Criteria for the Operating Room Confirmation of The Diagnosis of Hip Instability: The Results of An International Expert Consensus Conference
Purpose: The purpose of this study was to establish an international expert consensus on operating room findings that aid in the diagnosis of hip instability.
Methods: An expert panel was convened to build an international consensus on the operating room diagnosis / confirmation of hip instability. Seventeen surgeons who have published and/or lectured nationally or internationally on the topic of hip instability were invited to participate. Fifteen panel members completed a pre-meeting questionnaire and agreed to participate in a 1-day consensus meeting on 15th May 2021. A review of the literature was performed to identify published intra-operative reference criteria used in the diagnosis of hip instability. Studies were included for discussion if they reported and intra-operative findings associated with hip instability. The evidence for and against each criteria were discussed followed by an anonymous voting process. For consensus, defined a priori, items were included in the final criteria set if at least 80% of experts agreed.
Results: A review of the published literature identified 11 operating room criteria that have been used to facilitate the diagnosis of hip instability. Six additional criteria were proposed by panel members as part of the pre-meeting questionnaire. Consensus agreement was achieved for eight criteria, namely ease of hip distraction under anesthesia (100.0% agreement), inside out pattern of chondral damage (100.0% agreement), location of chondral damage on the acetabulum (93.3% agreement), pattern of labral damage (93.3% agreement), anteroinferior labrum chondral damage (86.7% agreement), perifoveal cartilage damage (97.6% agreement), a capsular defect (86.7% agreement) and capsular status (80.0% agreement). Consensus was not achieved for nine items, namely Ligamentum Teres tear (66.7% agreement), arthroscopic stability tests (46.7% agreement), persistent distraction after removal of traction (46.7% agreement), findings of examination under anesthesia (46.7% agreement), the femoral head divot sign (40.0% agreement), inferomedial synovitis (26.7% agreement), drive through sign (26.7% agreement), iliopsoas irritation (26.7% agreement) and Ligamentum Teres - labral kissing lesion (13.3% agreement). All experts agreed on the final list of eight criteria items reaching consensus.
Conclusion: This expert panel identified eight criteria that can be used in the operating room to help confirm the diagnosis of hip instability.