Hip Instability Overview
While some joints in the body (such as the shoulder) are predisposed to dislocations and instability, the hip is considered a relatively stable joint. Therefore, true instability of the hip is a relatively rare condition. This can occur in patients who have sustained a traumatic dislocation of the hip, patients with ligamentous laxity (loose joints), patients with dysplasia (a poorly formed socket), and can be seen in patients after a hip replacement. Dr. Boykin specializes in the treatment of hip instability for patients in Asheville, Arden, Fletcher and surrounding communities.
The hip is a ball and socket joint composed of the femoral head (ball) and an area of the pelvis known as the acetabulum (socket). The joint is very stable due to a number of factors. First, the bony socket is much deeper than the shoulder, which helps to keep the ball in place. There is also a ring of cartilage called the acetabular labrum which provides stability by deepening the socket and creates a suction seal to keep the ball in the socket. In addition, there is a ligament inside the hip called the ligamentum teres which provides stability. Finally, there are three very strong ligaments that surround the hip and form a capsule to hold the hip in place called the iliofemoral ligament, ischiofemoral ligament, and pubofemoral ligament.
Instability of the hip joint is mostly seen in three situations: in patients who have a high energy trauma such as a car accident, fall from height, or severe hit during contact sports. In these cases the ball may completely dislocate (come out) of the socket and medical attention should be sought immediately to reduce the hip (put it back in place). In some instances, the patient may be left with symptoms of instability of the hip after a dislocation. In active patients and athletes whose activities involve repetitive motion in the hips (twisting and rotating as is the case in golf, baseball, tennis, and hockey) damage can occur to the labrum and acetabular cartilage. This is commonly seen in patients with femoroacetabular impingement, and can eventually lead to microinstability of the hip. Instability may also be a problem in patients who are born with ligamentous laxity (loose joints) or those whose hips fail to develop properly (called hip dysplasia).
Symptoms of Hip Instability
Symptoms associated with hip instability include:
- Pain or the feeling that the hip will dislocate when placing weight on the leg
- Deep aching in the hip joint
- Clicking or shifting of the hip during activities such as walking or sports
- The ability to voluntarily bring the hip out of joint and place it back into joint
Diagnosis of Hip Instability
If a patient presents with symptoms of hip instability, Dr. Boykin will conduct a detailed history, physical examination, and X-rays to look for causes of hip instability in addition to other hip problems. Specific physical exam tests for hip instability include the dial test and the logroll test. A MRI may be ordered to assess the status of the articular cartilage, labrum, ligamentum teres, and surrounding ligaments and muscles. In the event that the damage to the hip is not severe, Dr. Boykin will usually recommend conservative, non-surgical treatment methods in order to treat the instability. A few of these treatments include rest, exercises to strengthen specific muscles to stabilize the hip, anti-inflammatory pain relievers, and ceasing activities which cause pain or instability. In the non-surgical management of this condition, physical therapy is of the utmost importance to properly strengthen the muscles of the core and leg and allow the best chance for recovery. In the event that these treatment methods are not found to be beneficial, or the initial injury itself will not respond to treatment methods, Dr. Boykin may begin to discuss surgical treatment alternatives with the patient.
Surgical Treatment for Hip Instability
If surgery is thought to be necessary for hip instability, Dr Boykin will typically perform an arthroscopic procedure with small incisions, a camera, and special instruments. The type of surgery will depend on the specific injury and cause of instability and varies with each patient. In many cases the labrum needs to be repaired or reconstructed, the femoroacetabular impingement has to be addressed, the capsule will be tightened, and the ligamentum teres may need to be tightened (or in severe cases reconstructed). These procedures will stabilize the hip, allow for more normal motion, and in most cases prevent future instability. In certain cases or patients where multiple injuries are present an open procedure may be needed to adequately stabilize the hip.
For more information on instability of the hip or to learn about other hip injuries, please contact the office of Dr. Robert Boykin, orthopedic hip surgeon serving patients in Asheville, Arden, Fletcher and surrounding North Carolina communities.