Skip to main content
SpringerLink
Log in

Female gender, decreased lateral center edge angle and a positive hyperextension–external rotation test are associated with ease of hip distractability at time of hip arthroscopy

  • HIP
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To identify factors associated with ease of hip distraction at the time of hip arthroscopy.

Methods

A retrospective review of patients 17–50 years old undergoing hip arthroscopy with a single high-volume hip arthroscopist was performed from 2014 to 2020. Demographics, clinical history, examination, and imaging findings were collected. Distractibility was quantified using turns of fine traction (1 turn = 4 mm axial distraction) with the patient paralyzed on a fracture table with a well-padded perineal post Fine axial traction was applied after the patient’s perineum contacted the post. Demographic and clinical predictors of ease of distractibility were analyzed with simple linear regression models. Significant predictors were subsequently added to a multivariable linear regression model, estimating the effect of each variable.

Results

In total, 453 patients were included, with an average age of 31.6 years (± 9.2) and 45.9% females. In univariate analysis, gender, race, BMI, range of motion, hyperextension–external rotation (HEER) test, the abduction–extension–external rotation test, and lateral center edge angle (LCEA) were associated with the number of fine traction turns required to distract the hip. On multivariable analysis, lower LCEA (p = 0.002), female gender (p < 0.001), and a positive HEER test (p = 0.045) were associated with decreased turns required for adequate hip distraction.

Conclusion

Female gender, decreased LCEA, and a positive HEER test are associated with decreased axial traction required for adequate hip distraction at the time of hip arthroscopy. As ease of distractibility has been associated with hip microinstability, these findings may allow pre-operative identification of hip instability patients and aid in pre-operative counseling, risk stratification and capsular management planning.

Level of evidence

IV.

Clinical relevance

Preoperative identification of risk factors for ease of hip distraction may raise pre-surgical suspicion and, when coupled with other intraoperative findings, may aid in the diagnosis and management of hip microinstability.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Beck M, Kalhor M, Leunig M, Ganz R (2005) Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip. J Bone Jt Surg Br 87:1012–1018

    Article  CAS  Google Scholar 

  2. Bhatia S, Lee S, Shewman E, Mather RC 3rd, Salata MJ, Bush-Joseph CA et al (2015) Effects of acetabular rim trimming on hip joint contact pressures: how much is too much? Am J Sports Med 43:2138–2145

    Article  Google Scholar 

  3. Bolia I, Chahla J, Locks R, Briggs K, Philippon MJ (2016) Microinstability of the hip: a previously unrecognized pathology. Muscles Ligaments Tendons J 6:354–360

    Article  Google Scholar 

  4. Boykin RE, Anz AW, Bushnell BD, Kocher MS, Stubbs AJ, Philippon MJ (2011) Hip instability. J Am Acad Orthop Surg 19:340–349

    Article  Google Scholar 

  5. Charbonnier C, Kolo FC, Duthon VB, Magnenat-Thalmann N, Becker CD, Hoffmeyer P et al (2011) Assessment of congruence and impingement of the hip joint in professional ballet dancers: a motion capture study. Am J Sports Med 39:557–566

    Article  Google Scholar 

  6. Clohisy JC, Carlisle JC, Beaule PE, Kim YJ, Trousdale RT, Sierra RJ et al (2008) A systematic approach to the plain radiographic evaluation of the young adult hip. J Bone Jt Surg Am 90(Suppl 4):47–66

    Article  Google Scholar 

  7. Curtis DM, Murray IR, Money AJ, Pullen WM, Safran MR (2022) Hip microinstability: understanding a newly defined hip pathology in young athletes. Arthroscopy 38:211–213

    Article  Google Scholar 

  8. Dehghan F, Haerian BS, Muniandy S, Yusof A, Dragoo JL, Salleh N (2014) The effect of relaxin on the musculoskeletal system. Scand J Med Sci Sports 24:e220-229

    Article  CAS  Google Scholar 

  9. Economopoulos KJ, Kweon CY, Gee AO, Morris ST, Hassebrock JD, Chhabra A (2019) The pull test: a dynamic test to confirm hip microinstability. Arthrosc Sports Med Rehabil 1:e67–e74

    Article  Google Scholar 

  10. Ellenrieder M, Tischer T, Bader R, Kreuz PC, Mittelmeier W (2017) Patient-specific factors influencing the traction forces in hip arthroscopy. Arch Orthop Trauma Surg 137:81–87

    Article  Google Scholar 

  11. Henak CR, Abraham CL, Anderson AE, Maas SA, Ellis BJ, Peters CL et al (2014) Patient-specific analysis of cartilage and labrum mechanics in human hips with acetabular dysplasia. Osteoarthr Cartil 22:210–217

    Article  CAS  Google Scholar 

  12. Hoppe DJ, Truntzer JN, Shapiro LM, Abrams GD, Safran MR (2017) Diagnostic accuracy of 3 physical examination tests in the assessment of hip microinstability. Orthop J Sports Med 5:2325967117740121

    Article  Google Scholar 

  13. Kalisvaart MM, Safran MR (2017) Hip instability treated with arthroscopic capsular plication. Knee Surg Sports Traumatol Arthrosc 25:24–30

    Article  Google Scholar 

  14. Kalisvaart MM, Safran MR (2015) Microinstability of the hip-it does exist: etiology, diagnosis and treatment. J Hip Preserv Surg 2:123–135

    Article  Google Scholar 

  15. Kapron AL, Karns MR, Aoki SK, Adeyemi TF, Baillargeon EA, Hartley MK et al (2018) Patient-specific parameters associated with traction in primary and revision hip arthroscopic surgery. Orthop J Sports Med 6:2325967118807707

    Article  Google Scholar 

  16. Kraeutler MJ, Garabekyan T, Pascual-Garrido C, Mei-Dan O (2016) Hip instability: a review of hip dysplasia and other contributing factors. Muscles Ligaments Tendons J 6:343–353

    Article  Google Scholar 

  17. LaPrade MD, Melugin HP, Hale RF, Leland DP, Bernard CD, Sierra RJ et al (2021) Incidence of hip dysplasia diagnosis in young patients with hip pain: a geographic population cohort analysis. Orthop J Sports Med 9:2325967121989087

    PubMed  PubMed Central  Google Scholar 

  18. Mitchell RJ, Gerrie BJ, McCulloch PC, Murphy AJ, Varner KE, Lintner DM et al (2016) Radiographic evidence of hip microinstability in elite ballet. Arthroscopy 32:1038-1044 e1031

    Article  Google Scholar 

  19. Mortensen AJ, Tomasevich KM, Ohlsen SM, O’Neill DC, Featherall J, Aoki SK (2021) Increased hip distractibility in the revision hip arthroscopy setting: a comparison between revision and native contralateral hips with an intraoperative axial stress examination under anesthesia. Arthroscopy. https://doi.org/10.1016/j.arthro.2021.09.021

    Article  PubMed  Google Scholar 

  20. Nepple JJ, Ambastha C, Abu-Amer W, Clohisy JC (2021) Mid-term outcomes of combined hip arthroscopy and limited open capsular plication in the non-dysplastic hip. Iowa Orthop J 41:133–139

    PubMed  PubMed Central  Google Scholar 

  21. O’Neill DC, Mortensen AJ, Cannamela PC, Aoki SK (2020) Clinical and radiographic presentation of capsular iatrogenic hip instability after previous hip arthroscopy. Am J Sports Med 48:2927–2932

    Article  Google Scholar 

  22. Parvaresh KC, Rasio J, Azua E, Nho SJ (2021) Hip instability in the athlete: anatomy, etiology, and management. Clin Sports Med 40:289–300

    Article  Google Scholar 

  23. Pullen WM, Curtis DM, Safran MR (2021) Central femoral head chondromalacia is associated with a diagnosis of hip instability. Arthrosc Sports Med Rehabil. https://doi.org/10.1016/j.asmr.2021.10.023

    Article  PubMed  PubMed Central  Google Scholar 

  24. Rosinsky PJ, Mayo BC, Kyin C, Shapira J, Maldonado DR, Meghpara MB et al (2020) The femoral head “Divot” sign: a useful arthroscopic sign of hip microinstability. Orthop J Sports Med 8:2325967120917919

    Article  Google Scholar 

  25. Rosinsky PJ, Shapira J, Lall AC, Domb BG (2020) All about the ligamentum teres: from biomechanical role to surgical reconstruction. J Am Acad Orthop Surg 28:e328–e339

    Article  Google Scholar 

  26. Safran MR (2019) Microinstability of the hip-gaining acceptance. J Am Acad Orthop Surg 27:12–22

    Article  Google Scholar 

  27. Safran MR, Lopomo N, Zaffagnini S, Signorelli C, Vaughn ZD, Lindsey DP et al (2013) In vitro analysis of peri-articular soft tissues passive constraining effect on hip kinematics and joint stability. Knee Surg Sports Traumatol Arthrosc 21:1655–1663

    Article  Google Scholar 

  28. Shibata KR, Matsuda S, Safran MR (2017) Is there a distinct pattern to the acetabular labrum and articular cartilage damage in the non-dysplastic hip with instability? Knee Surg Sports Traumatol Arthrosc 25:84–93

    Article  Google Scholar 

  29. Shu B, Safran MR (2011) Hip instability: anatomic and clinical considerations of traumatic and atraumatic instability. Clin Sports Med 30:349–367

    Article  Google Scholar 

  30. Wiberg G (1939) Studies on dysplastic acetabula and congenial subluxation of the hip joint. Acta Chir Scand Suppl 83:1–130

    Google Scholar 

  31. Woodward RM, Vesey RM, Bacon CJ, White SG, Brick MJ, Blankenbaker DG (2020) Microinstability of the hip: a systematic review of the imaging findings. Skeletal Radiol 49:1903–1919

    Article  Google Scholar 

Download references

Funding

No sources of funding were used for this study.

Author information

Authors and Affiliations

  1. Reno Orthopedic Center, 555 N. Arlington Ave., Reno, NV, 89503, USA

    Daniel M. Curtis

  2. Medical University of South Carolina, Charleston, SC, USA

    W. Michael Pullen

  3. University of Edinburgh, Edinburgh, UK

    Iain R. Murray

  4. Rothman Institute, Orlando, FL, USA

    Adam J. Money

  5. Stanford University, Redwood City, CA, USA

    Nicole Segovia & Marc R. Safran

Authors
  1. Daniel M. Curtis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. W. Michael Pullen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Iain R. Murray
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Adam J. Money
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Nicole Segovia
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Marc R. Safran
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

DMC participated in data collection, analysis, manuscript writing, and editing. WMP participated in data collection, analysis, manuscript writing and editing. IRM participated in data analysis and manuscript editing. AM participated in data analysis and manuscript editing. NS participated in data analysis and manuscript editing. MRS conceived of the study and participated in manuscript writing and editing.

Corresponding author

Correspondence to Daniel M. Curtis.

Ethics declarations

Conflict of interest

DC reports a non-financial interest (Editorial Board: Arthroscopy) unrelated to the current manuscript. IM reports a financial interest (Consultant: Arthrex) and non-financial interests (Editorial Board: Bone & Joint Journal and Bone & Joint Research) unrelated to the current manuscript.

Ethical approval

This study received institutional review board approval at Stanford University.

Informed consent

Informed consent was not needed for this study since it was a retrospective analysis.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Curtis, D.M., Pullen, W.M., Murray, I.R. et al. Female gender, decreased lateral center edge angle and a positive hyperextension–external rotation test are associated with ease of hip distractability at time of hip arthroscopy. Knee Surg Sports Traumatol Arthrosc 30, 2188–2194 (2022). https://doi.org/10.1007/s00167-022-06925-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-022-06925-4

Keywords

Search

Navigation