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Hip microinstability diagnosis and management: a systematic review

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this systematic review is to present the most common causes, diagnostic features, treatment options and outcomes of patients with hip micro-instability.

Methods

Three online databases (MEDLINE, Embase, and PubMed) were searched from database inception March 2022, for literature addressing the diagnosis and management of patients with hip micro-instability. Given the lack of consistent reporting of patient outcomes across studies, the results are presented in a descriptive summary fashion.

Results

Overall, there were a total of 9 studies including 189 patients (193 hips) included in this review of which 89% were female. All studies were level IV evidence with a mean MINORS score of 12 (range: 10–13). The most commonly used features for diagnosis of micro-instability on history were anterior pain in 146 (78%) patients and a subjective feeling of instability with gait in 143 (81%) patients, while the most common feature on physical examination was the presence of anterior apprehension with combined hip extension and external rotation in 123 (65%) patients. The most common causes of micro-instability were iatrogenic instability secondary to either capsular insufficiency or cam over-resection in 76 (62%) patients and soft tissue laxity in 38 (31%) patients.

Conclusion

The most common symptom of micro-instability on history was anterior hip pain and on physical exam was pain with hip extension and external rotation. There are many treatment options and when managed appropriately based on the precise cause of micro-instability, patients may demonstrate improved outcomes.

Level of evidence

IV.

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Abbreviations

PAO:

Peri-acetabular osteotomy

MRA:

Magnetic resonance arthrogram

MINORS:

Methodological index for non-randomized studies

PRISMA:

Preferred reporting items for systematic reviews and meta-analyses

LCEA:

Lateral center edge angle

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Funding

No funding was provided for this study.

Author information

Authors and Affiliations

  1. Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, 1200 Main St West, 4E15, Hamilton, ON, L8N 3Z5, Canada

    Dan Cohen, Pierre-Olivier Jean, Nicole Simunovic, Andrew Duong & Olufemi R. Ayeni

  2. Faculty of Science, McMaster University, Hamilton, ON, Canada

    Milin Patel & Neveadan Aravinthan

  3. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, L8N 3Z5, Canada

    Olufemi R. Ayeni

  4. Department of Orthopedic Surgery, Stanford University, Redwood City, CA, USA

    Marc R. Safran

  5. Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, UK

    Vikas Khanduja

Authors
  1. Dan Cohen
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Contributions

DC participated in the design of the study, carried out the systematic review, extracted data, provided illustrations, and drafted the manuscript. POJ carried out the systematic review and drafted the manuscript. MP screened articles, extracted data and aided with drafting the manuscript. NA screened articles, extracted data and aided with drafting the manuscript. AD participated in the editing and revision of the manuscript. NS participated in the editing and revision of the manuscript. MS and VK participated in the editing and revision of the manuscript. OA conceived of the study and participated in the revision of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Olufemi R. Ayeni.

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Conflict of interest

Dr. Olufemi R Ayeni declares that he has a non-financial conflict of interest as he is associated with the Speakers Bureau for Conmed and Stryker Canada. Dr. Marc Safran declares that he has a non-financial conflict of interest as he is a consultant for Medacta and Smith & Nephew, gets fellowship support from Smith & Nephew and royalties from Smith & Nephew and Stryker. All other authors declare that they have no competing interests.

Ethical approval

This study does not contain any studies with human participants or animals performed by any of the authors.

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Cohen, D., Jean, PO., Patel, M. et al. Hip microinstability diagnosis and management: a systematic review. Knee Surg Sports Traumatol Arthrosc 31, 16–32 (2023). https://doi.org/10.1007/s00167-022-06976-7

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