Hip microinstability diagnosis and management: a systematic review

Cohen, Dan; Jean, Pierre-Olivier; Patel, Matthew; Aravinthan, Neveadan; Simunovic, Nicole; Duong, Andrew; Safran, Marc R.; Khanduja, Vikas; Ayeni, Olufemi R.

doi:10.1007/s00167-022-06976-7

Cited by 13 publications

(4 citation statements)

References 42 publications

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“… 24 , 25 In addition, several studies have demonstrated the microinstability of hip joints after hip arthroscopy, which may be caused by the lack of an intact joint capsule. 9 , 23 , 34 Nevertheless, the need for hip capsule repair after arthroscopy is controversial. The studies performed to date have yielded differing results: Some have shown no significant difference between groups of patients who undergo capsular repair and those who do not, 1 , 13 while others have shown a significant advantage, in the form of superior postoperative scores, for patients who undergo capsule repair.…”

Section: Discussionmentioning

confidence: 99%

Capsular Repair Versus No Repair After Hip Arthroscopy in Patients Without Dysplasia or Generalized Ligamentous Laxity: A Systematic Review and Meta-analysis

Shen,

Li,

Xue

et al. 2024

Orthopaedic Journal of Sports Medicine

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Background: Many recent studies have shown that patients who undergo capsular repair after hip arthroscopy achieve superior clinical outcomes compared with those who do not. However, patients with dysplasia or generalized ligamentous laxity (GLL) were not excluded from most of these studies, which may have affected the outcomes. Purpose: To determine whether capsular repair influences the outcomes of hip arthroscopy for patients without dysplasia or GLL. Study Design: Systematic review; Level of evidence, 1. Methods: Under the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, randomized controlled trials comparing the outcomes of capsulotomy with versus without repair were included, but studies that included patients with dysplasia or GLL were excluded. The study outcomes were patient-reported outcome measures (PROMs) at 6 months and 2 years postoperatively—including the modified Harris Hip Score (mHHS), Hip Outcome Score–Activities of Daily Living (HOS-ADL), and Hip Outcome Score–Sport-Specific Subscale (HOS-SSS)— and were compared between the repair and no-repair groups. A narrative analysis and meta-analysis were performed to integrate and compare the results of the 2 groups. In the meta-analysis of the outcome measures, studies with significant differences in the preoperative scores between the repair and no-repair groups were excluded because previous studies have shown that these can affect the outcomes. Results: A total of 761 studies were initially identified, of which 3 were included. Of the 322 included patients, 136 underwent capsular repair, and 186 underwent capsulotomy with no repair. The meta-analysis showed that capsular repair was associated with significantly higher postoperative PROMs: the mHHS at 2 years ( P = .03), the HOS-ADL at 6 months ( P = .02) and 2 years ( P < .0001), and the HOS-SSS at 6 months ( P = .02) and 2 years ( P = .001). Conclusion: Capsular repair after hip arthroscopy was associated with superior clinical outcomes when compared with no capsular repair in patients without dysplasia or GLL.

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Section: Discussionmentioning

confidence: 99%

Capsular Repair Versus No Repair After Hip Arthroscopy in Patients Without Dysplasia or Generalized Ligamentous Laxity: A Systematic Review and Meta-analysis

Shen,

Li,

Xue

et al. 2024

Orthopaedic Journal of Sports Medicine

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“…Second, this study did not evaluate demographic or physical examination variables that have been correlated with microinstability. 14-16,40 However, previous data have demonstrated that atraumatic microinstability is associated with less articular cartilage damage compared with cam deformity FAIS. 1 Therefore, it is unlikely that this limitation would confound the study results.…”

Section: Discussionmentioning

confidence: 99%

Association of Cam Deformity on Anteroposterior Pelvic Radiographs and More Severe Chondral Damage in Femoroacetabular Impingement Syndrome

et al. 2022

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Background: Abnormal proximal femoral morphology in femoroacetabular impingement syndrome (FAIS) identifiable on the anteroposterior (AP) pelvic radiograph has been described as the “pistol grip” deformity. The effect of a superior cam deformity identified on this radiographic view remains unknown. Purposes: To assess the relationship between AP cam deformity (AP alpha angle [AP AA] >55°) and cartilage injury; to assess the relationship between AP cam deformity and labral injury; and to determine if patient factors are correlated with cartilage and labral injury. Study Design: Case-control study; Level of evidence, 3. Methods: Patients undergoing osteochondroplasty and labral repair for FAIS with a single surgeon were identified retrospectively. Intraoperative size, location, and severity of cartilage and labral damage were prospectively collected. Chondrolabral and femoral/acetabular cartilage damage were graded with the Beck labral and cartilage injury criteria. Radiographic data included the AP AA, lateral center-edge angle (LCEA), and maximum femoral alpha angle (MF AA). Patients with hip dysplasia (LCEA <18°; LCEA 18°-25° with acetabular index >10°) were excluded. Outcomes were compared across cartilage and labral severity grades. We report odds ratios (ORs) with 95% confidence intervals and P values from multivariable logistic regressions. Results: Of the 158 included hips (154 patients), 69% were female and the mean (± standard deviation [SD]) age was 30.3 ± 9.7 years. Increase in age, increase in body mass index (BMI), and male sex were associated with increasing severity of cartilage and labral injury. More severe cartilage damage was associated with increasing AP AA ( P < .001) and MF AA ( P < .001). The odds of developing a higher category of cartilage injury severity (grade ≥3) were 119% higher (OR, 2.19 [95% CI, 1.36-3.64]; P = .002) for every SD increase (16.7°) in AP AA, adjusting for age, sex, and BMI. The odds of developing a severe labral injury (grade ≥3) were 118% higher (OR, 2.18 [95% CI 1.17-4.32]; P = .018) for every SD increase (10.5°) in MF AA, adjusting for age, sex, BMI, and AP AA. Conclusion: Increasing age and BMI, and male sex are associated with increasing severity of cartilage and labral injury in FAIS. The odds of developing a cartilage injury are significantly higher with independent increases in AP AA and MF AA.

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“…The hip joint is generally viewed as an inherently constrained joint because of the high degree of bony congruity between the femoral head and the acetabulum [ 6 ]. Recent studies focused on dynamic instability of the hip joint as a cause of hip disorders [ 3 , 14 ]. Dynamic instability of the hip joint is characterized by excessive femoral head translation within the acetabulum [ 16 ], which is determined by the bone morphology and integrity and laxity of surrounding soft tissues, including the labrum, capsular-ligamentous complex, and ligamentous teres.…”

Section: Introductionmentioning

confidence: 99%

Femoral head translation in borderline and definite dysplastic hips during weight‐bearing: 2D/3D image registration analysis

Sakai,

Kutsuna,

Kono

et al. 2023

J. exp. orthop.

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Purpose The aims of this study were to 1) assess femoral head translation during weight-bearing in symptomatic developmental dysplasia of the hip (DDH) and 2) compare it between borderline DDH and definite DDH. Methods The study included four individuals with borderline DDH and nine with definite DDH, scheduled for periacetabular osteotomy. Anteroposterior X-ray images of the hip joint were obtained in the standing position, and computed tomography images of the pelvis were obtained in the supine position. Femoral head translation from the supine to a standing position was measured using 2D/3D X-ray image registration. Results From a supine to a standing position, the femoral head translated 0.3 mm laterally, 0.5 mm anteriorly, and 0.5 mm superiorly on average. The mean femoral head translation in 3D between the supine and standing positions was 1.5 mm. The 3D femoral head translation in the borderline DDH group was significantly greater than that in the definite DDH group. In the definite DDH group, there was a significant correlation between the center edge (CE) angle and 3D femoral head translation (ρ = -0.78, P = 0.012). Conclusions Symptomatic DDH showed femoral head translation in the anterior, lateral, and superior directions during weight-bearing. In definite DDH, the amount of femoral head translation was negatively correlated with the CE angle. The amount of 3D translation in patients with borderline DDH was larger than that in definite DDH. Dynamic joint instability during weight-bearing was observed in borderline DDH as well as definite DDH. Treatment to enhance joint stability during weight-bearing is important in both cases.

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Hip microinstability diagnosis and management: a systematic review

Cited by 13 publications

References 42 publications

Capsular Repair Versus No Repair After Hip Arthroscopy in Patients Without Dysplasia or Generalized Ligamentous Laxity: A Systematic Review and Meta-analysis

Capsular Repair Versus No Repair After Hip Arthroscopy in Patients Without Dysplasia or Generalized Ligamentous Laxity: A Systematic Review and Meta-analysis

Association of Cam Deformity on Anteroposterior Pelvic Radiographs and More Severe Chondral Damage in Femoroacetabular Impingement Syndrome

Femoral head translation in borderline and definite dysplastic hips during weight‐bearing: 2D/3D image registration analysis

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