Hip microinstability

Last revised by Henry Knipe on 16 Jun 2022

Hip microinstability is a multifactorial disorder referred to as painful, excessive mobility of the femoral head within the acetabulum 1,2.  It results from impaired joint stability, secondary to functional and architectural abnormalities 1,2. AB-HEER test on clinical examination remains the most specific test of hip microinstability 3.

Causes of hip microinstability include many conditions which lead to structural and/or functional abnormalities due to soft tissue damage or bony deficiencies as 1-3:

The main role of imaging is to assess for risk factors and rule out differential diagnoses.

  • femoral head subluxation
  • disrupted Shenton line
  • loss of sphericity of the lateral femoral head, which is called the cliff sign 3
  • concave shape
  • >5 mm anterior hip joint recess widening
  • thinning of anterior hip capsule <3 mm
  • contrast accumulation in the posterior-inferior plane 3,4

Primary therapy consists of workout adaptation, physiotherapy and enhancement of the periarticular muscle. Surgical treatment options include osteotomy, capsular plication, labral reconstruction and capsular reconstruction 1-3.

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