Hip Instability

Nonarthritic Hip Joint Pain

“…16, 178 Hip instability may be traumatic, atraumatic, or secondary to bony or soft tissue abnormality. Factors related to structural instability of the joint include a shallow acetabulum and an excessive femoral anteversion.…”

Influence of Capsular Repair Versus Unrepaired Capsulotomy on 2-Year Clinical Outcomes After Arthroscopic Hip Preservation Surgery

“…[20][21][22][23][24] Recently, there has been a growing focus on preserving or restoring capsular integrity through a more judicious approach to capsular management or through arthroscopic repair techniques. 1,2,[4][5][6][7]21,[25][26][27] Advocates of capsular repair argue that even if a pseudocapsule forms, it is composed largely of fibrous scar tissue, with poorer compliance and biomechanical properties. A growing number of iatrogenic instability events are emerging in the literature, ranging from joint subluxation to frank dislocation to "rapidly progressive osteoarthritis" after hip arthroscopy.…”

“…13 Capsular insufficiency and altered joint mechanics may then lead to an augmented shear vector across the articular cartilage and contribute to early joint degeneration. 1,2,6,13 In clinical studies, unaddressed capsular laxity represents a common cause for failure of primary arthroscopic hip surgery and a frequent indication for revision surgery. [14][15][16] Traditionally, hip arthroscopists have used strategic capsulotomies or focal capsulectomy for atraumatic entry into the joint and effective mobility within the central and peripheral compartments.…”

“…[1][2][3][4][5][6][7][8][9] The capsuloligamentous envelope is composed of the iliofemoral, pubofemoral, and ischiofemoral ligaments, in addition to the zona orbicularis and iliocapsularis. [1][2][3][4][5][6][7][8][9] Capsular anatomy has been extensively mapped out, and its biomechanical role defined, in several anatomic studies. [3][4][5][7][8][9] The relative importance of the hip joint capsule is believed to depend largely on the volume, morphology, and version of the quasihemispheric acetabulum and proximal femur, as well as the biology of the surrounding connective tissues.…”

“…[3][4][5][7][8][9] The relative importance of the hip joint capsule is believed to depend largely on the volume, morphology, and version of the quasihemispheric acetabulum and proximal femur, as well as the biology of the surrounding connective tissues. 1,2,6,10 This marriage of complementary bony and soft-tissue restraints has been used to define a "stability index," which has been used to predict microinstability and attrition of the ligamentum teres. 11,12 Structural instability of the hip, resulting from acetabular dysplasia or alterations in proximal femoral version, may further potentiate capsular attenuation by increasing demand on the capsuloligamentous constraints.…”