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Hip Capsular Deficiency—A Cause of Post-Surgical Instability in the Revision Setting Following Hip Arthroscopy for Femoroacetabular Impingement

  • HIP/FAI (A Zhang and Y-M Yen, Section Editors)
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Current Reviews in Musculoskeletal Medicine Aims and scope Submit manuscript

Abstract

Purpose of Review

To characterize current concepts in capsular repair and hip instability, and examine findings from biomechanical and clinical studies on hip capsular management strategies as they pertain to hip stability, patient outcomes, and hip arthroscopy failure. Further, we discuss the clinical evaluation and treatment of capsular deficiency.

Recent Findings

There remains debate regarding the optimal capsular management strategies in hip arthroscopy, particularly concerning the necessity of routine capsular repair. A variety of capsulotomy techniques exist and may be used to access the hip joint. Additionally, a wide variety of techniques are employed to repair the hip capsule. Biomechanical evidence supports capsular closure restores hip joint stability to that of the intact, native state. Several clinical studies in both primary and revision hip arthroscopy settings have demonstrated improved pain and functional outcomes in patients who underwent capsular repair or capsular reconstruction. Studies have shown capsular repair may be especially important in patients with ligamentous laxity and hip dysplasia, and in competitive athletes.

Summary

Post-surgical hip instability secondary to capsular insufficiency is increasingly recognized as a cause of hip arthroscopy failure. Capsular closure restores native biomechanical stability to the hip joint, and several clinical studies report improved pain and functional outcomes following capsular repair or capsular reconstruction in both the primary and revision hip arthroscopy settings. There remains much to learn regarding capsular hip instability as it relates to optimal capsular management surgical technique, intra-operative capsular management decision-making, clinical diagnosis, and related advanced imaging findings.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA

    Alexander J. Mortensen, Allan K. Metz & Stephen K. Aoki

  2. University of Utah, School of Medicine, 30 N 1900 E, Salt Lake City, UT, 84132, USA

    Devin L. Froerer

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  1. Alexander J. Mortensen
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Stephen Aoki is a paid education consultant for Stryker Medical, outside of the submitted work.

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Mortensen, A.J., Metz, A.K., Froerer, D.L. et al. Hip Capsular Deficiency—A Cause of Post-Surgical Instability in the Revision Setting Following Hip Arthroscopy for Femoroacetabular Impingement. Curr Rev Musculoskelet Med 14, 351–360 (2021). https://doi.org/10.1007/s12178-021-09732-5

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