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A Year in Review-4

Day 4 already! If you missed Day 1, Day 2 or Day 3 of my 12 Top Hip Papers series featuring 12 top hip papers, you might like to read these also. In the first 2 days we covered a couple of important FAIS papers and yesterday an excellent paper on acetabular dysplasia. Today we continue a theme of joint instability to take a look at one of the first papers to really highlight the issue of instability after hip arthroscopy. Gross instability is likely under-reported in the literature and micro-instability likely under-recognized following hip arthroscopy. Below you'll find an infographic and some key learnings from this paper.

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For your convenience, we have also developed this content into a FREE 26-page full colour ebook!

Packed full of 12 Top Hip Papers - peer reviewed scientific papers that have contributed to our understanding of hip conditions and/or the assessment or management of hip pain or injury.

PAPER 4: Gross Instability After Hip Arthroscopy: An Analysis of Case Reports Evaluating Surgical and Patient Factors

Iatrogenic hip instability is increasingly recognised as a cause of persistent pain and disability following hip arthroscopy. Physiotherapists and other rehab professionals often underestimate the potential risk of instability and even frank dislocation following hip arthroscopy, even months after surgery. It concerns me how many patients are prescribed standing or prone through-range hip extension exercises in the early post operative period. The innocuously small portals visible at skin level belie the often dramatic insult that has been imparted on the anterior stability mechanisms of the hip joint.

I have added this paper to my 12 top papers series as it was one of the first that drew together the disparate case studies published (likely the tip of a much larger iceberg) and started ringing alarm bells for surgeons. The implications for those providing post-operative care were equally profound. Since this paper was published it seems that the floodgates have begun to open, and a number of recent papers have reported poorer outcomes following surgery with unrepaired versus repaired capsulotomy. The role of post-operative microinstability has now been recognised in many with persistent pain and disability following hip arthroscopy.

12 HIP days of Christmas 2021-19

Key learnings about instability after hip arthroscopy:

  1. Gross instability (dislocation – most commonly anteriorly) may occur even months after hip arthroscopy.
  2. The risk is likely to be multifactorial including patient, surgical and post operative factors.
  3. Patient risk factors include female gender, acetabular dysplasia and ligamentous laxity.
  4. The strongest surgical factors appear to be an unrepaired capsulotomy and iliopsoas release, but debridement of the labrum (rather than repair) and acetabular rim trimming may also reduce stability post operatively.
  5. Early and/or excessive hip extension and/or external rotation will increase risk of anterior dislocation.

You can learn more about assessing and managing anterior hip instability in my Anterior Hip & Groin Pain Course and workshops - read more below.

Another great Anterior Hip Pain blog


Anterior Hip Pain: Causes & Contributing Factors

Adequate consideration of individual causes and contributing factors is important for best outcomes.

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Join Hip Academy Today

Join Hip Academy Today

By becoming a member today you can enjoy the benefits of a world class educational Hip Program, specifically designed by Dr Alison Grimaldi to help improve your knowledge surrounding the Hip and Pelvis, and become an expert in your field.

By becoming a member today you can enjoy the benefits of a world class educational Hip Program, specifically designed by Dr Alison Grimaldi to help improve your knowledge surrounding the Hip and Pelvis, and become an expert in your field.

Like to learn more about assessment and treatment of patients with anterior hip instability?

In this course, you can find detailed information on pathoaetiology, assessment and management of anterior hip pain associated with anterior instability and many other conditions.

Interested in a live workshop on this topic? 

Workshop registration is now open for 2022. If you are in Australia, you might like to attend my face-to-face Brisbane workshops in July 2022. If Brisbane is too far, you might like to join us for an action packed 6 hours (2 x 3 hour blocks) interactive zoom online workshop in May 2022. Both workshops include 3 months access to the online learning course, and the online workshop includes 6 weeks access to recordings. 

I hope you enjoyed the infographic and key learnings from Day 4 of my 12 Top Hip Papers. There are 8 more papers to come, so stay tuned and return to the blog page each day to see what other top papers and infographics I have for you!

Click the image above to read Paper 3

Click the image above to read Paper 5

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About Dr Alison Grimaldi

Dr Alison Grimaldi is a physiotherapist, researcher and educator with over 30 years of clinical experience. She has completed a Bachelor of Physiotherapy, a Masters of Sports Physiotherapy and a PhD, with her doctorate topic in the hip region. Dr Grimaldi is Practice Principal of PhysioTec Physiotherapy in Brisbane, a Fellow of the Australian College of Physiotherapy and an Adjunct Senior Research Fellow at the University of Queensland. She runs a global Hip Academy and has presented over 100 workshops around the world.