Anterior Dislocation of the Hip After Arthroscopy in a Patient with Capsular Laxity of the Hip: A Case Report

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Capsular laxity is a poorly understood but increasingly recognized cause of hip pain1,2. As with shoulder instability, hip instability represents a wide spectrum of pathologic entities, ranging from acute traumatic dislocation to chronic capsular laxity. Primary capsular laxity is often associated with underlying collagen abnormalities, such as those seen with Ehlers-Danlos or Marfan syndrome. Secondary capsular laxity is seen more commonly in athletes and is secondary to overuse or repetitive activities2.Although the mainstay of treatment for these conditions has been nonoperative, surgical intervention may be indicated because of either recurrent instability or lack of pain relief with nonoperative measures. Surgical treatment may require access to both the hip capsule and the labrum through either an open3-5 or an arthroscopic6-12 approach. Although the latter techniques are relatively new, two studies have demonstrated that arthroscopic surgery can provide stability to the hip joint10,11. However, while arthroscopic techniques are generally less invasive than open surgical techniques, hip arthroscopy is not without complications13. This case study documents the first report, to our knowledge, of a hip dislocation following an arthroscopic procedure of the hip. The patient was informed that data concerning the case would be submitted for publication, and she consented.Case ReportA fifty-two-year-old Caucasian woman presented to our clinic in the fall of 2005 with a two-year history of pain in the right groin and anterior part of the thigh and a sensation of “popping” in the right hip. She had undergone bilateral shoulder capsulorrhaphy for multidirectional instability (the right shoulder in 2002, and the left in 2000) as well as bilateral knee meniscal repairs (both in 1999). On physical examination, both the affected right hip and the asymptomatic left hip had flexion to 120° and hyperextension to 15° to 20° in each hip. In 90° of flexion, each hip had 60° of external rotation and 40° of internal rotation. During range-of-motion testing, the patient had right groin pain with flexion and internal rotation of the hip as well as apprehension when the hip was placed in a position of extension, abduction, and external rotation14. With axial traction, the right hip was easily distracted approximately 1 to 2 cm and with no appreciable firm end point.In full extension, the right hip had approximately 60° of external rotation and 30° of internal rotation, whereas the left hip had only 50° of external rotation and 30° of internal rotation. In flexion, abduction, and external rotation (FABER test15), each knee could be pressed downward such that there was a distance of <3 cm between the lateral aspect of the knee and the examination table. The patient had normal results bilaterally on the Ober test15 (for iliotibial band tightness) and no tenderness about either greater trochanter.The patient also had ligamentous laxity of other joints, demonstrated by hyperextension of the interphalangeal, first carpometacarpal, elbow, and knee joints. We also noted hyperelasticity of the skin on examination. She had never had a genetic workup for a collagen disorder, but it is notable that results were normal on echocardiograms that had been performed previously to rule out aortic abnormalities associated with collagen disorders. The results of motor, sensory, and vascular examination were normal.The imaging examination included plain radiographs and a magnetic resonance arthrogram of the right hip. The plain radiographs showed no evidence of degenerative changes, developmental dysplasia of the hip, or femoroacetabular impingement (Figs. 1-A and 1-B). The magnetic resonance arthrogram showed a peripheral tear of the anterosuperior portion of the right labrum (Fig. 1-C).

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