Emerging Techniques for Hip Instability: From Advanced Arthroscopic Capsular Management to PAO (2024 Annual Meeting)-Emerging Techniques for Hip Instability: From Advanced Arthroscopic Capsular Management to PAO

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Video Summary

The panel discussion on hip instability highlights evolving diagnostic and treatment approaches for this complex condition. Dr. Yi-Man Yan Bang emphasized that hip instability is a recognized but challenging diagnosis lacking standardized scientific criteria, requiring a nuanced clinical assessment incorporating history, physical exam, radiographic parameters, and dynamic ultrasound to detect abnormal translational movements beyond normal rotational hip motion. Instability can be anterior microinstability or posterior instability often linked to femoroacetabular impingement (FAI). Bony morphology (acetabular depth, femoral version, dysplasia), soft tissues (labrum, capsule, ligamentum teres), and neuromuscular factors (notably the psoas muscle) all contribute to stability. Dysplasia and altered femoral version significantly raise instability risk.<br /><br />Dr. Hal Martin elaborated on the biomechanics, noting flexion- versus extension-based instability influenced by acetabular morphology, ligament function, and muscle behavior. The ligamentum teres and iliofemoral ligament play crucial stabilizing roles, especially in specific hip positions. Dynamic intraoperative assessment and 3D imaging assist in identifying instability patterns.<br /><br />Dr. Tom Wurst focused on arthroscopic capsule management, advocating minimal interportal capsulotomies with meticulous capsule preservation and repair to optimize stability, avoiding over-resection or iliopsoas release. Dynamic ultrasound is valuable for assessing soft tissue competency.<br /><br />Dr. Travis Matheny discussed indications for periacetabular osteotomy (PAO) and femoral derotational osteotomy in treating borderline dysplasia and version abnormalities, stressing bony stability’s importance. PAO outcomes have improved significantly, making it a viable option even for mild dysplasia. He noted that hypermobility syndromes like Ehlers-Danlos complicate management as bony anatomy may appear normal yet exhibit instability. Femoral version abnormalities require clinical correlation for treatment decisions.<br /><br />Overall, the session underscores the multifactorial nature of hip instability, the need for comprehensive evaluation using clinical, imaging, and dynamic techniques, and a tailored treatment strategy ranging from arthroscopy with capsule management to open bony realignment procedures. Collaboration among experts and patient education are essential in managing this challenging patient population.

Asset Caption

Srino Bharam, M.D., M.B.A., Moderator | Yi-Meng Yen, M.D., Ph.D. | Hal Martin, M.D. | Thomas H. Wuerz, M.D., M.Sc. | Travis Matheney, M.D.

Keywords

hip instability

diagnostic approaches

treatment strategies

clinical assessment

dynamic ultrasound

femoroacetabular impingement

bony morphology

soft tissue structures

neuromuscular factors

arthroscopic capsule management

periacetabular osteotomy

femoral derotational osteotomy