Catastrophic Failure of Hip Arthroscopy Due to Iatrogenic Instability: Can Partial Division of the Ligamentum Teres and Iliofemoral Ligament Cause Subluxation?

Mei-Dan, Omer; McConkey, Mark O.; Brick, Matthew J.

doi:10.1016/j.arthro.2011.12.005

Cited by 213 publications

(111 citation statements)

References 22 publications

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“…Because the consequences of hip arthroscopy in unstable hips can be severe [12,13,15,17], we named this angle the Femoro-Epiphyseal Acetabular Roof (FEAR) index. This study was performed to verify a possible correlation between this new parameter and either unstable or stable borderline dysplastic hips.…”

Section: Introductionmentioning

confidence: 99%

The Femoro-Epiphyseal Acetabular Roof (FEAR) Index: A New Measurement Associated With Instability in Borderline Hip Dysplasia?

Wyatt

Weidner

Pflüger

et al. 2017

Clinical Orthopaedics &Amp; Related Research

144

161

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Background The definition of osseous instability in radiographic borderline dysplastic hips is difficult. A reliable radiographic tool that aids decision-makingspecifically, a tool that might be associated with instability-therefore would be very helpful for this group of patients. Questions/purposes (1) To compare a new radiographic measurement, which we call the Femoro-Epiphyseal Acetabular Roof (FEAR) index, with the lateral centeredge angle (LCEA) and acetabular index (AI), with respect to intra-and interobserver reliability; (2) to correlate AI, neck-shaft angle, LCEA, iliocapsularis volume, femoral antetorsion, and FEAR index with the surgical treatment received in stable and unstable borderline dysplastic hips; and (3) to assess whether the FEAR index is associated clinical instability in borderline dysplastic hips. Methods We defined and validated the FEAR index in 10 standardized radiographs of asymptomatic controls using two blinded independent observers. Interrater and intrarater coefficients were calculated, supplemented by Bland-Altman plots. We compared its reliability with LCEA and AI. We performed a case-control study using standardized radiographs of 39 surgically treated symptomatic borderline radiographically dysplastic hips and 20 age-matched controls with asymptomatic hips (a 2:1 ratio), the latter were patients attending our institution for trauma unrelated to their hips but who had standardized pelvic radiographs between January 1, 2016 and March 1, 2016. Patient demographics were assessed using univariate Wilcoxon two-sample tests. There was no difference in mean age (overall: 31.5 ± 11.8 years [95% CI, 27.7-35.4 years]; stable borderline group: mean, 32.1± 13.3 years [95% CI, 25.5-38.7 years]; unstable borderline group: mean, 31.1 ± 10.7 years [95% CI, 26.2-35.9 years]; p = 0.96) among study groups. Treatment received was either a periacetabular osteotomy (if the hip was unstable) or, for patients with femoroacetabular impingement, either an open or arthroscopic femoroacetabular impingement procedure. The association of received treatment categories with the variables AI, neck-shaft angle, LCEA, iliocapsularis volume, femoral antetorsion, and FEAR index were evaluated first using Wilcoxon two-sample tests (two-sided) followed by stepwise multiple logistic regression analysis to identify the potential associated variables in a combined setting. Sensitivity, specificity, and receiver operator curves were calculated. The primary endpoint was the association between the FEAR index and instability, which we defined as migration of the femoral head either already visible on conventional radiographs or recentering of the Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. Results The FEAR index showed excellent intra-and interobserver reliability, ...

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Section: Introductionmentioning

confidence: 99%

The Femoro-Epiphyseal Acetabular Roof (FEAR) Index: A New Measurement Associated With Instability in Borderline Hip Dysplasia?

Wyatt

Weidner

Pflüger

et al. 2017

Clinical Orthopaedics &Amp; Related Research

144

161

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“…Despite preservation of the labrum and no rim resection, this patient developed hip subluxation 3 months post-operatively with end stage arthritis at a year. This indicates that preservation of the anterior capsule/iliofemoral ligament might play a critical role in stability for some hips and in particular for those with borderline dysplastic features [37]. There are no published controlled studies to date, however, reporting outcomes and or stability after repaired and unrepaired capsulotomies.…”

Section: The Hip Capsulementioning

confidence: 86%

“…Although patients with connective tissue disorders such as Ehlers Danlos may be the most extreme example, there appears to be a subset of patients with activity induced anterior laxity and subtle dysplastic variants/borderline dysplasia for which preservation or even plication of the capsule might be an important factor to consider if arthroscopic management is pursued. In addition, there has been a recent case report of a mildly dysplastic hip that underwent labral repair, partial ligamentum teres debridement, and modest capsulotomy without repair [37]. Despite preservation of the labrum and no rim resection, this patient developed hip subluxation 3 months post-operatively with end stage arthritis at a year.…”

Section: The Hip Capsulementioning

confidence: 99%

Current concepts and trends for operative treatment of FAI: hip arthroscopy

Larson

Stone

2013

Curr Rev Musculoskelet Med

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There has been an increasing body of literature regarding arthroscopic management of femoroacetabular impingement (FAI). Refinement of arthroscopic techniques has allowed for more complete management of FAI, and metaanalysis and systematic reviews have shown comparable outcomes to surgical hip dislocation with appropriate indications. There are still, however, pathomorphologies that are not accessible or much more challenging to address arthroscopically, and open corrective procedures should be considered in these situations. Extra-articular FAI is receiving increased attention and can be secondary to anterior inferior iliac spine/subspine impingement, trochanteric-pelvic impingement, and ischiofemoral impingement. Femoral and acetabular version and their impact on hip stability as well as the concept of impingement induced instability are being increasingly recognized. Acetabular labral and capsular management and repair techniques have also received increased attention. Finally, 3-dimensional imaging and dynamic software analysis are beginning to emerge as potential tools to better evaluate hip pathomorphology.

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“…[2][3][4][5][6][7] Most of these cases have been successfully treated with revision primary capsular closure. 2,3 Conversely, Dierckman and Guanche 4 reported a case of anterior dislocation after an unclosed capsulotomy site progressed to a large 2.5 Â 4ecm capsular defect; at revision surgery, the senior author reconstructed the anterior capsule with iliotibial band autograft.…”

Section: Discussionmentioning

confidence: 99%

“…1 There are 7 reported cases of hip dislocation after hip arthroscopy, [2][3][4][5][6][7] but the actual number of dislocations is thought to be largely under-reported. Although gross instability of the hip is rare because of its osseous congruency, microinstability is attributed to improper capsular management after prior surgery.…”

mentioning

confidence: 99%

Capsular Plication for Treatment of Iatrogenic Hip Instability

Levy

Grzybowski

Salata

et al. 2015

Arthroscopy Techniques

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The most commonly reported reasons for persistent hip pain after hip arthroscopy are residual femoroacetabular impingement, dysplasia and dysplasia variants, or extra-articular impingement. There are some cases in which the underlying osseous pathomorphology has been appropriately treated, and the cause of persistent hip pain can be soft-tissue injuries such as chondrolabral tears or capsular abnormalities. Capsular defects after hip arthroscopy may suggest an alteration of the biomechanical properties of the iliofemoral ligament and lead to iatrogenically induced hip instability. There are a growing number of biomechanical and clinical studies showing the importance of capsular management during hip arthroscopy. We describe the workup, examination under anesthesia, diagnostic arthroscopy, and technique of capsular plication for iatrogenic instability of the hip.

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Catastrophic Failure of Hip Arthroscopy Due to Iatrogenic Instability: Can Partial Division of the Ligamentum Teres and Iliofemoral Ligament Cause Subluxation?

Cited by 213 publications

References 22 publications

The Femoro-Epiphyseal Acetabular Roof (FEAR) Index: A New Measurement Associated With Instability in Borderline Hip Dysplasia?

The Femoro-Epiphyseal Acetabular Roof (FEAR) Index: A New Measurement Associated With Instability in Borderline Hip Dysplasia?

Current concepts and trends for operative treatment of FAI: hip arthroscopy

Capsular Plication for Treatment of Iatrogenic Hip Instability

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