Stanford University, Redwood City, California, USA.
Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.
Am J Sports Med. 2022 Mar;50(4):1013-1019. doi: 10.1177/03635465221075349. Epub 2022 Mar 7.
Hip microinstability 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.
To determine the success rate of nonoperative treatment of hip microinstability.
Case series; Level of evidence, 4.
After institutional review board approval was obtained, a retrospective chart review was performed on patients at a university sports medicine practice between January 2013 and July 2016. All patients older than 18 years presenting with hip microinstability who were initially recommended for treatment with physical therapy were enrolled in this study. Formal physical therapy sessions focused on strengthening the hip and core muscles. These sessions took place twice a week for a minimum of 6 weeks in conjunction with a home exercise program. The number of patients who eventually underwent surgical treatment and the clinical scores for the cohort (modified Harris Hip Score [mHHS] and 33-item International Hip Outcome Tool) were recorded.
A total of 64 patients (63 female, 1 male), with a mean ± SD age of 32.2 ± 10.5 years, were identified and studied. Onset of symptoms was insidious (n = 45; 70.3%), acute atraumatic (n = 12; 18.8%), and traumatic (n = 7; 10.9%). A total of 9 (14.1%) patients were high-level athletes. After a follow-up of 45.7 ± 14.6 months, 14 (29.8%) patients eventually underwent hip arthroscopy for persistent hip pain. Capsular plication was performed in all surgical cases. High-level athletes were not more likely to need surgery (50% vs 26.8%; = .34). The mHHS was available in 24 patients who were treated nonoperatively, and it improved from 67.4 to 85.0 ( < .01).
More than two-thirds of patients treated for hip microinstability were able to avoid surgery; they were successfully treated nonoperatively with physical therapy and a home exercise program and demonstrated improved clinical outcome scores.
髋关节微不稳定最近被认为是髋关节疼痛的一个原因。在这种情况下，股骨头相对于髋臼表现出运动增加，这可能导致软骨盂唇损伤。尽管患者最初被开处非手术治疗，但康复的成功率是未知的。
确定髋关节微不稳定的非手术治疗成功率。
病例系列；证据水平，4 级。
在获得机构审查委员会批准后，对一所大学运动医学诊所于 2013 年 1 月至 2016 年 7 月间治疗的髋关节微不稳定患者进行了回顾性图表审查。所有年龄大于 18 岁、最初建议接受物理治疗的髋关节微不稳定患者均纳入本研究。正规的物理治疗课程侧重于加强髋关节和核心肌肉。这些课程每周进行两次，至少进行 6 周，并结合家庭锻炼计划。记录最终接受手术治疗的患者数量以及队列的临床评分（改良 Harris 髋关节评分[mHHS]和 33 项国际髋关节结果工具）。
共确定并研究了 64 名患者（63 名女性，1 名男性），平均年龄 ± 标准差为 32.2 ± 10.5 岁。症状发作隐匿（n = 45；70.3%）、急性无创伤性（n = 12；18.8%）和创伤性（n = 7；10.9%）。共有 9 名（14.1%）患者是高水平运动员。随访 45.7 ± 14.6 个月后，14 名（29.8%）患者因持续髋关节疼痛最终接受髋关节镜检查。所有手术病例均行关节囊缝合。高水平运动员更不可能需要手术（50%与 26.8%； =.34）。24 名接受非手术治疗的患者的 mHHS 可用，从 67.4 提高到 85.0（<.01）。
超过三分之二的髋关节微不稳定治疗患者能够避免手术；他们通过物理治疗和家庭锻炼计划成功地进行了非手术治疗，并且临床评分得到了改善。
