Microinstability of the Hip—Gaining Acceptance

The hip has generally been considered an inherently stable joint. However, the femoral head moves relative to the acetabulum. Although the bones are primarily important in hip stability, the importance of the soft tissues has recently been demonstrated. Symptomatic microinstability of the hip is defined as extraphysiologic hip motion that causes pain with or without symptoms of hip joint unsteadiness and may be the result of bony deficiency and/or soft-tissue damage or loss. Recent work has helped improve the ability to identify microinstability patients preoperatively. Initial management begins with activity modification and strengthening of the periarticular musculature. Failing nonsurgical management, surgical intervention can be beneficial, focusing on treatment of the underlying cause of microinstability, as well as associated intra-articular pathology. Bony deficiency may be treated with a redirectional osteotomy, whereas those with adequate bony coverage may be treated with capsular plication, capsular reconstruction, and/or labral reconstruction.