ePoster #904 - ISHA Annual Scientific Meeting 2016

Hip Dislocation Or Subluxation Following Hip Arthroscopy: A Systematic Review

Joshua David Harris, MD, Houston, TX UNITED STATES
Neil Duplantier, MD, New Orleans, LA UNITED STATES
Patrick C. McCulloch, MD, Houston, TX UNITED STATES
Shane J. Nho, MD, MS, Chicago, IL UNITED STATES
Richard C. Mather, MD, MBA, Durham, NC UNITED STATES
Brian D. Lewis, MD, Raleigj, NC UNITED STATES

Houston Methodist Orthopedics & Sports Medicine, Houston, TX, UNITED STATES

FDA Status Not Applicable

Summary: Post-arthroscopic hip instability was observed in patients with acetabular undercoverage (including iatrogenic resection), labral debridement, capsular insufficiency, or iliopsoas tenotomy with most dislocations anterior, occurring with hip extension and external rotation

Abstract:
Purpose: To determine patient- and surgery-specific characteristics of patients sustaining post-arthroscopic hip dislocation or subluxation. Methods: A systematic review of multiple medical databases was registered with PROSPERO and performed using PRISMA guidelines. Level I-IV clinical outcome studies reporting presence of hip dislocation or subluxation after hip arthroscopy were eligible. Length of follow-up was not an exclusion criterion. All patient- and surgery-specific variables were extracted from each, specifically evaluating osseous morphology and resection details; labral, iliopsoas, ligamentum teres, and capsular management; generalized ligamentous laxity; instability direction and mechanism; management; and outcome. Study authors were individually contacted to assess most recent outcome. Results: Ten articles with 11 patients were analyzed (mean patient age 36.6 ±12.3 years). There were nine hip dislocations and two subluxations. Mean time between surgery and dislocation was 3.2 ±4.0 months (range: recovery room - 14 months). Anterior was the most frequent dislocation direction (eight cases). Acetabular undercoverage (pre-operative dysplasia or iatrogenic rim over-resection) was observed in five cases. Labral debridement was performed in five cases, iliopsoas tenotomy in three cases, and ligamentum teres debridement in one case. A “T” capsulotomy was created in one case (isolated interportal in other 10 cases). Capsular closure was performed in two cases (both interportal). Generalized ligamentous laxity was diagnosed in one case. A combination of external rotation and extension was observed in five out of the six cases reporting mechanism of anterior dislocation. Four cases were successfully treated with closed reduction; four required total hip arthroplasty; three required revision capsulorrhaphy. Conclusions: Post-arthroscopic hip instability was observed in patients with acetabular undercoverage (including iatrogenic resection), labral debridement, capsular insufficiency, or iliopsoas tenotomy. Most dislocations were anterior, occurring with hip extension and external rotation. Level of evidence: Systematic review, Level IV