Diagnosis and Management of Traumatic and Atraumatic Hip Instability in the Athletic Patient

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Anatomy

The hip is a diarthrodial joint and is an articulation between the head of the femur and the acetabulum. The acetabulum is formed by the union of the ilium, ischium, and the pubis. The tri-radiate cartilage usually fuses by 15 to 16 years of age, and is oriented approximately 45° caudally and has 15° of anteversion. A variety of normal radiographic indices have been described to differentiate normal from abnormal bony anatomy and play an important role in understanding why some patients develop

Traumatic hip instability

The diagnosis of a traumatic hip injury is obvious in severe cases of dislocation. However, more subtle traumatic subluxation of the hip can occur with seemingly minimal trauma. The clinician should have a high index of suspicion for intraarticular injury even after minor trauma. A careful physical examination should be performed to differentiate intraarticular versus extraarticular pathology. Patients may also have concommitent soft tissue injuries such as chondral injuries, labral tears, and

Atraumatic instability

Due to a lack of a discrete acute event, the etiology of hip pain in the absence of trauma may be more difficult to determine. Furthermore, the differential diagnosis of hip pain is quite broad (Table 1). Based on the history and physical examination, various categories can be eliminated and the differential diagnosis further narrowed. The history should assess the timing of the onset of symptoms, the qualitative nature of the discomfort (pain, clicking catching, instability, stiffness,

Summary

Hip instability may be of traumatic or atraumatic origin. We define here the treatment algorithm for traumatic instability. The algorithm for atraumatic instability is less well defined. Hip arthroscopy is now becoming a more common orthopaedic procedure and potentially has a role for the treatment for traumatic and atraumatic instability. Further studies are warranted to understand the clinical course of this disease entity and to test the effectiveness of these procedures to treat them.

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