cysts for aspiration and injection purposes 3
• High-resolution 3T MRI may improve visualization of the acetabular labrum and associated pathology when available 4

Management Algorithm

For Asymptomatic Paralabral Cysts:

• Conservative management with monitoring is appropriate for incidentally discovered, asymptomatic paralabral cysts 2
• Follow-up imaging should be considered to monitor for potential growth or development of symptoms 4

For Symptomatic Paralabral Cysts:

1. Initial Management:

   • Ultrasound-guided aspiration can provide immediate relief of symptoms, especially when the cyst is compressing neurovascular structures 1, 5

2. Definitive Treatment:

   • Arthroscopic intervention is indicated for symptomatic paralabral cysts that are recalcitrant to conservative management 6
   • The procedure should include:
     • Arthroscopic cyst decompression through the site of the labral tear 2, 6
     • Labral repair or debridement of the degenerative labral tissue 1, 6

Surgical Technique

• Arthroscopic approach allows for minimally invasive access to both the labral tear and associated cyst 4, 2
• The procedure is typically performed with the patient under general anesthesia in a supine position on a fracture table 6
• Cyst decompression is achieved using an arthroscopic probe through the site of the labral tear, followed by suture anchor repair of the associated labrum 2, 7

Outcomes and Follow-up

• Clinical outcomes following arthroscopic treatment of symptomatic hip paralabral cysts are generally excellent with significant improvement in pain and function 6
• Complete cyst removal can be confirmed with follow-up MRI at approximately 6 months postoperatively 6, 7
• Recurrence rates are lower with arthroscopic debridement compared to non-operative interventions such as aspiration alone 2

Special Considerations

• For paralabral cysts causing compression of major neurovascular structures (e.g., common femoral vein), a two-stage approach with initial ultrasound-guided aspiration followed by arthroscopic labral repair may be necessary to provide immediate decompression 1, 5
• Untreated labral tears with associated cysts may lead to persistent pain, progressive cartilage damage, and potential development of osteoarthritis 4
• The underlying cause of the labral tear (e.g., femoroacetabular impingement, trauma, dysplasia) should be addressed during the same procedure to prevent recurrence 2

Potential Complications

• Surgical risks include infection, nerve injury, and adhesive capsulitis 4
• Patients with extensive cartilage damage may have less favorable outcomes and might require additional interventions 4