Criteria for the Operating Room Confirmation of the Diagnosis of Hip Instability: The Results of an International Expert Consensus Conference

Safran, Marc R.; Murray, Iain R.; Andrade, A. J.; Aoki, Stephen K.; Ayeni, Olufemi R.; Balakumar, Jitendra; Bonin, Nicolas; Brick, Matthew J.; Cakic, Josip Nenad; Domb, Benjamin G.; Field, Richard E.; Laude, F.; Mei-Dan, Omer; Nho, Shane J.; O’Donnell, John; Philippon, Marc J.; Khanduja, Vikas

doi:10.1016/j.arthro.2022.03.027

Cited by 15 publications

(5 citation statements)

References 73 publications

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“…A recent consensus on intra-operative criteria for the diagnosis of hip micro-instability has been published [ 328 ]. However, at MR imaging, the diagnostic criteria are not clear.…”

Section: Hipmentioning

confidence: 99%

SSR white paper: guidelines for utilization and performance of direct MR arthrography

Chang,

Bencardino,

French

et al. 2023

Skeletal Radiol

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Objective Direct magnetic resonance arthrography (dMRA) is often considered the most accurate imaging modality for the evaluation of intra-articular structures, but utilization and performance vary widely without consensus. The purpose of this white paper is to develop consensus recommendations on behalf of the Society of Skeletal Radiology (SSR) based on published literature and expert opinion. Materials and methods The Standards and Guidelines Committee of the SSR identified guidelines for utilization and performance of dMRA as an important topic for study and invited all SSR members with expertise and interest to volunteer for the white paper panel. This panel was tasked with determining an outline, reviewing the relevant literature, preparing a written document summarizing the issues and controversies, and providing recommendations. Results Twelve SSR members with expertise in dMRA formed the ad hoc white paper authorship committee. The published literature on dMRA was reviewed and summarized, focusing on clinical indications, technical considerations, safety, imaging protocols, complications, controversies, and gaps in knowledge. Recommendations for the utilization and performance of dMRA in the shoulder, elbow, wrist, hip, knee, and ankle/foot regions were developed in group consensus. Conclusion Although direct MR arthrography has been previously used for a wide variety of clinical indications, the authorship panel recommends more selective application of this minimally invasive procedure. At present, direct MR arthrography remains an important procedure in the armamentarium of the musculoskeletal radiologist and is especially valuable when conventional MRI is indeterminant or results are discrepant with clinical evaluation.

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“…A recent consensus on intra-operative criteria for the diagnosis of hip micro-instability has been published [ 328 ]. However, at MR imaging, the diagnostic criteria are not clear.…”

Section: Hipmentioning

confidence: 99%

SSR white paper: guidelines for utilization and performance of direct MR arthrography

Chang,

Bencardino,

French

et al. 2023

Skeletal Radiol

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“…The anterior wall index, posterior wall index, and femoroepiphyseal acetabular roof index are radiographic markers of hip instability that were not included in this investigation 60 . Recently, the inside-out pattern of chondral damage on the acetabulum 61 , in addition to other intraoperative findings of hip instability during hip arthroscopy, was described 62 . However, these were not recorded during the study period.…”

Section: Discussionmentioning

confidence: 99%

Borderline Dysplasia After Primary Hip Arthroscopy with Capsular Plication and Labral Preservation

Domb

Owens

Glein

et al. 2023

Journal of Bone and Joint Surgery

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Background: The arthroscopic management of borderline hip dysplasia (BHD) is controversial, and long-term follow-up data are scarce. The purpose of this study was to report prospectively collected survivorship and patient-reported outcome measures (PROMs) at a minimum 10-year follow-up following primary hip arthroscopy with capsular plication and labral preservation in patients with BHD.Methods: Data were prospectively collected on all patients who underwent primary hip arthroscopy between September 2008 and September 2011. Patients with BHD (defined by a lateral center-edge angle [LCEA] between 18°and 25°) were included. Preoperative and minimum 10-year follow-up scores for the modified Harris hip score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score-Sports Specific Subscale (HOS-SSS), and visual analog scale (VAS) for pain were collected. Exclusion criteria were prior ipsilateral hip surgery, Workers' Compensation status, Tönnis grade of >1, previous hip conditions, or LCEA of <18°. Survivorship was defined as no conversion to total hip arthroplasty (THA). The risk factors for THA conversion were analyzed. The achievement rate for the minimal clinically important difference (MCID) was reported. A propensity-matched comparison with a control group without BHD was performed.Results: Forty-five (80%) of 56 eligible hips were included in this study: 38 hips (84%) of female patients and 7 hips (16%) of male patients. The mean patient age was 31.0 ± 12.9 years, and the mean patient body mass index (BMI) was 24.5 ± 5.4 kg/m 2 . The 10-year survivorship was 82.2%, and there was significant improvement in all PROMs and VAS pain from baseline to the minimum 10-year follow-up (p < 0.001). The odds of undergoing conversion to THA were 4.4 times higher for patients with a BMI of ‡23 kg/m 2 and 7.1 times higher for patients who were ‡42 years of age. The MCID was achieved at high rates for the mHHS (79%), NAHS (79%), HOS-SSS (70%), and VAS pain (76%). The minimum 10-year survivorship, PROMs, and MCID achievement rates for the BHD group were comparable with those for the control group.Conclusions: Patients with BHD who underwent primary hip arthroscopy with capsular plication and labral preservation demonstrated an overall survivorship of 82.2% and significant improvement in all PROMs and achieved the MCID at high rates at a minimum 10-year follow-up.

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“… 5 , 7 , 17 , 19 While there is continued debate on an objective definition of hip instability, a generally accepted definition for the diagnosis of hip instability is painful, extraphysiological movement of the hip joint. 30 Demographic characteristics have also been associated with joint laxity, including hip dysplasia and female sex. 9 , 36 It has also been shown in women that intraoperative joint laxity is associated with a thinner hip capsule as measured on magnetic resonance imaging (MRI).…”

mentioning

confidence: 99%

Relationship Between Hip Capsular Thickness and Instability After Previous Hip Arthroscopic Surgery: A Matched-Cohort Analysis

Ohlsen,

Metz,

Froerer

et al. 2024

Orthopaedic Journal of Sports Medicine

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Background: Thinner anterior hip capsules are associated with hip laxity, but there is little known about the impact of capsular thickness on the development of instability after primary hip arthroscopic surgery. Purpose: To investigate the relationship between hip capsular thickness as measured on preoperative magnetic resonance imaging (MRI) and the development of hip instability after hip arthroscopic surgery for femoroacetabular impingement. Study Design: Case-control study; Level of evidence, 3. Methods: We reviewed revision hip arthroscopic procedures performed between January 1, 2019, and May 1, 2021, at a single institution. Inclusion criteria were preoperative MRI/magnetic resonance arthrography, completion of the study traction protocol, and asymmetric distraction between the hips of ≥3 mm on examination under anesthesia. A comparison group of patients treated for femoroacetabular impingement with primary hip arthroscopic surgery who did not develop capsular instability were matched 1:1 to the patients with instability. Superolateral hip capsular thickness was measured on MRI before index surgery. Analysis was conducted using independent-samples t tests and multivariable linear regression. Results: A total of 44 patients were included, with 22 patients each in the instability and no-instability groups. The mean capsular thickness was lower in the patients with hip instability than in those without (1.9 ± 0.6 vs 3.4 ± 1.1 mm, respectively; P < .001). Decreased capsular thickness was significantly associated with hips with instability versus no-instability (β = −1.468 [95% CI, –2.049 to −0.887]; P < .001). Conclusion: Thinner preoperative hip capsules in the region of the iliofemoral ligament were seen in patients who subsequently underwent revision arthroscopic surgery for hip instability compared to patients who underwent primary hip arthroscopic surgery without subsequent revision. Patients at a higher risk for the development of postoperative hip instability had a superolateral hip capsular thickness of <2 mm.

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Criteria for the Operating Room Confirmation of the Diagnosis of Hip Instability: The Results of an International Expert Consensus Conference

Cited by 15 publications

References 73 publications

SSR white paper: guidelines for utilization and performance of direct MR arthrography

SSR white paper: guidelines for utilization and performance of direct MR arthrography

Borderline Dysplasia After Primary Hip Arthroscopy with Capsular Plication and Labral Preservation

Relationship Between Hip Capsular Thickness and Instability After Previous Hip Arthroscopic Surgery: A Matched-Cohort Analysis

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