2015 ISAKOS Biennial Congress ePoster #816

Hip Instability Treated With Arthroscopic Capsular Plication

Michael Kalisvaart, MD, Reno, NV UNITED STATES
Marc R. Safran, MD, Prof., Redwood City, CA UNITED STATES
Stanford University, Redwood City, California, USA

FDA Status Not Applicable

Summary: Microinstability of the hip, though lacking objective clinical criteria, exists and can be treated with capsular plication

Abstract:

Purpose

Although the hip is anatomically a relatively constrained joint, excessive hip laxity is felt to be a cause of intra-articular pathology, particularly tears of the anterior labrum and cartilage. Atraumatic microinstability of the hip remains a controversial topic, however, as there is no objective measurement of laxity of the hip joint. The purpose of this study is to evaluate a consecutive series of patients with atraumatic hip microinstability that resulted in anterior labral and cartilage pathology, treated with hip arthroscopy and capsular plication without any associated bony procedures.
Study Type: Retrospective consecutive clinical case series.

Methods

Thirty-two patients underwent hip arthroscopy and suture capsular plication for the treatment of hip instability without concomitant bony resections of the acetabulum or proximal femur between November 2009 and November 2012 and were followed for a minimum of 12 months. All patients experienced significant symptom relief with preoperative intra-articular local anesthetic injection. Patients were clinically evaluated preoperatively and again at 3 months, 6 months, 12 months, 24 months, and 36 months postoperatively with the modified Harris Hip Score (mHHS) and iHOT score in some patients (as this was introduced late in the study). After IRB approval, comparison was made evaluating center edge angle (CEA), physical exam findings, and demographics on outcome.

Results

The study group was entirely female with a mean age of 27 years (range, 14 to 40 years), mean duration of symptoms of 24 months (range, 2 to 120 months), and mean follow-up of 20 months (range, 12 to 46 months). There was significant improvement in the mean modified Harris Hip Score (mHHS) from 67 to 97 (p < 0.001) and iHOT score from 41 to 85 (p < 0.001) at final follow-up. When comparing patients with hip dysplasia (CEA = 25° and/or Tonnis angle > 10°) and patients without hip dysplasia (CEA > 25° and/or Tonnis angle = 10°), there was no significant difference in clinical outcome at any point in follow-up. There was no significant association between patient age, duration of preoperative symptoms, previous ipsilateral hip arthroscopy, nature of onset of symptoms, center-edge angle (CEA), Tonnis angle, or preoperative physical exam findings with clinical outcome at final follow-up. One patient required revision hip arthroscopy consisting of lysis of adhesions. No patients experienced worsening of their symptoms at final follow-up.

Conclusion

Isolated arthroscopic suture capsular plication performed for the treatment of hip instability resulted in improved patient pain and function at a minimum of 1 year follow-up. The results of this study suggest that this is a safe and reliable surgical procedure that may also be considered in patients with borderline or mild acetabular dysplasia.