OPEN, SO THAT YOU CAN CLOSE: THE TREATMENT OF HYPERMOBOBILITY-RELATED HIP PAIN WITH OPEN HIP DEBRIDEMENT

Hypermobility is a well-known cause for hip pain, commonly caused by femoral acetabular impingement (FAI) or labral tears through repeated microtrauma. It is difficult to achieve strong capsular repair during hip arthroscopy and there are well-documented poor outcomes for patients with hypermobility following hip arthroscopy. Open hip debridement using the Ganz surgical hip dislocation approach provides excellent access to the labrum and femoral head, allowing for labrum repair and reshaping of the femoral head. Importantly, after hip relocation clear access to the capsule allows for strong, stable repair compared with arthroscopy. This can not only restore the capsule to preoperative strength, but, in the case of a patient with hypermobility, can be used to tighten it beyond preoperative levels. In these patients a more stable hip is created, leaving the patient with a decreased range of motion. There is currently nothing in the literature that supports the use of the Ganz surgical dislocation approach in patients with hypermobility. We describe a case series of 11 patients with hypermobility causing hip pain who underwent open hip debridement with strong and stable capsule repair. Each patient had a Beighton score >6 and worked up using CT scanning 3D motion analysis and MRA scans of the hip. The motion analysis showed how the patients’ excessive range of motion caused FAI, and the MRA demonstrated labral tears that would benefit from surgical repair. Non-arthritic hip score (NAHS) was used to assess the impact on pain and function. The average NAHS prior to surgery was 29% compared to 77% post op. All patients answered ‘yes’ when asked if they were glad they had the operation, reporting decreased hip pain, decreased use of analgesia and improved quality of life. The follow up period ranged between 11–84 months showing maintained effects. There were no severe complications, but metalwork of the trochanteric flip was removed in 4 of 11 cases after union. This case series demonstrates that open hip debridement for patients with hypermobility causing hip pain is an effective treatment.