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Atraumatic Instability and Surgical Technique

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Hip Arthroscopy and Hip Joint Preservation Surgery

Abstract

The normal hip has a natural tendency to stability due to its depth, congruency, and surrounding contractile and inert tissues. Hip instability may occur either with or without trauma. Hip microinstability may also occur with or without trauma. However, microinstability is a concept that is currently unproven, but sound anatomically, biomechanically, and radiographically, and with limited in vivo clinical studies. In the absence of other clear sources for persistent hip symptoms despite treatment, the astute clinician may diagnose microinstability. However, microinstability may also be the cause or the effect of other concomitant hip pathologies. If prior surgery has been performed, the operative report, photographs, and videos should be scrutinized in detail, especially in regard to osseous, chondrolabral, and capsuloligamentous management. Patients should be assessed for generalized hypermobility. Certain subjects (such as young female gymnasts, ballet, dance, yoga) may be at particular risk. Impingement-induced instability may also be an underlying contributor, especially in males with cam deformities. The examiner must assess the difference between laxity (asymptomatic) and instability (symptomatic). The true location of pain and tenderness, motion, and strength should be evaluated. Both radiographic and advanced imaging may be indicated. Initial management of microinstability should be nonoperative. In patients that have failed conservative treatment, arthroscopic evaluation for diagnostic and therapeutic purposes may be undertaken. Without femoroacetabular impingement or labral pathology, examination under anesthesia may better reveal subtle loss or excessive motion asymmetries. Capsulorrhaphy (plication) with or without ligamentum teres management may provide successful clinical outcome. Short-term results are successful. However, mid- and long-term outcomes do not yet exist.

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Author information

Authors and Affiliations

  1. Houston Methodist Center for Orthopaedics & Sports Medicine, 6550 Fannin Street, Smith Tower, Suite 2500, Houston, TX, 77030, USA

    Joshua D. Harris

  2. Midwest Orthopaedics at Rush, 1611 W. Harrison Street, Suite 300, Chicago, IL, 60612, USA

    William Slikker III

  3. Department of Orthopaedic Surgery, Stanford University, Veterans Administration Palo Alto, 3801 Miranda Avenue, Palo Alto, CA, 94304, USA

    Geoffrey D. Abrams

  4. Rush University Medical Center, Chicago, IL, USA

    Joshua D. Harris

  5. Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA

    Shane J. Nho

  6. Midwest Orthopaedics at Rush, Hip Preservation Center, Rush University Medical Center, Chicago, IL, USA

    Shane J. Nho

Authors
  1. Joshua D. Harris
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  2. William Slikker III
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  3. Geoffrey D. Abrams
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  4. Shane J. Nho
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Corresponding author

Correspondence to Joshua D. Harris .

Editor information

Editors and Affiliations

  1. Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA

    Shane J. Nho

  2. Department of Orthopaedic Surgery, Schulthess Klinik, Zurich, Switzerland

    Michael Leunig

  3. Minnesota Orthopedic Sports Medicine Institute, Twin Cities Orthopedics - Edina, Edina, Minnesota, USA

    Christopher M. Larson

  4. Department of Orthopaedics, University of Michigan, Ann Arbor, Michigan, USA

    Asheesh Bedi

  5. Sports Medicine and Shoulder Service and Center for Hip Preservation Surgery, Hospital for Special Surgery, New York, New York, USA

    Bryan T. Kelly

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© 2015 Springer Science+Business Media New York

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Harris, J.D., Slikker, W., Abrams, G.D., Nho, S.J. (2015). Atraumatic Instability and Surgical Technique. In: Nho, S., Leunig, M., Larson, C., Bedi, A., Kelly, B. (eds) Hip Arthroscopy and Hip Joint Preservation Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-6965-0_88

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  • DOI: https://doi.org/10.1007/978-1-4614-6965-0_88

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-6964-3

  • Online ISBN: 978-1-4614-6965-0

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