Hip Instability and Capsular Laxity

Hip instability causes pain and impairment for patients. Traumatic instability results from a distinct dislocation or subluxation event. Atraumatic instability results from overuse, generalized ligamentous laxity, inherited collagen disorders, or developmental dysplasia of the hip. Patients present with vague symptoms that make diagnosis difficult. Hip examination findings can demonstrate increased external rotation in neutral and extension, as well as apprehension with hyperextension and external rotation. Secondary impingement caused by capsular laxity is observed when impingement physical examination findings are present without cam or pincer bony anomalies on radiographs. Patients who respond to diagnostic hip injection and easily distract with manual traction under fluoroscopy are candidates for an arthroscopic anterior capsular placation with suture. After capsular plication, patients regain full range of motion at 3 months and return to full activity between 4 and 6 months postoperatively. Capsular plication with suture is an effective and safe method for treating hip instability.