How Effective Is Nonoperative Hip Micro-Instability Treatment?

Patients with hip micro-instability can be successfully treated nonoperatively with physical therapy and a home exercise program, according to a new study.

The study, “Effectiveness of Nonoperative Management of Hip Microinstability,” was published on March 7, 2022, in The American Journal of Sports Medicine.

“Hip micro-instability has recently gained acceptance as a cause of hip pain. In this condition, the femoral head demonstrates increased motion relative to the acetabulum, which may lead to chondrolabral damage. Even though patients are initially prescribed a trial of nonoperative treatment, the success rates of rehabilitation are unknown,” the researchers wrote.

In their study, they wanted to determine the success rate of nonoperative treatment of hip micro-instability. To do this, they performed a retrospective chart review on patients at a university sports medicine practice between January 2013 and July 2016.

All the patients older than 18 years who presented with hip micro-instability were initially prescribed physical therapy which focused on strengthening the hip and core muscles. The sessions were scheduled for twice a week for a minimum of 6 weeks. Patients also completed a home exercise program.

The primary endpoints were the number of patients who eventually went on to have surgery and the clinical scores which included modified Harris Hip Score and 33-item International Hip Outcome Tool.

Overall, there were 64 patients (63 female and 1 male) included in the study with a mean ± SD age of 32.2 ± 10.5 years. Nine of the patients were high-level athletes. The onset of symptoms was categorized as insidious (n = 45; 70.3%), acute atraumatic (n = 12; 18.8%), and traumatic (n = 7; 10.9%).

Patients were followed for 45.7 ± 14.6 months. Fourteen patients eventually underwent hip arthroscopy for persistent hip pain. In all of the surgeries, the surgeons performed capsular plication.

The researchers determined that high-level athletes were not any more likely to need surgery than the other patients (50% vs 26.8%; p = .34). The modified Harris Hip Score was available in 24 patients treated nonoperatively. It improved from 67.4 to 85.0 (p < .01).

“More than two-thirds of patients treated for hip micro-instability were able to avoid surgery; they were successfully treated nonoperatively with physical therapy and a home exercise program and demonstrated improved clinical outcome scores,” they wrote.

Study authors included Leandro Ejnisman, M.D., Katerina Elisman and Marc R. Safran, M.D., all of Stanford University in California. Dr. Ejnisman is also associated with Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil and Hospital Israelita Albert Einstein, Sao Paulo, Brazil.