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Keogh JAJ, Keng I, Ifabiyi M, Patel M, Duong A, Malviya A, Wuerz TH, Ayeni OR. Adhesions After Hip Arthroscopy Are Associated With Revision But Show Poorly Defined Criteria for Diagnosis and Operative Management: A Systematic Review. Arthroscopy 2024:S0749-8063(24)00303-7. [PMID: 38697325 DOI: 10.1016/j.arthro.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 04/01/2024] [Accepted: 04/09/2024] [Indexed: 05/04/2024]
Abstract
PURPOSE To evaluate the current body of evidence surrounding the diagnosis, management, and clinical outcomes of adhesions that developed after hip arthroscopy (HA). METHODS A systematic search of the MEDLINE, Embase, Web of Science, and CENTRAL (Cochrane Central Register of Controlled Trials) databases was designed and conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Eligible studies included patients with confirmed adhesions after HA that reported one or more of the following: (1) diagnostic procedures and criteria used; (2) indications for and details surrounding surgical management; and (3) clinical outcomes after the operative management of adhesions (e.g., patient-reported outcome measures). RESULTS Nineteen studies involving a total of 4,145 patients (4,211 hips; 38% female sex) were included in this review. The quality of evidence was found to be fair for both comparative studies (mean, 17; range, 13-21) and noncomparative studies (mean, 10; range, 5-12) according to the Methodological Index for Non-randomized Studies (MINORS) instrument, with the level of evidence ranging from IIB to IV. Adhesions were often diagnosed intraoperatively at the time of revision surgery (10 of 19 studies, 53%), with only 3 studies specifying the criteria used to adjudicate adhesions. The most common indication for operative management (i.e., release or lysis of adhesions) was persistent pain (9 of 19, 47%), but this was often grossly stated for revision HA rather than being specific to adhesions. Patient-reported outcome measures were the most reported postoperative outcomes (9 of 19, 47%) and generally showed significant improvement from preoperative assessment across the short-term follow-up period (range, 24.5-38.1 months). There was a paucity of objective measures of clinical improvement (3 of 19, 16%) and of mid- and long-term follow-up (i.e., 5-7 years and ≥10 years, respectively). CONCLUSIONS Despite the growing body of evidence suggesting that adhesions are highly contributory to revision HA, there is ambiguity in the diagnostic approach and indications for operative management of adhesions. Additionally, although the operative management of adhesions after HA has shown satisfactory clinical outcomes in the short term, there is a paucity of research elucidating the mid- to long-term outcomes, as well as minimal use of objective assessment of clinical improvement (e.g., biomechanics). LEVEL OF EVIDENCE Level IV, systematic review of Level II to IV studies.
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Affiliation(s)
- Joshua A J Keogh
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada; Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Canada
| | - Isabelle Keng
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada; Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Canada
| | - Muyiwa Ifabiyi
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Canada
| | - Mansi Patel
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Canada
| | - Andrew Duong
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Canada
| | - Ajay Malviya
- Department of Trauma and Orthopaedics, Northumbria Healthcare NHS Foundation Trust, Ashington, England
| | - Thomas H Wuerz
- Boston Sports & Shoulder Center, Waltham, Massachusetts, U.S.A
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Canada.
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Maldonado DR, Padmanabhan S, George T, Domb BG. Defining the Percent Thresholds for Achieving the Maximum Outcome Improvement of the Modified Harris Hip Score, the Non-Arthritic Hip Score, the Hip Outcome Score-Sports Subscale, the Visual Analog Scale for Pain, and the International Hip Outcome Tool-12 in Revision Hip Arthroscopy at Minimum 2-Year Follow-Up. Arthroscopy 2024; 40:1143-1152. [PMID: 37906239 DOI: 10.1016/j.arthro.2023.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 07/17/2023] [Accepted: 08/18/2023] [Indexed: 11/02/2023]
Abstract
PURPOSE To determine the respective percent thresholds for achieving the maximal outcome improvement (MOI) for the modified Harris Hip Score (mHHS), the Non-Arthritic Hip Score (NAHS), the Hip Outcome Score-Sports Subscale (HOS-SSS), the visual analog scale (VAS) for pain, and the International Hip Outcome Tool-12 (iHOT-12) that were associated with satisfaction following revision hip arthroscopy, and to identify predictors for achieving the MOI. METHODS An anchor question was provided to patients who underwent revision hip arthroscopy between April 2017 and July 2020. Patients were included for the final analysis if they answered the anchor question and had minimum 2-year follow-up. Receiver operating characteristic analysis was used to determine the thresholds for the percentage of the MOI predictive of satisfaction. A P-value of < .05 was considered significant. RESULTS In total, 318 patients underwent revision hip arthroscopy. Of those patients, 292 (91.8%) had minimum 2-year follow-up. Of this cohort, 68 answered the anchor question, with 49 (72.1%) female and 19 (27.9%) male patients. The mean age, and body mass index time were 32.9 ± 13 years and 25.4 ± 5.1, respectively. It was determined that 42.1%, 50%, 48.1%, 50%, and 50% of MOI were the thresholds for maximal predictability of satisfaction for mHHS, NAHS, HOS-SS, VAS for pain, and the iHOT-12, respectively. The presence of unaddressed subspine impingement was a significant predictor for achieving the MOI threshold for the VAS (odds ratio 1.40; 95% confidence interval 1.00-1.95; P = 0.0273). CONCLUSIONS Following revision hip arthroscopy, the percent thresholds for achieving the MOI at a minimum 2-year follow-up for the mHHS, NAHS, HOS-SS, VAS for pain, and iHOT-12 were 42.1%, 50%, 48.1%, 50%, and 50.9%, respectively. Addressing residual subspine impingement was identified as significant positive predictor for achieving the MOI. LEVEL OF EVIDENCE Level IV, case-series.
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Affiliation(s)
- David R Maldonado
- Department of Orthopaedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, U.S.A
| | | | - Tracy George
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A.; American Hip Institute, Chicago, Illinois, U.S.A..
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3
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Jackson T. Editorial Commentary: Capsule Repair Is Necessary at the Conclusion of Arthroscopy to Optimize Return to Full Activity. Arthroscopy 2024; 40:371-372. [PMID: 38296441 DOI: 10.1016/j.arthro.2023.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 07/12/2023] [Indexed: 02/08/2024]
Abstract
Hip capsulotomy and capsule repair have minimal effect on joint kinematics during activities of daily living. With low demands placed on the hip, the hip capsule may provide little to no role on hip stability or microinstability. But the majority, if not all, patients undergoing hip arthroscopy are not content with only resuming basic activities of daily living. Seeking to optimize the hip joint to its maximum capacity should be the goal. Capsule repair is necessary in most to achieve that goal.
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Bonin N, Manzini F, Viamont-Guerra MR. No Differences in Clinical Outcomes Between Hip Arthroscopy With Versus Without Capsular Closure in Patients With Cam- or Mixed-Type Femoroacetabular Impingement: A Randomized Controlled Trial. Arthroscopy 2024:S0749-8063(23)01023-X. [PMID: 38307448 DOI: 10.1016/j.arthro.2023.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 12/04/2023] [Accepted: 12/27/2023] [Indexed: 02/04/2024]
Abstract
PURPOSE To compare 2-year clinical outcomes of primary hip arthroscopy with versus without capsular closure after interportal capsulotomy in patients with cam- or mixed-type femoroacetabular impingement (FAI). METHODS Patients with cam- or mixed-type FAI undergoing primary hip arthroscopy with interportal capsulotomy were prospectively enrolled in this randomized controlled trial (RCT) and allocated into either capsular closure or no capsular closure groups. Patients were blinded to group allocation. Clinical outcomes were assessed preoperatively and at 2-year follow-up using the 12-item International Hip Outcome Tool (iHOT-12), modified Harris Hip Score (mHHS), and 6 subsections of the Copenhagen Hip and Groin Outcome Score (HAGOS). Complications and reoperations were noted. RESULTS Eighty-four patients (100 hips) were enrolled, 49 hips in the capsular closure group and 51 in the no capsular closure group, with no significant differences in age (28.5 ± 7.5 vs 30.4 ± 8.4, P = .261), body mass index (23.5 ± 3.0 vs 23.4 ± 1.9, P = .665), and sex distribution (female: 10.2% vs 13.7%, P = .760). Four patients were lost to follow-up (2.0% vs 5.9%, P = .618) and 6 had reoperations (6.1% vs 5.9%, P = 1.000), which left 45 hips per group for clinical assessment. There were no significant differences between groups in the net change of iHOT-12 (28.3 ± 19.6 vs 32.5 ± 22.7, P = .388), mHHS (7.6 ± 13.1 vs 7.5 ± 10.2, P = .954), and subsections of HAGOS (P > .05). Complication rates were also similar between groups (P > .05). CONCLUSIONS The present RCT compared primary hip arthroscopy with versus without capsular closure after interportal capsulotomy in a male-dominated, non-dysplastic, non-arthritic cohort with cam- or mixed-type FAI and found no significant differences in patient-reported clinical outcomes, complication rates, or reoperation rates. LEVEL OF EVIDENCE Level I, randomized controlled trial.
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Affiliation(s)
- Nicolas Bonin
- Lyon Ortho Clinic, Clinique de la Sauvegarde, Lyon, France
| | | | - Maria-Roxana Viamont-Guerra
- Lyon Ortho Clinic, Clinique de la Sauvegarde, Lyon, France; Hospital Israelita Albert Einstein, São Paulo, Brazil
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Hartwell MJ, Moulton SG, Zhang AL. Capsular Management During Hip Arthroscopy. Curr Rev Musculoskelet Med 2023; 16:607-615. [PMID: 37436651 PMCID: PMC10733234 DOI: 10.1007/s12178-023-09855-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2023] [Indexed: 07/13/2023]
Abstract
PURPOSE OF REVIEW Hip arthroscopy is widely used for the management of intra-articular pathology and there has been growing interest in strategies for management of the hip capsule during surgery. The hip capsule is an essential structure that provides stability to the joint and it is necessarily violated during procedures that address intra-articular pathology. This article reviews different approaches to capsular management during hip arthroscopy including anatomical considerations for capsulotomy, techniques, clinical outcomes, and the role of routine capsular repair. This article also reviews the concept of hip microinstability and its potential impact on capsular management options as well as iatrogenic complications that can occur as a result of poor capsular management. RECENT FINDINGS Current research highlights the key functional role of the hip capsule and the importance of preserving its anatomy during surgery. Capsulotomies that involve less tissue violation (periportal and puncture-type approaches) do not appear to require routine capsular repair to achieve good outcomes. Many studies have investigated the role of capsular repair following more extensive capsulotomy types (interportal and T-type), with most authors reporting superior outcomes with routine capsular repair. Strategies for capsular management during hip arthroscopy range from conservative capsulotomy techniques aimed to minimize capsular violation to more extensive capsulotomies with routine capsule closure, all of which have good short- to mid-term outcomes. There is a growing trend towards decreasing iatrogenic capsular tissue injury when possible and fully repairing the capsule when larger capsulotomies are utilized. Future research may reveal that patients with microinstability may require a more specific approach to capsular management.
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Affiliation(s)
- Matthew J Hartwell
- Department of Orthopaedic Surgery, University of California-San Francisco, 1500 Owens Street, Box 3004, San Francisco, CA, 94158, USA
| | - Samuel G Moulton
- Department of Orthopaedic Surgery, University of California-San Francisco, 1500 Owens Street, Box 3004, San Francisco, CA, 94158, USA
| | - Alan L Zhang
- Department of Orthopaedic Surgery, University of California-San Francisco, 1500 Owens Street, Box 3004, San Francisco, CA, 94158, USA.
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Kolaczko JG, Wait T, Stevanovic O, Orahovats A, Griffith E, Genuario JW. A Modified "Shuttle" Method Technique for Arthroscopic Hip Capsular Reconstruction in Capsular Deficiency. Arthrosc Tech 2023; 12:e1479-e1485. [PMID: 37780666 PMCID: PMC10533681 DOI: 10.1016/j.eats.2023.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 04/18/2023] [Indexed: 10/03/2023] Open
Abstract
The hip capsule has been recognized as a vital structure in the stability and proper function of the hip. Preserving its integrity during arthroscopic surgery is one of the utmost important principles in hip preservation surgery. When capsular deficiency is present, capsular reconstruction may be indicated to restore stability and proper hip mechanics. In this technical note, we introduce a simple and reproducible shuttle method technique for hip capsular reconstruction using a dermal allograft.
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Affiliation(s)
- Jensen G. Kolaczko
- University of Colorado School of Medicine, Aurora, Colorado, U.S.A
- Eric Griffith's Assisting Services, LLC, Fraser, Colorado, U.S.A
- Steadman Hawkins Clinic Denver, Cleveland, Ohio, U.S.A
| | - Trevor Wait
- University of Colorado School of Medicine, Aurora, Colorado, U.S.A
- Eric Griffith's Assisting Services, LLC, Fraser, Colorado, U.S.A
| | - Ognjen Stevanovic
- University of Colorado School of Medicine, Aurora, Colorado, U.S.A
- Eric Griffith's Assisting Services, LLC, Fraser, Colorado, U.S.A
| | - Alexandra Orahovats
- University of Colorado School of Medicine, Aurora, Colorado, U.S.A
- Eric Griffith's Assisting Services, LLC, Fraser, Colorado, U.S.A
| | - Eric Griffith
- Steadman Hawkins Clinic Denver, Cleveland, Ohio, U.S.A
| | - James W. Genuario
- University of Colorado School of Medicine, Aurora, Colorado, U.S.A
- Eric Griffith's Assisting Services, LLC, Fraser, Colorado, U.S.A
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Melugin HP, Comfort SM, Shelton TS, Day HK, Ruzbarsky JJ, Dornan GJ, Philippon MJ. The revision hip arthroscopy complex: capsular deficiency, labral deficiency, femoral over-resection and adhesions can result in good survivorship with revision hip arthroscopy. J Hip Preserv Surg 2023; 10:197-203. [PMID: 38162272 PMCID: PMC10757422 DOI: 10.1093/jhps/hnad026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 06/18/2023] [Accepted: 08/16/2023] [Indexed: 01/03/2024] Open
Abstract
To evaluate the patient-reported outcomes (PROs) and survivorship of combined arthroscopic hip labral reconstruction/augmentation, capsular reconstruction, femoral neck remplissage and lysis of adhesions. Patients ≥18 years old who underwent this combination of procedures during revision hip arthroscopy and were eligible for minimum 2-year follow-up were identified. PRO scores including Hip Outcome Score (HOS)-Activities of Daily Living scale, HOS-Sports scale, modified Harris Hip Score, Short Form 12, and Western Ontario & McMaster Universities Osteoarthritis Index, patient satisfaction and failure rates were analyzed. Seven patients (5 females and 2 males) with average age of 45.0 ± 5.2 (range: 40-54 years) met inclusion criteria. Patients had a median of 1 (range: 1-3) prior hip surgery at an outside institution. All patients had previously undergone femoral osteoplasty, and 85% (6/7) of patients had a labral repair performed. Four patients had no capsule closure performed in their prior procedures. Six patients were available for minimum 2-year follow-up. Two patients converted to total hip arthroplasty: one patient with four prior hip arthroscopies and the other had advanced osteoarthritis with outerbridge grade 3/4 defects requiring microfracture. Mean patient satisfaction was 7 (range: 2-9). At mean follow-up of 3 years, most patients who underwent the combination of labral reconstruction, capsular reconstruction, femoral neck remplissage and lysis of adhesions during revision hip arthroscopy demonstrated improved PROs. This salvage procedure has the potential to restore hip function in patients who have failed an initial hip arthroscopy procedure. In patients with these pathologies present and concomitant joint space narrowing, a total hip arthroplasty may be a more appropriate salvage option.
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Affiliation(s)
- Heath P Melugin
- Center for Outcomes-Based Orthopaedic Research, Steadman Philippon Research Institute, 181 W Meadow Dr, Ste 1000, Vail, CO 81657, USA
- Steadman Clinic and United States Coalition for the Prevention of Illness and Injury in Sport, 181 W Meadow Dr, Ste 400, Vail, CO 81657, USA
| | - Spencer M Comfort
- Center for Outcomes-Based Orthopaedic Research, Steadman Philippon Research Institute, 181 W Meadow Dr, Ste 1000, Vail, CO 81657, USA
| | - Trevor S Shelton
- Steadman Clinic and United States Coalition for the Prevention of Illness and Injury in Sport, 181 W Meadow Dr, Ste 400, Vail, CO 81657, USA
| | - Hannah K Day
- Center for Outcomes-Based Orthopaedic Research, Steadman Philippon Research Institute, 181 W Meadow Dr, Ste 1000, Vail, CO 81657, USA
| | - Joseph J Ruzbarsky
- Center for Outcomes-Based Orthopaedic Research, Steadman Philippon Research Institute, 181 W Meadow Dr, Ste 1000, Vail, CO 81657, USA
- Steadman Clinic and United States Coalition for the Prevention of Illness and Injury in Sport, 181 W Meadow Dr, Ste 400, Vail, CO 81657, USA
| | - Grant J Dornan
- Center for Outcomes-Based Orthopaedic Research, Steadman Philippon Research Institute, 181 W Meadow Dr, Ste 1000, Vail, CO 81657, USA
| | - Marc J Philippon
- Center for Outcomes-Based Orthopaedic Research, Steadman Philippon Research Institute, 181 W Meadow Dr, Ste 1000, Vail, CO 81657, USA
- Steadman Clinic and United States Coalition for the Prevention of Illness and Injury in Sport, 181 W Meadow Dr, Ste 400, Vail, CO 81657, USA
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Mameri ES, Batra AK, Kerzner B, Jackson GR, Jawanda H, Khan ZA, Chahla J. Hip Capsular Reconstruction With Indirect Head of the Rectus Femoris Tendon. Arthrosc Tech 2023; 12:e503-e509. [PMID: 37138681 PMCID: PMC10149979 DOI: 10.1016/j.eats.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/03/2022] [Indexed: 05/05/2023] Open
Abstract
Hip capsulotomy is performed during arthroscopic hip procedures to achieve adequate visualization of the joint and instrument access. The hip capsule, and in particular the iliofemoral ligament, is an important stabilizer of the hip joint, and patients who undergo capsulotomy without subsequent repair may experience hip pain and instability, with increased risk of requiring revision hip arthroscopy. Therefore, restoring watertight closure of the capsule is necessary to restore native biomechanics and achieve desired postoperative outcomes. Although primary repair or plication suffice in most cases, capsule reconstruction may instead be necessary when there is insufficient tissue, often due to capsular insufficiency following index surgery. The purpose of this Technical Note is to describe the authors' current technique for arthroscopic hip capsular reconstruction using the indirect head of the rectus femoris tendon in the setting of capsular iatrogenic hip instability, as well as its advantages and disadvantages and technical pearls and pitfalls.
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Affiliation(s)
- Enzo S. Mameri
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
- Escola Paulista de Medicina, Federal University of São Paulo, São Paulo - SP, Brazil
- Instituto Brasil de Tecnologias da Saúde, Rio de Janeiro - RJ, Brazil
| | - Anjay K. Batra
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Benjamin Kerzner
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Garrett R. Jackson
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Harry Jawanda
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Zeeshan A. Khan
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Jorge Chahla
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
- Address correspondence to Jorge Chahla, M.D., Ph.D., Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W Harrison St., Suite 300, Chicago, IL 60612
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Cohen D, Jean PO, Patel M, Aravinthan N, Simunovic N, Duong A, Safran MR, Khanduja V, Ayeni OR. Hip microinstability diagnosis and management: a systematic review. Knee Surg Sports Traumatol Arthrosc 2023; 31:16-32. [PMID: 35441843 DOI: 10.1007/s00167-022-06976-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/29/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE The purpose of this systematic review is to present the most common causes, diagnostic features, treatment options and outcomes of patients with hip micro-instability. METHODS Three online databases (MEDLINE, Embase, and PubMed) were searched from database inception March 2022, for literature addressing the diagnosis and management of patients with hip micro-instability. Given the lack of consistent reporting of patient outcomes across studies, the results are presented in a descriptive summary fashion. RESULTS Overall, there were a total of 9 studies including 189 patients (193 hips) included in this review of which 89% were female. All studies were level IV evidence with a mean MINORS score of 12 (range: 10-13). The most commonly used features for diagnosis of micro-instability on history were anterior pain in 146 (78%) patients and a subjective feeling of instability with gait in 143 (81%) patients, while the most common feature on physical examination was the presence of anterior apprehension with combined hip extension and external rotation in 123 (65%) patients. The most common causes of micro-instability were iatrogenic instability secondary to either capsular insufficiency or cam over-resection in 76 (62%) patients and soft tissue laxity in 38 (31%) patients. CONCLUSION The most common symptom of micro-instability on history was anterior hip pain and on physical exam was pain with hip extension and external rotation. There are many treatment options and when managed appropriately based on the precise cause of micro-instability, patients may demonstrate improved outcomes. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Dan Cohen
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, 1200 Main St West, 4E15, Hamilton, ON, L8N 3Z5, Canada
| | - Pierre-Olivier Jean
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, 1200 Main St West, 4E15, Hamilton, ON, L8N 3Z5, Canada
| | - Milin Patel
- Faculty of Science, McMaster University, Hamilton, ON, Canada
| | | | - Nicole Simunovic
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, 1200 Main St West, 4E15, Hamilton, ON, L8N 3Z5, Canada
| | - Andrew Duong
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, 1200 Main St West, 4E15, Hamilton, ON, L8N 3Z5, Canada
| | - Marc R Safran
- Department of Orthopedic Surgery, Stanford University, Redwood City, CA, USA
| | - Vikas Khanduja
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, 1200 Main St West, 4E15, Hamilton, ON, L8N 3Z5, Canada. .,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, L8N 3Z5, Canada.
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10
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Matthewson G, Williams A, Macciacchera M, Shahabinezhad A, Duong A, Ayeni OR. Effective Management Options for Treatment of Microinstability of the Hip: a Scoping Review. Curr Rev Musculoskelet Med 2022; 16:9-18. [PMID: 36472785 PMCID: PMC9839911 DOI: 10.1007/s12178-022-09808-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW To review the recent literature identifying and summarizing the research involving management of microinstability of the hip and highlight new and evolving techniques in its treatment. RECENT FINDINGS Recent updates in the understanding of capsular management hip arthroscopy will likely lead to less revision surgery and a decreased incidence of persistent post-operative pain. Repair of residual capsular defects has shown good outcomes with high patient satisfaction. Capsular plication remains the gold standard for hips with increased pain that show signs of capsular laxity/deficiency on exam or imaging. Capsular reconstruction has shown equivalent results to other revision hip arthroscopy procedures with low rates of complications. Ligamentum teres pathology, although rare, should be considered a source of pain, particularly in patients with laxity on exam. In cases where CAM over-resection has occurred, remplissage using allograft is an effective option for restoring the capsular suction seal and stability. Microinstability is increasingly being recognized as a source of post-operative hip pain. Patients with collagen disorders remain a challenging clinical entity with increased rates of complications and post-operative pain. CAM resection should be performed carefully and not disrupt the suction seal but be sufficient to not cause further impingement. Improved evidence including well-designed prospective studies with large sample sizes will determine the future management of this complex problem.
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Affiliation(s)
- Graeme Matthewson
- grid.25073.330000 0004 1936 8227Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 1200 Main St West, 4E15, Hamilton, Ontario L8N 3Z5 Canada
| | - Allison Williams
- grid.28046.380000 0001 2182 2255Faculty of Medicine, University of Ottawa, Ottawa, ON Canada
| | - Matthew Macciacchera
- grid.4912.e0000 0004 0488 7120Faculty of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ali Shahabinezhad
- grid.25073.330000 0004 1936 8227Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 1200 Main St West, 4E15, Hamilton, Ontario L8N 3Z5 Canada
| | - Andrew Duong
- grid.25073.330000 0004 1936 8227Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 1200 Main St West, 4E15, Hamilton, Ontario L8N 3Z5 Canada
| | - Olufemi R. Ayeni
- grid.25073.330000 0004 1936 8227Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 1200 Main St West, 4E15, Hamilton, Ontario L8N 3Z5 Canada
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