Hip Labral Repair vs. Reconstruction: Why I Rebuild Most of Them

“What happens if you get in there and my labrum is worse than we thought? Will you still be able to fix it?”

Yes. That’s the short answer.

It’s also hands down the most common question I get in a surgical consultation, and it deserves a longer one — because the way this decision is usually framed, repair or reconstruct, pick one, doesn’t match what actually happens inside a hip. So this is going to be a longer read than most surgical explainers. If you’re trying to decide what to do about your hip, or you’ve had a scope that didn’t work, I think it’s worth your time.

Start with the goal, because everything follows from it

My goal is not to fix your labrum. My goal is for you to have one operation, done properly, followed by a recovery done properly, and then never need me again.

That sounds obvious. It isn’t, and it changes the calculus more than you’d think.

There are good data supporting all kinds of labral operations. But that isn’t what you actually want to know. What you want to know is which operation is right for your hip — in the short term, the medium term, and ten years from now. If the goal is just to get you feeling better in six months, several different operations will do that. If the goal is that you’re still doing well in a decade and nobody has to go back in, the choices narrow considerably — because the thing that brings people back to surgery usually isn’t a technique that failed outright. It’s a hip where something got left behind.

The anatomy nobody explains — and a word that’s used wrong

Bear with me for a minute, because this makes everything after it clearer.

Your hip socket has a rim of tissue around it called the labrum. Think of it as a gasket seal: it holds a thin layer of fluid under pressure between the ball and the socket so the joint glides instead of grinding. In laboratory testing it supplies roughly 70–77% of the resistance when you try to pull the ball out of the socket a millimeter or two. Take it away and the joint’s ability to pressurize fluid drops to about a quarter of normal.

Now the part that gets glossed over. Surgeons describe the socket like a clock face. On a right hip: 12 o’clock is the top, 3 o’clock is the front, 6 o’clock is the bottom, 9 o’clock is the back. The labrum itself doesn’t go all the way around. It runs from about 4:30 in the front, up over the top, around to about 7:30 in the back. The gap at the bottom is bridged by a structure with a different name — the transverse acetabular ligament.

Different name — but functionally, anatomically and histologically it’s the same tissue, and together they form one continuous ring. That ring is what makes the seal.

Which is why the term you’ll often see — “circumferential” labral reconstruction — is a misnomer, including when I’ve used it myself in research I’ve published and talks I’ve given. What’s usually meant is a graft from 4:30 around to 7:30: the labrum’s own footprint, not the full circle. The transverse acetabular ligament portion isn’t reconstructed. It’s a long graft. It isn’t circumferential.

For that reason I prefer complete labral reconstruction to circumferential — and when I’m being precise about what I actually do, patient-specific complete labral restoration describes it better still. More on that further down.

None of which is to say it doesn’t work. Done right, a so-called circumferential reconstruction does provide a circumferential seal on the ball and recreates normal anatomy and function. My objection is to the word, not the operation.

I’m being pedantic about this on purpose, because the vocabulary in this field is causing real confusion for patients trying to understand their options. Two surgeons can both say “circumferential reconstruction” and be describing meaningfully different operations. They can both say “segmental reconstruction,” or “augmentation,” and be describing procedures that vary enormously.

The problem you can’t see from the outside

Here’s the thing that changed how I operate.

Almost every labral tear I see is an attritional injury. It’s the exception when a patient can tell me exactly when they tore their labrum. Nobody tackled them, they didn’t slip and fall, or pivot and feel a sharp pain — although all of those things can and do happen. There’s usually no moment.

The hip was shaped a certain way from adolescence — most commonly that’s the impingement, or FAI, story (which is a post of its own) — and it then begins accruing damage gradually. The labrum tears, and often people compensate for it for a while. Until they don’t. Then it shows up: it hurt one day after a run, or after a lacrosse practice, or it started when they went on a long plane ride, or someone shoveled snow — and their hip never went back to normal.

The truth is that tissue may have been getting beaten up for a long time and, for whatever reason, never bothered them. They were compensating — until they weren’t. Maybe it tore a little more. Maybe their mechanics changed subtly. (Also a subject for another post: this is exactly why, unless we’re starting to see articular cartilage breakdown, I generally like to give someone with new onset hip pain a chance to right the ship by modifying what they’re doing, usually under the guidance of a good physical therapist, before we start considering anything invasive.)

The trouble is, that labral tissue has usually been rode hard and put up wet. And attritional damage doesn’t announce itself — not even when you’re looking right at it from the outside. The labrum frequently looks perfectly fine on the surface but can be full of degenerative, inflamed tissue on the inside. We can sometimes see that on MRI. Often we can’t — or the radiologist can’t (no offense, radiology colleagues).

Part of the problem is what people picture when they hear “tear.” Most think of an ACL tear or an Achilles tear — something clean and separated, a rope cut and pulled apart. That’s not what this is. Others, including many in the medical profession, think of it as the labrum being torn off the bone where it belongs, which is why you’ll see MRI arthrograms ordered with dye injected into the joint: if dye tracks between the labrum and the bone, it’s a tear; if it doesn’t, it isn’t.

I’d argue it isn’t nearly that simple. Plenty of labra are still reasonably attached to the socket while the tissue itself has been compromised for years and has largely broken down.

Watch this one. It’s a big labral repair I did in the early 2010s:

From the outside, that’s a nice-looking labrum — good size, decent tissue, no obvious reason not to fix it. And the repair worked, in the sense that you can see a good seal against the ball once the hip comes out of traction at the end.

But look at about seven seconds in. Those small bubbles are paralabral cysts — little pockets that form because of chronic inflammation coming from inside the labrum. They’re a tell. The outside of that labrum is telling you one story and the inside is telling you another.

Now watch what “inside” actually looks like. Different hip, one I’m about to reconstruct. I’m carefully removing the damaged labrum — and there’s a counter in the corner so you can see how long this goes on:

The deeper I go, the worse it gets. Red, angry, inflamed tissue where the outside looked acceptable. At about nineteen seconds I stop and show you the midsubstance — that isn’t a labrum with a tear in it. That’s a labrum that’s been degenerating for years.

And watch the counter keep climbing. It isn’t until well over a minute of continuous shaving, most of the way out toward the far side of the labrum, that I start reaching tissue that looks like it might be healthy.

That’s the argument in one clip. Nothing about the outside of that labrum predicted how far in the damage went.

Why I care so much about the diseased tissue specifically

Two reasons, and they’re the load-bearing ones for everything that follows.

Damaged labral tissue has nerve fibers in it. Chronically inflamed tissue hurts. It can be a pain generator all by itself, whether or not it’s mechanically attached to bone. If I fix that tissue back down to the bone, I’ve reattached a structure and left the pain source in place.

Damaged tissue probably doesn’t heal as well. A repair depends on that tissue healing back to bone. Tissue that’s been getting beaten up for years almost certainly has diminished healing potential.

So when I look at a chronically damaged labrum, I’m worried about two failure modes. It doesn’t heal properly and the person is disappointed in the first year. Or it heals reasonably well, they do fine for a while, and it breaks down at three or five or ten years — and now they’re back, older, needing the labral reconstruction anyway.

As one of my former coaches used to say, “if you’re not getting better…you’re getting worse.”

That labrum in the first video, the one I repaired in the early 2010s? I wouldn’t repair it today. Not because it was done badly — it wasn’t. Honestly, it looks pretty sweet, if I do say so myself. But because I’ve now seen enough of those people come back years later when it broke down over time. And so my approach to these tears has evolved, as has my technique, as I’ve learned what works well and what works better. I continue to try to get better every day.

The five things a surgeon can actually do

This is where the vocabulary matters, so here they are side by side — including what each one leaves behind, which is the part nobody writes down.

Every one of these is a legitimate operation performed by good surgeons. I’ve done all of them. What follows is why I’ve landed where I have — and it’s a set of tradeoffs, not a set of verdicts.

Why I don’t do segmental reconstruction

Segmental means grafting only the damaged part — say 11 o’clock to 2 o’clock on a right hip — and leaving the rest.

The appeal is obvious: take out less, keep more. And honestly, it’s technically easier and faster. Two problems.

The junctions are the weak points, and a segmental graft puts them in the worst possible place. Wherever graft meets native labrum you have a seam. Now think about where the hip actually carries load: roughly from 4 o’clock, up over the top, around to 10 o’clock in most patients. That’s the highest-force arc for ordinary human function and for sports.

A segmental graft from 11 to 2 has both of its seams sitting squarely inside that arc — in the middle of the load zone. That’s precisely where you’d least want a junction.

You’re also trusting tissue you haven’t looked inside. Go back to that second video. The damage extended much further than the outside of the labrum suggested. If I graft 11-to-2 and the degeneration actually runs to 4 o’clock, I’ve left a pain generator in place and put a junction right in the middle of bad tissue.

There’s a practical issue too: getting the graft length exactly right in a segmental reconstruction is genuinely difficult to do reproducibly, and the risk of leaving a gap is too high. Too short and it’s tight and/or leaves a gap in what is supposed to be a circumferential seal. Too long and it bunches and the lack of tension results in decreased stability. That’s a technical coin-flip I’d rather not build an operation around.

Why I don’t do augmentation as it’s usually described

Augmentation keeps the native labrum and places graft behind it to bolster it in the damaged zone. The intent is sound — preserve what’s there, add reinforcement.

I have a couple hesitations with augmentation. 1) It keeps the damaged tissue, which is the tissue with the nerve fibers in it. And in practice, by the time you’re in a hip where augmentation is being considered, there’s often not much left worth augmenting. 2) The remaining tissue can also sit in the way of the graft making clean continuous contact with the ball, so the seal isn’t quite what it could be.

Why I stopped doing full-footprint reconstruction on everybody

Early on I did a lot of the long 4:30-to-7:30 grafts. They work. But I kept having the same reaction in the operating room: I am removing a lot of perfectly good tissue to do this. Am I replacing it with something better?

There are hips where the entire labrum is cooked and that’s exactly what’s needed. In that case, I am replacing it with something better. But there are many more where the damage — or the insufficiency (a labrum that was never big enough to begin with) — is more focal than that. Taking out healthy tissue that’s still doing its job isn’t always a neutral or benign act.

So what do I actually do?

I tailor the reconstruction to the hip in front of me, inside a few firm guardrails. As far as I’m aware, nobody else does it in exactly this way — which is either a good sign or a bad one, so let me show you the reasoning and you can decide.

1. All the damaged and insufficient tissue comes out. Not just the visibly torn part — all of it, as far as the degeneration actually goes. I get some of that from the MRI, but mostly from working into the labrum and looking. This step dictates everything else, and it’s why I can’t always tell patients the exact operation in advance.

2. The graft length is set by the damage — plus enough to get past the high-stress zones. If the entire labrum is destroyed (most often seen in severe global pincer type impingement), then a full circumferential graft is the way to go. If it isn’t, the graft should span everything I’ve removed and then keep going, overlapping the native labrum until it’s past what I consider the high-stress zones in the front and the back of the hip.

In practice that usually means running from about 4 or 4:30 in the front, up over the top, around to about 9 or 8 o’clock in the back.

An example to illustrate what I’m talking about. Say the damaged and inadequate tissue runs from 2:30 around to 11 — a fairly typical cam-impingement pattern. All of that comes out, and that zone becomes pure graft. But the graft doesn’t stop at 2:30 and 11. It continues down to 4:30 in the front, where the labrum runs into the transverse acetabular ligament, and back to 9 behind. In those two extra stretches — 2:30 to 4:30, and 11 to 9 — the graft lies on top of and augments your own healthy labrum, which I’ve left in place.

That overlap at each end is the part I think matters most, and it deserves a name: the graft buttresses your own healthy labrum instead of meeting it end to end. A junction that overlaps isn’t a junction that has to hold on its own.

Look at where those overlaps end up relative to the load zone. The weight-bearing arc runs roughly 4 to 10 o’clock. My junctions sit at 2:30-to-4:30 and 11-to-9 — straddling the edges of that arc, not sitting in the middle of it. A segmental graft does the opposite. That’s not an accident of the technique; it’s the reason for it.

3. Which means what I’m actually doing is replacing damaged tissue and augmenting healthy tissue. That’s the distinction I’d most want you to take away, because it’s the one the vocabulary hides.

Conventional augmentation leaves the diseased labrum in place and adds graft to reinforce it. What I do is the mirror image: the diseased tissue is gone, and the graft is reinforced by — and reinforces — the healthy tissue on either side of it. Same word. Opposite substrate.

That overlap is the whole trick. Instead of two seams sitting in high-stress positions, the graft and your own tissue lie against each other over a distance and heal together into one continuous structure. Two boards glued along an overlap, not two boards butted end to end.

That’s the anteroinferior end, where the graft runs past the native labrum and transitions into the transverse acetabular ligament. This is a right hip out of traction in flexion moving thru motion and retaining a circumferential seal.

The same handoff from another angle: articular cartilage on the left, graft running down the rim, and at the bottom the graft passing behind the patient’s own healthy labral tissue.

4. Erring long, on purpose. If I’m unsure how far the damage goes, I go longer rather than shorter. A graft slightly longer than strictly necessary costs you nothing. A graft that stops short of the damage creates a gap and nullifies a large part of what we were trying to achieve.

5. The seal has to be continuous — including the bottom. Because the transverse acetabular ligament is functionally part of the same ring, the goal is a structure at the rim that seals the whole way around the femoral head, not one that stops where the anatomy textbook stops naming things.

Here’s what that produces:

This is a right hip out of traction — ball seated in the socket where it lives — moving through a normal arc of flexion and rotation.

Watch the labrum against the ball. First half, a failed repair: as the hip moves, the tissue doesn’t stay down on the ball, because it’s inadequate in size and is being tethered above the ball by scar tissue. The seal breaks. Second half, the same hip after reconstruction: as the hip goes from traction to out of traction, you can see the seal form as bubbles get expressed from the joint. The graft stays sealed against the head through the arc of motion.

A seal that only holds when the joint is still isn’t a functional seal.

What I’m trying to accomplish, stated plainly: restore the hoop-stress stability of a contiguous ring, replace worn-out tissue with sturdier collagen that has no nerve endings in it, and avoid the vulnerable junctions that come with grafting only a segment. As close to the original design as I can get.

What to call it

None of the five names above quite fits what I’ve just described, which is a problem when you’re trying to compare one surgeon to another. I’ve used “circumferential” myself — in published research and in talks — and it isn’t the right word. “Complete labral reconstruction” is closer. The most accurate description is something like patient-specific complete labral restoration: all the diseased tissue comes out, the healthy labrum at each end stays and gets buttressed by graft laid over it, and everything in between is rebuilt.

It’s a mouthful, and I doubt it catches on. But the label matters less than the thinking behind it — what came out, what stayed, and where the graft ends. Those are the questions worth asking whoever operates on your hip.

When I still repair — because I do

Everything above is about labra that shouldn’t be repaired, so let me show you one that should.

That’s a right hip, looking from back to front. Two sutures holding healthy labral tissue back down to the bone — and that’s all this hip needed. Compare it to the first two videos: same operation, completely different tissue.

Repair is the right operation when the tissue deserves it. That means, roughly, all of the following:

• A more acute injury. An actual traumatic tear, which in hip preservation is the exception rather than the rule.
• A younger patient, with healing capacity on their side.
• Native labral tissue that’s genuinely big and sturdy enough to form a seal and hold the femoral head steady after the repair — assessed from the inside, not the outside.
• Not hypermobile.

When those line up, I repair, and I’m glad to. The point of this post isn’t that repair is a bad operation. It’s that the conditions under which it’s the most durable and predictable operation are less common than the way we talk about it suggests.

A note on hypermobility

If you have a generalized hypermobility disorder — Ehlers-Danlos and its relatives — my working assumption is that your collagen isn’t going to do you any favors. That’s the whole condition. Repairing loose, stretchy tissue and asking it to hold a seal against a hip that’s already unstable is asking a lot. In those hips I want to put in stronger, more reliable collagen than the tissue you have, and I’m going to be thinking about microinstability and the capsule and the stability conferred by the bone structure at the same time.

And when I just debride

There are hips where the labrum genuinely isn’t contributing to the problem. In those, I’ll do a limited debridement, or just leave it alone. The labrum isn’t always a cause of a person’s hip pain/dysfunction.

That said, I also want to eliminate any variable that might compromise the result — so this is pretty rare in my practice. Let’s do this once and be done with it is my approach in every case.

Does it hold up?

Fair question, and hard to answer honestly — the only way to truly know what a hip looks like inside is to look inside it, and we don’t re-operate on people who are doing well. Occasionally someone needs another arthroscopy years later for an unrelated reason, and we get to see.

Two years out, out of traction, moving through flexion and rotation. The graft has been incorporated into a contiguous ring and it’s still sealing all the way around the femoral head.

Here’s one earlier in the healing curve — a second look at six months, with me probing the graft and the junction where it meets the patient’s own labrum to test whether it’s stable:

I’ll note the date on that one: 2015. I’ve been doing this operation, and showing the results of my technique and approach as it has evolved at various meetings, for well over a decade.

Two hips isn’t a study and I won’t pretend otherwise. But it’s consistent with what’s been published: when surgeons have gone back in and looked at reconstructed labra a couple of years out, the vast majority of grafts are well integrated, with the junction to the bone restored. What I can show you is what it looks like — not what a histology slide would show.

“Wait — donor tissue? Will my body reject it?”

Another common question, usually about four seconds after the word “graft.”

No. Nobody takes anti-rejection medication after this, and clinically significant rejection of processed soft-tissue graft has not been demonstrated.

The confusion makes sense, because everyone’s mental model for donor tissue is organ transplant — matching, waiting lists, immunosuppressants for life. That model doesn’t apply. There’s no tissue typing and no matching, because compatibility isn’t the relevant question. There are no anti-rejection medications, before or after.

Here’s why. What goes into your hip isn’t living tissue. It’s processed collagen — the cellular material your immune system would react to has been removed. What’s left is a scaffold of structural protein.

Which answers the other questions I get, usually phrased as “if it’s dead tissue, why doesn’t it just rot in there?” or “doesn’t it just wear out if it’s dead?” It doesn’t rot because rotting is what bacteria do to tissue that isn’t sterile, and the grafts are sterile. It doesn’t need a blood supply because it isn’t alive and has no cells to feed. And over the months following surgery your own cells migrate in and colonize it. The scaffolding is donated. What grows into it is yours. (You’ll hear this called “cadaver tissue,” including by other patients. Accurate word, misleading impression.)

Is it perfectly inert? Not quite, researchers have been able to detect low-level immune activity around orthopedic grafts under a microscope. What hasn’t been shown, across an enormous number of these procedures, is that it’s of any clinical consequence. This is a theoretical concern far more than a practical one.

On safety: allografts in the US come from tissue banks accredited by the American Association of Tissue Banks and regulated by the FDA, with donor history screening, blood testing, and nucleic acid testing for HIV and hepatitis. About 2.5 million tissue grafts are transplanted in this country annually and transmitted infection is extraordinarily rare.

What the research says — and how I read it

I’ve published on this a lot, so let me be straight about both what my own data shows and where I’m going beyond it.

In our 2018 study in the American Journal of Sports Medicine we compared 162 hips — 99 repairs and 63 reconstructions — at two years. The reconstruction patients were in worse shape going in by a wide margin: average age 43 versus 30, more arthritis, and severe labral damage in 68% of them versus 5% of the repair group. After accounting for those differences, we found no significant difference in outcomes.

Put another way: we were solving objectively tougher problems and achieving the same results as we do in patients with objectively easier ones.

We followed these patients out to a minimum of five years and published that in 2022: results held, and the reconstruction group actually showed a larger improvement in hip scores as more time passed.

Zoom out and the whole field says roughly the same thing. Pooled across 17 studies and more than 2,000 hips, patient-reported outcomes come out equivalent between repair and reconstruction. There are no randomized trials, and there probably never will be.

So why don’t I read that as “it’s a tie”? Two reasons.

First: the studies are comparing labels, not operations. Every one of those papers sorts hips into buckets — repair, segmental, circumferential, augmentation. I’ve just spent two thousand words explaining why those buckets contain meaningfully different operations, and I haven’t even raised the differences in surgeon technique, skill, and experience. Two surgeons both reporting “reconstruction” may differ on how much diseased tissue came out, whether the graft overlapped native tissue or butted against it, and whether the entire ring was restored, etc. Those aren’t details. In my experience they’re the things that decide whether a hip is still doing well in ten years. When you pool operations that differ on the variables that matter, you should expect to find no difference — that’s what averaging does.

Second: the questionnaires top out. Nearly all of these studies are decided by patient-reported scores that ask about climbing stairs, putting on socks, walking a few blocks. Think about what that means for someone doing well: a patient back at work at a desk job with a hip that sometimes aches on long days and a patient back to competitive rowing who never thinks about her hip answer those questions identically. The instrument has nothing left to measure.

That’s not a complaint I invented. The modified Harris Hip Score has a documented 24% ceiling at one to two years. In one 300-patient study, between 13% and 43% of patients hit the literal maximum on every instrument tested except a general health survey. When 38 international investigators reviewed these tools in 2020, they declined to recommend the modified Harris Hip Score or the HOS at all. And in a study our own multicenter group published, the composite score held up reasonably — but nine of the twelve individual questions had topped out by two years and all twelve had by five years.

Where the ceiling can’t hide things, the picture changes. A ten-year study published this year looked at patients whose labra were small on preoperative MRI: roughly three times the revision rate and four times the rate of going on to hip replacement — with no difference on the questionnaires at all. Another looked at patients who’d had both hips done by the same surgeon, a repair on one side and a reconstruction on the other. None of the reconstructions failed. Nine of twenty-nine repairs did. Among the hips that didn’t fail, the outcome scores were identical.

And our own multicenter data on more than 600 labral repairs found that when the labrum was degenerated at surgery — yellowed, calcified, or ossified across at least half of it — the odds of reaching a meaningful improvement dropped by roughly half. Same operation, different tissue, worse result.

Where I could be wrong

I’d be doing you a disservice if I only gave you what agrees with me.

The most prominent counterargument came last year in the Journal of Bone and Joint Surgery: comparing 150 primary reconstructions to nearly 1,000 repairs, reconstruction patients converted to hip replacement about three times as often, 20% versus 7%. The accompanying editorial was titled “A Vote Against the Widespread Adoption of Primary Labral Reconstruction.” That’s a serious paper, from serious people I know, like, and respect.

My read is that it’s largely confounded by who gets which operation — reconstruction patients in every study are older with worse cartilage, which is why they got reconstructions, and articular cartilage is what determines who needs a replacement. But that’s my interpretation of their result, not a refutation of it.

Two things I won’t claim, because the evidence isn’t there: reconstruction has not been shown to prevent arthritis or delay hip replacement. And in laboratory models, reconstruction is dramatically better than removing the labrum but does not outperform a good repair on sealing — which is exactly why I still repair when the tissue genuinely deserves it, that is–I believe it will heal and stay healthy for the long term.

And here’s the part I want to say out loud, because someone will think it: “my technique is different, so the studies don’t apply to me” is a convenient thing for any surgeon to believe. It’s also the last refuge of people whose results don’t hold up. I’m aware of the shape of that argument.

It’s why I keep publishing, and why I’ve contributed to the multicenter registry even though it doesn’t isolate what I do. When our MASH group publishes, it’s typical that we can’t find a significant difference between one technique and another. In some ways that’s frustrating, because I’m confident differences exist — I’ve seen them and lived them with patients. Our outcome measures as a field don’t really capture what I hear and see in my clinic. In other ways it’s reassuring: it means there are many viable options across a broad range of patients and problems, and that competent surgeons can get to satisfactory results by different routes.

The trick is knowing which option will optimize the outcome for the patient in front of you that day. In my mind, the goal has to be: do it once — or once more — do it right, recover right, and never do it again.

So judge the reasoning. And ask any surgeon you see, including me, to tell you exactly what they’re going to do and why.

Will I know before surgery? What if the plan changes while I’m asleep?

Before surgery, I try to give people my best prediction and my contingency plans. What I expect to find, what I’m likely to do, and what I’m going to do if I see something different from what I expect. Those are good questions to ask before any operation, not just this one — and if a surgeon can’t tell you their plan B, that’s worth knowing beforehand rather than after.

And yes, some of it genuinely gets decided in the room — you’ve now seen why. An MRI often gives us a good idea. But MRI machines and techniques vary, and so do the radiologists reading them. That’s not a knock on radiologists; they usually don’t know what I’m looking for, and they don’t know the patient or the history beyond a one-line “hip pain.” I find it extremely valuable to look at the actual images myself, to get a better sense of whether someone should have surgery at all, what operation it should be, and what we might run into. Even then, an MRI may show a tear but is less reliable about what the tissue is like inside where we can see it and touch it, and watch how it behaves when the hip is moved around.

Ask for the pictures. I take intraoperative photos that I give to patients and I’d love it if you understood what the problem was and how we addressed it. To be fair, not everyone is actually interested, which is fine. One patient told me he’d been handed “a bunch of pictures that look like they might’ve been taken on the moon,” which is fair. I do my best to explain what we did, but sometimes I think I could be showing people actual pictures of the moon. That’s fine. Ask anyway — those images can come in very handy if you ever have trouble down the road.

“Am I too old for this?”

Patients get told they’re too old at 39, at 45, at 54.

There isn’t a number. The major criterion is your cartilage, not your birthday. A 55-year-old with well-preserved cartilage and a destroyed labrum is a better candidate than a 32-year-old whose joint space — the articular cartilage — is already gone. Age correlates with cartilage wear, which is why it gets used as shorthand. But shorthand is how people get turned away from an operation that would have helped them.

If you’ve been told you’re too old, ask: too old, or is my cartilage too far along? Different sentences, different consequences, and only one of them is actually about you.

Can a reconstruction fail?

Yes — though the graft itself is rarely the reason.

A graft can break down, and that does happen. But far more often the problem is something else that went wrong or was inadequately addressed: a capsule that didn’t heal, scar tissue, bone correction that wasn’t quite right, a reinjury, loading the hip to extremes before it was ready, or persistent microinstability that wasn’t addressed.

That’s a big part of why revision cases take me longer to plan than primary ones. Redoing a hip surgery without figuring out why the last one failed is how people end up on their third operation.

Does the operation change my recovery?

No. I rehab repairs and debridements the same way I rehab reconstructions.

The philosophy is simple: the hip knows. We’re operating because somewhere along the line your hip stopped compensating for the mechanical flaws it had, and you got caught in a cycle of inflammation and the loss of neuromuscular control and function that follows it (often heard in my clinic: “I can’t get my glute to work”). You’ve already proven you can’t get back on the right side of that equation without the mechanics being fixed first.

So how do we do that? Let the inflammation come down, and gradually get you moving without the inflammation and dysfunction coming back. That varies between patients — but rarely between operations. With rare exceptions, your hip is mechanically sound and stable by the time we leave the operating room. It’s the biology and the inflammation that need to get right, and normal function returns on its own if you don’t push too hard or get pushed too hard during the recovery process.

Roughly: weight-bearing as tolerated from day one, crutches about four weeks — crutches are there to let inflammation settle, not because your hip is fragile — walking short distances within a week or two, driving around ten days to two weeks for a right hip and a few days for a left, normal life somewhere between six weeks and three months, running around three months, sport around six months.

Two honest caveats, because I think our specialty has a credibility problem here.

The tail is long and most quoted timelines ignore it. A fair version: about 80–90% of the way back at around six months, and the last 10–20% can take a year or two. If someone hands you a single number and stops there, that number is describing the good part of the curve.

Feeling good at six weeks is the most dangerous moment in the recovery. The pain is gone, the hip feels great, and it’s very easy to do too much and set yourself back several weeks. The people who get in trouble are almost never the ones who did too little.

Better at a year, better still at two. The goal isn’t to be healed by a date on the calendar. It’s to not be thinking about your hip at all in a year or two.

The bottom line

The question isn’t really “repair or reconstruct.” It’s: how much of this labrum is actually healthy, how far does the damage go, and what’s the most durable, mechanically sound seal I can build with what’s there?

Most of the time, once I’ve considered all of the factors and can look directly at the labral tissue, the answer is a tailored reconstruction: all the diseased tissue out, and a graft that runs past it on both ends to overlap and reinforce the healthy labrum that’s left. Not reinforcing damaged tissue — replacing it, and reinforcing the good tissue on either side. Sometimes the answer is a repair. Occasionally, it’s to leave the labrum alone entirely.

What determines your result isn’t which of those you get. It’s whether the surgeon looking at your hip can do all of them, looks at the tissue and the patient who it belongs to critically before deciding, picks correctly, and executes precisely — with the goal of doing this only once.

Hip preservation is the only thing I do. I don’t do hip replacements. So if your hip hurts and you don’t have arthritis or your hip still hurts following a previous scope, or if you just want a straight answer about what your hip needs — request an appointment or set up a telehealth visit.

Dr. Andrew Wolff is a hip preservation specialist in the Washington, DC area and a member of the Multicenter Arthroscopic Study of the Hip (MASH) group. He is lead author of Primary Circumferential Acetabular Labral Reconstruction (American Journal of Sports Medicine, 2018) and Primary Arthroscopic Labral Management: Labral Repair and Complete Labral Reconstruction Both Offer Durable, Promising Results at Minimum 5-Year Follow-up (American Journal of Sports Medicine, 2022). Read more of Dr. Wolff’s research.

Copyright 2026. Andrew Wolff MD.