Late post-arthroscopy hip instability. Diagnosis, treatment, and 5-year follow-up: A case report

• Published in: International journal of surgery case reports Vol. 115; p. 109323
• Main Authors: Zárate Leal, Milán Fernando, Bautista, María, Sánchez-Vergel, Alfredo
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.02.2024; Elsevier
• Subjects: Case Report; Femoroacetabular impingement; Hip arthroscopy; Hip capsule reconstruction; Iatrogenic hip dislocation; Hip capsule reconstruction; Case report; Hip arthroscopy; Iatrogenic hip dislocation; Femoroacetabular impingement
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2024.109323

Hip instability following arthroscopy is a rare complication with a clinical spectrum ranging from gross dislocation (macro-instability) to micro-instability, characterized by pain and limitation for daily activities. Therefore, it should be considered as a potential differential diagnosis in patients experiencing persistent pain after hip arthroscopy. A 41-year-old male presented with a history of anterior hip dislocation and macro-instability symptoms three years post-hip arthroscopy. Magnetic resonance imaging (MRI) revealed a disruption of the anterior hip capsule. The patient initiated physiotherapy and resumed activities, but ten months later, experienced another anterior dislocation. Pain and apprehension during external hip rotation were evident. Three-dimensional computed tomography (CT) indicated irregularities in the anterior and superior margin of the acetabulum, while MRI arthrogram showed a rupture of the anterior capsule and deficiency in the anterior hip ligaments. Open reconstruction of the anterior capsule was performed, resulting in favorable progression over the 5-year follow-up. This case highlights post-arthroscopy hip instability with a delayed presentation, possibly linked to chronic anterior capsule deficiency and inadequate acetabular coverage. Primary capsule repair after hip arthroscopy has proven effective in reducing the occurrence of instability symptoms and reoperations. Post-arthroscopic hip instability may manifest immediately after surgery or several years later. Open reconstruction of the anterior capsule emerges as a successful strategy for addressing this complication, demonstrating satisfactory outcomes in a 5-year follow-up. •Post-arthroscopic hip instability varies from gross dislocation to micro-instability presented as pain and limitation for daily activities.•Increased femoral anteversion, hip dysplasia, hyperlaxity, and traumatic injuries have been described as predisposing factors for iatrogenic hip instability.•Post-arthroscopic hip instability can be present at any time after the procedure.•Open reconstruction of the anterior capsule with tendon allografts is an effective option for treatment of post-arthroscopic hip instability.