Zárate Leal Milán Fernando, Bautista María, Sánchez-Vergel Alfredo
Department of Orthopedics and Traumatology, Hospital Universitario Fundación Valle del Lili, Cali, Colombia.
Department of Orthopedics and Traumatology, Hospital Universitario Fundación Valle del Lili, Cali, Colombia; School of Health Sciences, Universidad ICESI, Cali, Colombia.
Int J Surg Case Rep. 2024 Feb;115:109323. doi: 10.1016/j.ijscr.2024.109323. Epub 2024 Jan 27.
Hip instability following arthroscopy is a rare complication with a clinical spectrum ranging from gross dislocation (macro-instability) to micro-instability, characterized by pain and limitation for daily activities. Therefore, it should be considered as a potential differential diagnosis in patients experiencing persistent pain after hip arthroscopy.
A 41-year-old male presented with a history of anterior hip dislocation and macro-instability symptoms three years post-hip arthroscopy. Magnetic resonance imaging (MRI) revealed a disruption of the anterior hip capsule. The patient initiated physiotherapy and resumed activities, but ten months later, experienced another anterior dislocation. Pain and apprehension during external hip rotation were evident. Three-dimensional computed tomography (CT) indicated irregularities in the anterior and superior margin of the acetabulum, while MRI arthrogram showed a rupture of the anterior capsule and deficiency in the anterior hip ligaments. Open reconstruction of the anterior capsule was performed, resulting in favorable progression over the 5-year follow-up.
This case highlights post-arthroscopy hip instability with a delayed presentation, possibly linked to chronic anterior capsule deficiency and inadequate acetabular coverage. Primary capsule repair after hip arthroscopy has proven effective in reducing the occurrence of instability symptoms and reoperations.
Post-arthroscopic hip instability may manifest immediately after surgery or several years later. Open reconstruction of the anterior capsule emerges as a successful strategy for addressing this complication, demonstrating satisfactory outcomes in a 5-year follow-up.
关节镜检查后髋关节不稳定是一种罕见的并发症，临床范围从严重脱位（宏观不稳定）到微观不稳定，其特征为疼痛和日常活动受限。因此，对于髋关节镜检查后持续疼痛的患者，应将其视为一种潜在的鉴别诊断。
一名41岁男性在髋关节镜检查三年后出现髋关节前脱位病史及宏观不稳定症状。磁共振成像（MRI）显示髋关节前囊破裂。患者开始接受物理治疗并恢复活动，但十个月后又发生了一次前脱位。髋关节外旋时疼痛和恐惧明显。三维计算机断层扫描（CT）显示髋臼前上缘不规则，而磁共振关节造影显示前囊破裂和髋关节前韧带缺失。进行了前囊开放重建，在5年的随访中进展良好。
本病例突出了关节镜检查后髋关节不稳定的延迟表现，可能与慢性前囊缺损和髋臼覆盖不足有关。髋关节镜检查后进行一期囊修复已被证明可有效减少不稳定症状的发生和再次手术的需求。
关节镜检查后髋关节不稳定可能在手术后立即出现，也可能在数年后出现。前囊开放重建是解决这一并发症的成功策略，在5年的随访中显示出令人满意的结果。
