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Effective Management Options for Treatment Of Microsinstability of the Hip: A Scoping Review


Olufemi R. Ayeni, MD, PhD, MSc, FRCSC
CANADA

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Effective Management Options for Treatment Of Microsinstability of the Hip: A Scoping Review

Graeme Matthewson, MD, CANADA Ali Shahabinezhad , MD, CANADA Allison Williams, BSc, CANADA Matthew Macciacchera , BMSc, IRELAND Olufemi R. Ayeni, MD, PhD, MSc, FRCSC, CANADA

McMaster University, Hamilton, Ontario, CANADA

2023 Congress   ePoster Presentation   2023 Congress   Not yet rated

 

Anatomic Location

Hip / Groin / Thigh

Summary: Microinstability is increasingly being recognized as a source of post-operative hip pain and sources should be addressed at the time of the index surgery addressing impingement, including primary closure of the hip capsule.

Purpose

We reviewed the recent literature to identify and summarize the research involving management of microinstability of the hip and highlight new and evolving techniques in its treatment.

Methods

Three online databases (MEDLINE, Embase, and PubMed) were searched from database inception to July 2022, for literature addressing the management of patients with hip micro-instability. The studies were systematically screened, and data abstracted in duplicates.

Results

Recent updates in the understanding of capsular management in primary hip arthroscopy will likely lead to less revision surgery and a decreased incidence of persistent post-operative pain. Repair of residual capsular defects in a previously treated hip 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. In patients with a deficient capsule, 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 inheritable collagen disorders or generalized laxity on exam. In cases where CAM over-resection has occurred, Remplissage using an ITB autograft or tibialis anterior allograft is an effective option for restoring the capsular suction seal and increasing stability.

Conclusion

Microinstability is increasingly being recognized as a source of post-operative hip pain and sources should be addressed at the time of the index surgery addressing impingement, including primary closure of the hip capsule. Microinstability in patients with collagen disorders remain a challenging clinical entity with increased rates of complications and post-operative pain. Current management relies on anatomic reconstruction of ligamentous stabilizers and reducing any capsular redundancy coupled with intensive strengthening focusing on dynamic stability. A tightly adhered to strengthening program has shown good success with similar outcomes scores as surgery and should be exhausted prior to any operative intervention. Regarding osteochondroplasty, the Goldilocks principle should be followed assuring CAM resection does not disrupt the suction seal, but also is sufficient to not cause further impingement.

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