Total dislocation of the hip joint after arthroscopy and ileopsoas tenotomy

Abstract

The hip is a highly stable joint. Non-traumatic dislocation of the hip is extremely uncommon. In this article, we report two cases of non-traumatic hip dislocations following hip arthroscopy. In both cases, capsulotomy and ileopsoas tenotomy had been performed. These cases raise questions about the importance of the natural stabilisers of the hip. Level of evidence V.

Arthroscopic Anterior Capsular Reconstruction of the Hip for Recurrent Instability

“…[3][4][5][6][7][8] Inadequate capsular repair after hip arthroscopy, especially in patients with dysplastic or borderline dysplastic characteristics, hyperlaxity, and anterior instability, has been reported to be a risk factor for hip instability. 10 The IFL is a condensation of anterior capsular fibers originating at the AIIS and terminating along the intertrochanteric line, and it provides primary restraint against extension, external rotation, and anterior translation of the hip.…”

“…2 Several reported cases of iatrogenic instability after hip arthroscopy led many authors to speculate that an unrepaired anterior capsulotomy or capsulectomy should be avoided in the at-risk patient with subtle or borderline dysplastic features, [3][4][5][6][7][8] especially when concomitant labral debridement and iliopsoas tenotomy are performed. Of these cases, 2 were salvaged with a total hip replacement, 3,6 2 were successfully treated with closed reduction and physiotherapy, 8 2 underwent capsular repair or plication, 5,7 and 1 required open capsular reconstruction with iliotibial band autograft because of capsular deficiency. 4 We present an arthroscopic technique for IFL reconstruction with Achilles tendon allograft (Fig 1) for recurrent anterior hip instability (Video 1).…”

Capsular Plication for Treatment of Iatrogenic Hip Instability

“…[2][3][4][5][6][7] Most of these cases have been successfully treated with revision primary capsular closure. 2,3 Conversely, Dierckman and Guanche 4 reported a case of anterior dislocation after an unclosed capsulotomy site progressed to a large 2.5 Â 4ecm capsular defect; at revision surgery, the senior author reconstructed the anterior capsule with iliotibial band autograft.…”

“…1 There are 7 reported cases of hip dislocation after hip arthroscopy, [2][3][4][5][6][7] but the actual number of dislocations is thought to be largely under-reported. Although gross instability of the hip is rare because of its osseous congruency, microinstability is attributed to improper capsular management after prior surgery.…”

Arthroscopic Technique of Capsular Plication for the Treatment of Hip Instability

“…From a biomechanical standpoint, capsulotomy in hip arthroscopic procedures could theoretically have an adverse effect on joint stability. 4 Routine capsular repair may mitigate this adverse effect, restoring the normal capsular stability. Furthermore, in cases of ligamentous laxity or microinstability, tightening of the capsuloligamentous structures may reinforce the screw-home mechanism and help restore stability.…”