Effectiveness of Nonoperative Management of Hip Microinstability

BACKGROUND: Hip microinstability has recently gained acceptance as a cause of hip pain. In this condition, the femoral head demonstrates increased motion relative to the acetabulum, which may lead to chondrolabral damage. Even though patients are initially prescribed a trial of nonoperative treatment, the success rates of rehabilitation are unknown. PURPOSE: To determine the success rate of nonoperative treatment of hip microinstability. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: After institutional review board approval was obtained, a retrospective chart review was performed on patients at a university sports medicine practice between January 2013 and July 2016. All patients older than 18 years presenting with hip microinstability who were initially recommended for treatment with physical therapy were enrolled in this study. Formal physical therapy sessions focused on strengthening the hip and core muscles. These sessions took place twice a week for a minimum of 6 weeks in conjunction with a home exercise program. The number of patients who eventually underwent surgical treatment and the clinical scores for the cohort (modified Harris Hip Score [mHHS] and 33-item International Hip Outcome Tool) were recorded. RESULTS: A total of 64 patients (63 female, 1 male), with a mean ± SD age of 32.2 ± 10.5 years, were identified and studied. Onset of symptoms was insidious (n = 45; 70.3%), acute atraumatic (n = 12; 18.8%), and traumatic (n = 7; 10.9%). A total of 9 (14.1%) patients were high-level athletes. After a follow-up of 45.7 ± 14.6 months, 14 (29.8%) patients eventually underwent hip arthroscopy for persistent hip pain. Capsular plication was performed in all surgical cases. High-level athletes were not more likely to need surgery (50% vs 26.8%; P = .34). The mHHS was available in 24 patients who were treated nonoperatively, and it improved from 67.4 to 85.0 (P < .01). CONCLUSION: More than two-thirds of patients treated for hip microinstability were able to avoid surgery; they were successfully treated nonoperatively with physical therapy and a home exercise program and demonstrated improved clinical outcome scores.