Protocol for a multicenter prospective cohort study evaluating arthroscopic and non-surgical treatment for microinstability of the hip joint

Axel Öhlin, Eric Hamrin Senorski, Mikael Sansone, Gretchen Leff, Neel Desai, Ida Lindman, Olufemi R Ayeni, Marc R Safran, Axel Öhlin, Eric Hamrin Senorski, Mikael Sansone, Gretchen Leff, Neel Desai, Ida Lindman, Olufemi R Ayeni, Marc R Safran

Abstract

Background: Microinstability of the hip joint is a proposed cause of hip pain and reduced function in young individuals. The underlying mechanism is thought to be extraphysiological hip motion due to bony deficiency and/or soft tissue deficiency or decreased soft tissue function. Recently, the condition has gained increased attention, and despite the fact that treatment today includes both non-surgical and surgical approaches, there is limited evidence on diagnostic specificity and treatment effects. The aim of this study is to evaluate clinical outcomes of both non-surgical and surgical treatment for microinstability of the hip joint.

Methods: A multicenter prospective cohort study is planned to evaluating the outcome of physical therapy aimed at stabilizing the hip joint, as well as arthroscopic plication of the hip joint capsule, if the physical therapy fails. Outcomes will be evaluated using hip-specific patient-reported outcome measures: the short version of the International Hip Outcome Tool and the Copenhagen Hip and Groin Outcome Score, strength and function tests, health-related quality of life as determined using the European Quality of Life-5 Dimensions and the European Quality of Life-Visual Analog Scale, sports activity levels according to the Hip Sport Activity Scale, and reported complications. Patients will be evaluated at 6, 12 and 24 months after each treatment.

Discussion: It is important to evaluate the clinical outcomes of both non-surgical and surgical treatment for suspected microinstability of the hip joint, and the planned prospective evaluation will contribute to the understanding of non-surgical as well as surgical treatment outcomes, including complications.

Trial registration: Clinicaltrials.gov: NCT04934462 . Registered June 22 2021.

Keywords: Arthroscopy; Hip joint; Microinstability; Physical therapy.

Conflict of interest statement

OA is an educational consultant for the speaker’s bureau of ConMed and Stryker. MS is a consultant for Medacta and Smith & Nephew and receives research and fellowship support from Smith & Nephew.

© 2022. The Author(s).

References

    1. Shu B, Safran MR. Hip instability: anatomic and clinical considerations of traumatic and atraumatic instability. Clin Sports Med. 2011;30(2):349–67. doi: 10.1016/j.csm.2010.12.008.
    1. Kalisvaart MM, Safran MR. Microinstability of the hip-it does exist: etiology, diagnosis and treatment. J Hip Preserv Surg. 2015;2(2):123–35. doi: 10.1093/jhps/hnv017.
    1. Safran MR. Microinstability of the hip-gaining acceptance. J Am Acad Orthop Surg. 2019;27(1):12–22. doi: 10.5435/JAAOS-D-17-00664.
    1. Jean P-O, Safran MR, Ayeni OR. Hip microinstability: fact or fiction? Knee Surg Sports Traumatol Arthrosc. 2022 doi: 10.1007/s00167-021-06835-x.
    1. Curtis DM, Murray IR, Money AJ, Pullen WM, Safran MR. Hip microinstability: understanding a newly defined hip pathology in young athletes. Arthroscopy. 2022;38(2):211–3. doi: 10.1016/j.arthro.2021.12.001.
    1. Kalisvaart MM, Safran MR. Hip instability treated with arthroscopic capsular plication. Knee Surg Sports Traumatol Arthrosc. 2017;25(1):24–30. doi: 10.1007/s00167-016-4377-6.
    1. d’Hemecourt PA, Sugimoto D, McKee-Proctor M, Zwicker RL, Jackson SS, Novais EN, et al. Can dynamic ultrasonography of the hip reliably assess anterior femoral head translation? Clin Orthop Relat Res. 2019;477:1086–98. doi: 10.1097/CORR.0000000000000457.
    1. Mitchell RJ, Gerrie BJ, McCulloch PC, Murphy AJ, Varner KE, Lintner DM, et al. Radiographic evidence of hip microinstability in elite ballet. Arthroscopy. 2016;32(6):1038–44. doi: 10.1016/j.arthro.2015.12.049.
    1. Han S, Alexander JW, Thomas VS, Choi J, Harris JD, Doherty DB, et al. Does capsular laxity lead to microinstability of the native hip? Am J Sports Med. 2018;46(6):1315–23. doi: 10.1177/0363546518755717.
    1. Duthon VB, Charbonnier C, Kolo FC, Magnenat-Thalmann N, Becker CD, Bouvet C, et al. Correlation of clinical and magnetic resonance imaging findings in hips of elite female ballet dancers. Arthroscopy. 2013;29(3):411–9. doi: 10.1016/j.arthro.2012.10.012.
    1. Shibata KR, Matsuda S, Safran MR. 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. 2017;25(1):84–93. doi: 10.1007/s00167-016-4342-4.
    1. Hoppe DJ, Truntzer JN, Shapiro LM, Abrams GD, Safran MR. Diagnostic accuracy of 3 physical examination tests in the assessment of hip microinstability. Orthop J Sports Med. 2017;5(11):2325967117740121.
    1. Packer JD, Cowan JB, Rebolledo BJ, Shibata KR, Riley GM, Finlay AK, et al. The cliff sign: a new radiographic sign of hip instability. Orthop J Sports Med. 2018;6(11):2325967118807176.
    1. Wyatt M, Weidner J, Pfluger D, Beck M. The Femoro-Epiphyseal Acetabular Roof (FEAR) Index: A new measurement associated with instability in borderline hip dysplasia? Clin Orthop Relat Res. 2017;475(3):861–9. doi: 10.1007/s11999-016-5137-0.
    1. Truntzer JN, Hoppe DJ, Shapiro LM, Safran MR. Can the FEAR Index be used to predict microinstability in patients undergoing hip arthroscopic surgery? Am J Sports Med. 2019;47(13):3158–65. doi: 10.1177/0363546519876105.
    1. Magerkurth O, Jacobson JA, Morag Y, Caoili E, Fessell D, Sekiya JK. Capsular laxity of the hip: findings at magnetic resonance arthrography. Arthroscopy. 2013;29(10):1615–22. doi: 10.1016/j.arthro.2013.07.261.
    1. Packer JD, Foster MJ, Riley GM, Stewart R, Shibata KR, Richardson ML, et al. Capsular thinning on magnetic resonance arthrography is associated with intra-operative hip joint laxity in women. J Hip Preserv Surg. 2020;7(2):298–304. doi: 10.1093/jhps/hnaa018.
    1. Pullen WM, Curtis DM, Safran MR. Central Femoral Head Chondromalacia Is Associated with a Diagnosis of Hip Instability. Arthrosc Sports Med and Rehabil. 2021 doi: 10.1016/j.asmr.2021.10.023.
    1. Johannsen AM, Behn AW, Shibata K, Ejnisman L, Thio T, Safran MR. The role of anterior capsular laxity in hip microinstability - a novel biomechanical model. Am J Sports Med. 2019;47(5):1151–8. doi: 10.1177/0363546519827955.
    1. Johannsen AM, Ejnisman L, Behn AW, Shibata K, Thio T, Safran MR. Contributions of the capsule and labrum to hip mechanics in the context of hip microinstability. Orthop J Sports Med. 2019;7(12):2325967119890846. doi: 10.1177/2325967119890846.
    1. Domb BG, Stake CE, Lindner D, El-Bitar Y, Jackson TJ. Arthroscopic capsular plication and labral preservation in borderline hip dysplasia: two-year clinical outcomes of a surgical approach to a challenging problem. Am J Sports Med. 2013;41(11):2591–8. doi: 10.1177/0363546513499154.
    1. Larson CM, Stone RM, Grossi EF, Giveans MR, Cornelsen GD. Ehlers-Danlos syndrome: arthroscopic management for extreme soft-tissue hip instability. Arthroscopy. 2015;31(12):2287–94. doi: 10.1016/j.arthro.2015.06.005.
    1. Griffin DR, Parsons N, Mohtadi NG, Safran MR, Multicenter Arthroscopy of the Hip Outcomes Research Network A short version of the International Hip Outcome Tool (iHOT-12) for use in routine clinical practice. Arthroscopy. 2012;28(5):611–6. doi: 10.1016/j.arthro.2012.02.027.
    1. Thorborg K, Holmich P, Christensen R, Petersen J, Roos EM. The Copenhagen Hip and Groin Outcome Score (HAGOS): development and validation according to the COSMIN checklist. Br J Sports Med. 2011;45(6):478–91. doi: 10.1136/bjsm.2010.080937.
    1. Naal F, Miozzari H, Kelly B, Magennis E, Leunig M, Noetzli H. The Hip Sports Activity Scale (HSAS) for patients with femoroacetabular impingement. Hip Int. 2013;23(2):204–11. doi: 10.5301/hipint.5000006.
    1. Rabin R, de Charro F. EQ-5D: a measure of health status from the EuroQol Group. Ann Med. 2001;33(5):337–43. doi: 10.3109/07853890109002087.
    1. Jonasson P, Baranto A, Karlsson J, Sward L, Sansone M, Thomee C, et al. A standardised outcome measure of pain, symptoms and physical function in patients with hip and groin disability due to femoro-acetabular impingement: cross-cultural adaptation and validation of the international Hip Outcome Tool (iHOT12) in Swedish. Knee Surg Sports Traumatol Arthrosc. 2014;22(4):826–34. doi: 10.1007/s00167-013-2710-x.
    1. Thomee R, Jonasson P, Thorborg K, Sansone M, Ahlden M, Thomee C, et al. Cross-cultural adaptation to Swedish and validation of the Copenhagen Hip and Groin Outcome Score (HAGOS) for pain, symptoms and physical function in patients with hip and groin disability due to femoro-acetabular impingement. Knee Surg Sports Traumatol Arthrosc. 2014;22(4):835–42. doi: 10.1007/s00167-013-2721-7.
    1. Öhlin A, Jónasson P, Ahldén M, Thomeé R, Baranto A, Karlsson J, et al. The Hip Sports Activity Scale for patients with femoroacetabular impingement syndrome - validation in Swedish. Transl Sports Med. 2019;2(4):209–13. doi: 10.1002/tsm2.76.
    1. Öhlin A, Sansone M, Ayeni OR, Swärd L, Ahldén M, Baranto A, et al. Predictors of outcome at 2-year follow-up after arthroscopic treatment of femoro-acetabular impingement. J Hip Preserv Surg. 2017;4(3):224–30. doi: 10.1093/jhps/hnx016.
    1. Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J. Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg. 2003;73(9):712–6. doi: 10.1046/j.1445-2197.2003.02748.x.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe