Controversy exists over the treatment of hip instability, including the durability of plications. The clinical outcomes of 24 patients who underwent arthroscopic capsular plication for hip microinstability with greater than 5 years follow up is reported. Twenty-one patients demonstrated excellent clinical results, confirming hip capsular plication provides benefit at medium term follow-up
Hip microinstability is an emerging cause of pain in young patients. One surgical option is arthroscopic plication of the hip capsule, with various techniques described in the literature. However, there are no medium or long-term follow up studies of hip plication. Thus, the durability of these procedures is not know, as some believe the soft tissues may stretch out at longer follow up.
Our goal was to report clinical outcomes after hip plication with a minimum 5 year follow-up.
Electronic medical records were reviewed to include patients who underwent hip arthroscopy where a plication was performed with no concomitant bony work (acetabuloplasty or cheilectomy). Hip instability was suspected clinically in patients presenting pain with the following tests: hyperextension-external rotation test, prone instability test and abduction-hyperextension-external rotation test. Radiographs excluded severe cases of hip dysplasia (center-edge angle (CEA) below 18o) and femoroaacetabular impingement (FAI). The diagnosis of instability was confirmed intra-operatively by ease of distraction of the hip before surgery, and/or inability of the hip to fully reduce after traction was removed. Capsular plication was performed lateral to the iliofemoral ligament, in a capsular region without ligaments. Clinical outcomes were evaluated by the modified Harris Hip Score (mHHS)
Twenty four patients (all females, age 27.4 years (range 15-52) were included. Patients reported symptoms for an average 25.2 months (range 2-120) before surgery. Five (20.8%) were revision surgery patients. Mean CEA was 28.1o (range 18-39). During surgery 16 patients had their labrum repaired, and 5 had a partial labral debridement. Microfractures were performed in 5 patients (2 femoral heads and 3 acetabula). During the follow-up period, 3 patients underwent further surgical procedures (2 arthroscopies and 1 PAO), and were excluded from the analysis. Five patients reported doing well, but did not complete their outcomes questionnaire at their last follow-up (84.2 months, range 70-100). The 16 patients with complete scores reported significant clinical improvement: preop mHHS 61.0 + 8.8 vs post-op mHHS 92.7 + 8.9) after a mean follow up of 79 months (range 68-105). No operative complications were reported, but one patient (4.1%) underwent a revision surgery for lysis of adhesions after 14 months, and is currently doing well (mHHS=95.7).
Hip microinstability is beginning to gain acceptance in the hip community, yet we are in our infancy in trying to understand this clinical entity and its potential associations. This study evaluated patients who underwent hip arthroscopy without bony work, so that the effect of the capsular plication could be observed in isolation. Some authors still dispute the possibility of hip microinstability in the absence of bone deficiency. We believe the current findings demonstrate microinstability may occur in a hip with normal bony architecture. Further, this study demonstrates that capsular plication is a safe procedure, with low incidence of complications, and yields durable good/excellent clinical results after a minimum 5 year follow-up.