Special Patients and Conditions: Capsular Laxity Including Ehlers-Danlos

In the past, due to the intrinsic osseous stability of the hip joint, the diagnosis of “hip instability” was rarely made outside of the dysplastic hip or pathologic hyperlaxity conditions. In the last decade, however, as the number of patients undergoing hip preserving surgery has risen, so have concerns regarding the potential for instability, particularly in highly active patients as well as those with genetic capsular laxity. Current research involving the soft tissues surrounding the hip, such as the capsular ligaments, acetabular labrum, ligamentum teres, and psoas tendon, has now demonstrated their importance in the maintenance of normal joint biomechanics, and has suggested that their repair in pathologic situations may be the difference between a satisfactory and a poor surgical result. Hip instability has commonly been thought to occur secondary to long-term repetitive stresses within the hip capsule, particularly during sports such as golf or ballet, but it can also arise as a result of traumatic hip dislocation or subluxation. Inherited collagen diseases such as Ehlers-Danlos should also be suspected and evaluated for, especially in the presence of multiple joint laxities, in order for appropriate treatment to be provided. Conservative treatment regimens are usually pursued when the diagnosis is first made, and surgical intervention is offered only if the patient fails to improve. Capsular laxity repair can be performed by either an open or arthroscopic approach. Arthroscopic thermal capsulorrhaphy or capsular plication has been described in the literature with good short-term results and is our preferred method of treatment for this pathology.