Article

With the development of conservative hip surgery techniques, new entities such as
microinstability have been identified. Microinstability is a painful
supra-physiological mobility of the hip. It results from the association of
architectural and functional abnormalities impairing joint stability. These risk
factors concern hip joint bone architecture or peri-articular soft tissues. Bone
abnormalities are identified on hip assessment parameters. Soft tissues also play
a key role in the static and dynamic stability of the hip: the joint capsule,
labrum, ligamentum teres and adjacent myotendinous structures affect joint
coaptation; any abnormality or iatrogenic lesion concerning these structures may
constitute a risk factor for microinstability. Diagnosis is based on interview,
clinical examination and imaging. Findings of labral lesions or femoro-acetabular
impingement do not rule out microinstability; they may be associated. Treatment
is based first on physiotherapy for muscle reinforcement to improve joint
coaptation. In case of failure, arthroscopic surgery is indicated for
femoro-acetabular impingement and capsular plicature which is being evaluated.
Periacetabular osteotomy or shelf acetabuloplasty may be indicated, according to
the severity of joint bone architecture abnormality. Microinstability is a
multifactorial entity. Lesions induced by microinstability may in turn become
risk factors for aggravation. Diagnosis and indications for surgery are thus
difficult to establish. Only full clinical examination and exhaustive imaging
assessment allow microinstability and associated lesions to be identified.
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Langue : FRANCAIS