Hip microinstability: fact or fiction?

Jean, Pierre-Olivier; Safran, Marc R.; Ayeni, Olufemi R.

doi:10.1007/s00167-021-06835-x

Cited by 7 publications

(5 citation statements)

References 27 publications

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“…A previously described iliofemoral ligament‐sparing hip arthroscopy technique was then performed and diagnostic arthroscopic findings from a posterolateral viewing portal were recorded [8]. Labral and chondral pathology were addressed in a standardized fashion, as were acetabular and femoral‐based impingement.…”

Section: Methodsmentioning

confidence: 99%

“…Hip microinstability, or atraumatic hip instability, is increasingly recognized as an etiology of non‐arthritic hip pain and disability in young patients and athletes [1–3, 6, 8, 10, 13, 17, 19]. Microinstability can be defined as extraphysiologic motion or pathological laxity that leads to symptomatic abnormal mechanics of the hip [21].…”

Section: Introductionmentioning

confidence: 99%

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The diagnosis of hip microinstability is correlated with ease of intra-operative hip distraction

Curtis

Pullen

Murray

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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PurposeHip microinstability has emerged as a contributor to young adult, non‐arthritic hip pain. There is a paucity of objective clinical data to identify patients with hip microinstability and guide surgical treatment. The purpose of this study was to identify the degree of distractibility in patients with and without microinstability undergoing hip arthroscopy. MethodsA single‐surgeon series of hip arthroscopies were retrospectively reviewed from 2014–2020. All procedures were performed with paralysis on a fracture table with a perineal post where 1 turn of fine traction equates to 4 mm of axial traction. Diagnosis was recorded as isolated instability, instability plus femoroacetabular impingement (FAI), and isolated FAI. Operative reports were reviewed to collect patient demographic data, number of turns of traction required for adequate distraction of the femoral head relative to the acetabulum (10 mm), and the presence of residual subluxation after initial traction was released. ResultsA total of 464 patients were identified, 26 (5.6%) with isolated microinstability, 183 (39.4%) with microinstability with FAI anatomy, and 255 (55.0%) with FAI. The concurrent diagnosis of microinstability was associated with decreased turns required to adequately distract the hip. Isolated microinstability patients required 6.9 turns (IQR 4.6–8.8) while those with instability plus FAI required 8.8 turns (IQR 6.5–11) and isolated FAI required 19.1 turns (IQR 15–22). Residual subluxation after removal of negative intra‐articular pressure but before performing the hip arthroscopy was more commonly associated with instability, occurring in 84.6% of isolated instability and 86.9% of instability plus FAI as compared with 29.8% in the isolated FAI cohort. ConclusionA diagnosis of hip microinstability, with or without features of FAI, is associated with decreased axial traction required to distract the hip. These data support the use of intra‐operative ease of distraction as a method of identifying patients with hip microinstability. Level of evidenceLevel III.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The diagnosis of hip microinstability is correlated with ease of intra-operative hip distraction

Curtis

Pullen

Murray

et al. 2022

Knee Surg Sports Traumatol Arthrosc

View full text Add to dashboard Cite

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“…Microinstability of the hip joint is defined as extraphysiologic hip motion or pathological laxity that causes hip pain, with or without a subjective feeling of instability, and results in reduced hip function among young and active individuals [1][2][3][4][5]. The prevalence of hip microinstability is still unknown; however, the current data suggest that it is more common in women [6].…”

Section: Introductionmentioning

confidence: 96%

Protocol for a multicenter prospective cohort study evaluating arthroscopic and non-surgical treatment for microinstability of the hip joint

Öhlin

Senorski

Sansone

et al. 2022

BMC Musculoskelet Disord

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Background Microinstability of the hip joint is a proposed cause of hip pain and reduced function in young individuals. The underlying mechanism is thought to be extraphysiological hip motion due to bony deficiency and/or soft tissue deficiency or decreased soft tissue function. Recently, the condition has gained increased attention, and despite the fact that treatment today includes both non-surgical and surgical approaches, there is limited evidence on diagnostic specificity and treatment effects. The aim of this study is to evaluate clinical outcomes of both non-surgical and surgical treatment for microinstability of the hip joint. Methods A multicenter prospective cohort study is planned to evaluating the outcome of physical therapy aimed at stabilizing the hip joint, as well as arthroscopic plication of the hip joint capsule, if the physical therapy fails. Outcomes will be evaluated using hip-specific patient-reported outcome measures: the short version of the International Hip Outcome Tool and the Copenhagen Hip and Groin Outcome Score, strength and function tests, health-related quality of life as determined using the European Quality of Life-5 Dimensions and the European Quality of Life-Visual Analog Scale, sports activity levels according to the Hip Sport Activity Scale, and reported complications. Patients will be evaluated at 6, 12 and 24 months after each treatment. Discussion It is important to evaluate the clinical outcomes of both non-surgical and surgical treatment for suspected microinstability of the hip joint, and the planned prospective evaluation will contribute to the understanding of non-surgical as well as surgical treatment outcomes, including complications. Trial registration Clinicaltrials.gov: NCT04934462. Registered June 22 2021.

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“…Similarly, for studies reported in the literature, microinstability is either defined arbitrarily by researchers setting their own “gold standard” diagnostic criteria or by reproducing the criteria used in previous studies [9, 18, 45]. Currently there is no consensus between experts regarding both the relative importance of criteria and which criteria must be satisfied to make a diagnosis of hip microinstability [24]. This aim of this online Delphi study was to seek the expert opinion to answer the above questions and formulate diagnostic criteria for hip microinstability.…”

Section: Introductionmentioning

confidence: 99%

Diagnosing Hip Microinstability: an international consensus study using the Delphi methodology

Khanduja

Darby

O’Donnell

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose Hip microinstability is a relatively new diagnosis which is increasingly being discussed in the literature and yet there are no clear guidelines for making a diagnosis. Microinstability has generally been defined as persistent excessive hip motion that has become symptomatic especially with pain. This aim of this Delphi study was to seek expert opinion to formulate a diagnostic criteria for hip microinstability. Methods A Delphi methodology was used for this consensus study. A literature search was conducted on PubMed up to March 2019 using the keywords ((hip) and (microinstability)) to identify relevant articles on this topic. All relevant criteria used for diagnosing hip microinstability were collated to create a questionnaire and further criterion suggested by the experts were included as well. Four rounds of questionnaires were delivered via an online survey platform. Between each round the authors acted as administrating intermediaries, providing the experts with a summary of results and synthesising the next questionnaire. The expert panel was comprised of 27 members: 24 (89%) orthopaedic surgeons and 3 (11%) physiotherapists from around the world. Results Expert panel participation in rounds 1–4 was: 27 (100%), 20 (74%), 21 (78%) and 26 (96%) respectively. A literature review by the authors identified 32 diagnostic criteria to populate the first questionnaire. Experts suggested amending three criteria and creating five new criteria. The panel converged on ranking 3 (8%) of criteria as “Not important”, 20 (54%) as “Minor Factors” and 14 (38%) as “Major Factors”. No criteria was ranked as “Essential”. Criteria were subcategorised into patient history, examination and imaging. Experts voted for a minimum requirement of four criteria in each subcategory, including at least six “Major factors”. The final diagnostic tool was approved by 20 (77%) of the final round panel. Conclusion This study describes the first known expert consensus on diagnosing hip microinstability. The relative complexity of the final diagnostic tool is illustrative of the difficulty clinicians’ face when making this diagnosis. Level of evidence V.

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Hip microinstability: fact or fiction?

Abstract: Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Cited by 7 publications

References 27 publications

The diagnosis of hip microinstability is correlated with ease of intra-operative hip distraction

The diagnosis of hip microinstability is correlated with ease of intra-operative hip distraction

Protocol for a multicenter prospective cohort study evaluating arthroscopic and non-surgical treatment for microinstability of the hip joint

Diagnosing Hip Microinstability: an international consensus study using the Delphi methodology

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