Instability of the hip is not a common condition because of the way your thigh bone fits into the hip socket. Although not common, the various symptoms of an unstable hip can be a thorn in your side. Regardless of the cause of hip instability, you will be happy to know you have treatment options. Hip instability treatment can range from nonsurgical treatment to surgical intervention. This post will give you insight into your hip pain, and most importantly what to do about it.
What is hip instability?
Hip instability is a condition where there is an increase in movement of the bony structures in the hip joint. This excess movement gives you the feeling of instability. While true hip instability is rare, problems with the hip capsule, ligamentous laxity, or bony changes can make it feel like your hip bone will pop out of the socket joint.
These types of unstable hip problems are now being referred to as microinstability of the hip. Before we get to the treatment of hip instability some basic information on the structure can help you narrow down the list of common causes. After all, knowing the problem and the symptoms is important to protect your hip from further damage.
Hip Anatomy
Your hip is a very stable ball and socket joint. The ball is at the top of the femur, your thigh bone. The femoral head normally fits securely inside the socket-shaped region of the pelvis. Your hip stability is the result of several things.
- Depth of the hip joint
- The acetabular labrum (the ligament that wraps around the rim of the socket to create a deeper socket seal)
- Three hip ligaments that for the hip capsule (pubofemoral ligament, iliofemoral ligament, ischiofemoral ligament)
What can cause hip instability?
There are two main causes of hip instability. First, traumatic events like a car accident or sports injuries that cause a specific injury are usually the most common causes of true instability.
Traumatic Injuries
Motor vehicle accidents could result in a simple subluxation or a severe dislocation. Even a partial displacement of the hip would require medical attention. Large fractures are also common with these high-energy events. Small fragments of bone or articular cartilage called loose bodies can shear off in traumatic events. Chronic instability may occur in a small percentage of people that have had a dislocation.
Nontraumatic injuries
Second, atraumatic hip instability can be something you are born with or something that is brought on by repetitive motions of the hip joint. The repetitive motion of the hip involving twisting and rotating in a weight bearing position could cause labral tears or damage the cartilage of the hip joint.
The repetitive forces could also result in extra bone growth which interferes with normal joint function. This atraumatic instability is referred to as femoroacetabular impingement (FAI). FAI could also be the result of congenital abnormalities of the hip joint causing pinching type pain.
Beyond a torn labrum, there are conditions that you are born with that could cause instability. First, ligament laxity, otherwise known as being double-jointed, could also cause instability. Usually part of a condition called Hypermobility Spectrum Disorder or Ehlers Danlos Syndrome, these loose joints will be found throughout your body.
Finally, hip dysplasia is another condition where the hip joint does not develop properly. Specifically, the socket of the joint is not deep enough to secure the hip bone. Although you are born with this condition, the signs of hip dysplasia may not be displayed until adulthood. If left untreated osteoarthritis or avascular necrosis could occur requiring a hip replacement.
What does hip instability feel like?
The most common symptoms of hip instability include:
- Pain
- Feeling like the hip will dislocate
- Your hip giving way
- Clicking in the joint
- Increase mobility
- The ability to pop your hip out and put it back in
How do you check hip instability?
Past medical history
The first step is to get a detailed history of what happened. This will help your orthopedic team customize the best plan for you. After a thorough history, your health care provider will move on to a series of special tests to identify what structures are affected.
Special tests
Special tests are used as part of a physical assessment to rule in or rule out a specific condition. Some common hip instability tests include the following.
- Flexion-adduction- internal rotation test (FADDIR). Also referred to as the anterior apprehension test, the FADDIR test is used to confirm femoroacetabular impingement.
- Abduction–hyperextension–external rotation test (AB-HEER). This test is the most accurate clinical test for hip instability.
- Prone instability test. The prone instability test is another clinical test that will reproduce pain in the front of your hip if positive confirming hip instability.
- Hyperextension-external rotation. This test is another clinical test that relies on positioning to reproduce your hip pain and diagnose hip instability.
Depending on the risk factors diagnostic imaging may be ordered.
Diagnostics
If your provider feels that diagnostics are needed the first step will be to get a series of plain x-rays. This will show any bony conditions, In severe cases with a higher risk for injury, further imaging may be done before any conservative medical treatment. CT scans (CT) or magnetic resonance imaging (MRI) scans will show possible conditions involving the soft tissues of the hip.
In some cases of instability, your orthopedic specialists may order an MRI arthrography. With the use of a contrast agent, your doctor can see if this dye moves out of the tissue rim of the hip. This would confirm a hip labral tear. Now that the problem is confirmed, the next step is treatment.
How do you fix hip instability?
Physical therapy
The non-operative treatment approach should involve seeing a physical therapist. During the physical examination, you will be asked to perform simple range of motion exercises to determine what triggers your symptoms. Using strength tests and hip instability tests, your physical therapist with come up with special exercises that will play an important role in your recovery.
Even if conservative options do not work, all the hard work you put in to recover should be rewarded after surgery. Referred to as prehab, decreasing inflammation and improving muscle strength will pay off during your recovery. Doing so will improve your outcomes and reduce the risk of complications.
Surgical management
While invasive surgery is the last resort, in some cases it is necessary. For FAI or other labral tears, a simple hip arthroscopy will be performed to clean out the joint. The good news, once you fully recover the pain will be a distant memory and you will be able to get back to your active lifestyle.
If you have advanced arthritis or avascular necrosis, you will need a different type of surgery. A total hip arthroplasty will give you a new hip. With your new hip, you can say goodbye to pain and limitations. As much as you want to avoid surgery, the outcomes will help you get back to the quality of life you deserve.
Hip instability treatment, final thoughts
Whether the injury came on suddenly or developed over time, you have treatment options that will help you recover. With the proper rehab program, you will be running, jumping, and enjoying your active lifestyle before you know it. However, if the instability persists, surgery to can eliminate the problem so you can get on with your life.