Hip Dislocation or Subluxation After Hip Arthroscopy: A Systematic Review.
PURPOSE: To determine patient- and surgery-specific characteristics of patients sustaining postarthroscopic hip dislocation or subluxation. METHODS: A systematic review of multiple medical databases was registered with PROSPERO and performed using Preferred Reporting Items for Systemic Reviews and Meta-Analysis guidelines. Level I to IV clinical outcome studies reporting the 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 9 hip dislocations and 2 subluxations. Mean time between surgery and dislocation was 3.2 ± 4.0 months (range: recovery room to 14 months). Anterior was the most frequent dislocation direction (8 cases). Acetabular undercoverage (preoperative dysplasia or iatrogenic rim over-resection) was observed in 5 cases. Labral debridement was performed in 5 cases, iliopsoas tenotomy in 3 cases, and ligamentum teres debridement in 1 case. A "T" capsulotomy was created in 1 case (isolated interportal in other 10 cases). Capsular closure was performed in 2 cases (both interportal). Generalized ligamentous laxity was diagnosed in 1 case. A combination of external rotation and extension was observed in 5 of the 6 cases reporting the mechanism of anterior dislocation. Four cases were successfully treated with closed reduction; 4 required total hip arthroplasty; and 3 required revision capsulorrhaphy. CONCLUSIONS: Postarthroscopic 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: Level IV, systematic review of Level IV studies.
Duplantier, NL; McCulloch, PC; Nho, SJ; Mather, RC; Lewis, BD; Harris, JD
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