Prevention and Treatment of Hip Adhesions Associated with Hip Arthroscopy Shows Positive Outcomes.

Abstract

Adhesions are known to occur following arthroscopic, as well as open surgery of multiple joints, including after hip arthroscopy, resulting in pain, stiffness, and dysfunction. Adhesions of the labrum to the overlying hip capsule can lead to eversion of the labrum, and potentially compromise the suction seal, leading to microinstability and pain. Generally, patient reported outcomes improve after surgical lysis of adhesions, with or without concurrent correction of labral, chondral, or bony pathology. Arthroscopic placement of autograft or allograft spacers may be effective when adhesions between the labrum and capsule prevent an adequate suction seal. Prevention using biologics, such as angiotensin II receptor blockers (e.g., losartan), may inhibit TGF-β1 (transforming growth factor beta 1), which has been associated with fibrogenesis, tissue fibrosis, and scarring. Side effects of losartan are rare but include hypotension, dizziness, angioedema, and acute kidney injury when co-prescribed with NSAIDs, which are often used in heterotopic ossification prophylaxis in hip arthroscopy, and are a significant concern. More data on losartan use is required prior to broader adoption.