Microinstability of the hip: a previously unrecognized pathology

Abstract

Background: Hip microinstability is an established diagnosis; however, its occurrence is still debated by many physicians. Diagnosis of hip microinstability is often challenging, due to a lack of specific signs or symptoms, and patients may remain undiagnosed for long periods. This may lead to early manifestation of degenerative joint disease. Consequently, careful patient and family history must be obtained and diagnostic imaging should follow. After a thorough clinical evaluation of the patient with suspected hip microinstability, the physician should focus on how to improve symptoms and functionality in daily and sports activities. Purpose: The purpose of this review article was to give a current update regarding this diagnosis and to provide a complete diagnostic approach in order to effectively treat hip microinstability. Methods: We reviewed the literature on the diagnosis, the non-operative and operative indications for the treatment of this complex and often misdiagnosed pathology. Conclusion: Conservative treatment is considered the best initial approach, though, surgical intervention should be considered if symptoms persist or other hip pathology exists. Successful surgical intervention, such as hip arthroscopy, should focus on restoring the normal anatomy of the hip joint in order to regain its functionality.The role of the hip joint capsule has gained particular research interest during the last years, and its repair or reconstruction during hip arthroscopy is considered necessary in order to avoid iatrogenic hip microinstability. Various capsular closure/plication techniques have been developed towards this direction with encouraging results. Level of evidence: V.KEY WORDS: hip arthroscopy, hip microinstability, hip dysplasia.

Persistent or recurrent symptoms after arthroscopic surgery for femoroacetabular impingement: A review of imaging findings

“…Although it lacks objective diagnostic criteria, there is growing literature supporting the concept . Iatrogenic microinstability is increasingly recognised as a cause for unsatisfactory outcome after hip arthroscopy and is an indication for revision arthroscopy . The aetiology is thought to be multifactorial .…”

“…Iatrogenic microinstability is increasingly recognised as a cause for unsatisfactory outcome after hip arthroscopy and is an indication for revision arthroscopy . The aetiology is thought to be multifactorial . Groups particularly at risk include women and those with underlying hip dysplasia or generalised hyperlaxity .…”

Three-dimensional architecture of the ligamentum teres in the human hip joint

“…Thus, it is also not clear whether the cause of osteoarthritis is the anatomy of the hip or a secondary consequence of LT rupture, or whether the cartilage injury is the consequence of the micro-instability. Recently, clinical attention has been paid to the LT and the possible involvement of the ligament in hip joint stability and in disease progression 4,5 . The LT is known as an important stabilizer of the hip joint, particularly during hip flexion and external rotation 5 .…”

“…Recently, clinical attention has been paid to the LT and the possible involvement of the ligament in hip joint stability and in disease progression 4,5 . The LT is known as an important stabilizer of the hip joint, particularly during hip flexion and external rotation 5 . Though older age and acetabular bony pathomorphology are two of the known risk factors for LT tears 5 , we are interested in whether the LT itself has a microanatomical vulnerable feature.…”

“…The LT is known as an important stabilizer of the hip joint, particularly during hip flexion and external rotation 5 . Though older age and acetabular bony pathomorphology are two of the known risk factors for LT tears 5 , we are interested in whether the LT itself has a microanatomical vulnerable feature. The LT in the human joint starts from the fovea of the femoral head and involves a ligament attached to the acetabular notch.…”