Case Report
Catastrophic Failure of Hip Arthroscopy Due to Iatrogenic Instability: Can Partial Division of the Ligamentum Teres and Iliofemoral Ligament Cause Subluxation?

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Abstract

Hip arthroscopy is an evolving surgical tool, and with any new procedure, it is important to learn from the complications encountered. A patient with mild hip dysplasia and a symptomatic labral tear underwent uneventful hip arthroscopy and labral repair including partial debridement of a hypertrophied ligamentum teres. Despite preservation of the labrum, no pincer resection, and a modest capsulotomy, 3 months, subluxation and joint space narrowing were noted. One year, end-stage arthritis was present, requiring total hip replacement. Instability after hip arthroscopy is due to a number of factors, including excessive rim trimming, capsulotomy, overzealous labral resection, or inadequate labral repair. This report emphasizes the importance of the ligamentum teres and small disruptions of the capsule in patients with mild dysplasia.

Section snippets

Case Report

A 42-year-old woman presented to our clinic with a 1-year history of right hip pain, worsened by impact loading and hip flexion. She reported decreased range of motion without locking episodes. She was otherwise well, with no previous hip problems or familial arthritis.

The patient had a normal gait, equal leg lengths, and no signs of hyperlaxity. Flexion was 120° bilaterally but painful on the right side. External rotation was limited to 45° on the right versus 60° on the left. Internal

Discussion

We report post-arthroscopy catastrophic arthritic progression due to femoral head subluxation in the presence of preserved labrum, no pincer resection, and a modest capsulotomy involving only a small percentage of the iliofemoral ligament. Instability of the hip is uncommon because of the substantial conformity of the osseous femoral head and acetabulum and the strong surrounding capsuloligamentous complex.

Two cases of post-arthroscopy hip instability have recently been reported. Matsuda4

References (23)

  • W.W. Lovell et al.

    Lovell and Winter's pediatric orthopaedics

    (1996)
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