TP1.8 What Is The Best Way To Examine a Hip For Hip Microinstability? A Comparative MultiCenter Study of 802 Patients With Surgically Confirmed Diagnoses

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ID: 331379
2026
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Abstract
Abstract Introduction Hip microinstability (MI) is an important, though underrecognized, source of pain and dysfunction. The aim of this study is to determine the best physical examination (PE) maneuver(s) to help diagnose hip MI. Methods Using prospectively obtained data, we analyzed 802 patients that underwent hip arthroscopy from 2023–2025 across 3 international high-volume hip preservation practices. Patients were categorized into two groups: those with and without intraoperative confirmation of hip MI. All patients underwent the same comprehensive pre-operative PE. Advanced statistical analyses were performed to analyze the relationships between the presence of symptom reproduction and/or range of motion (ROM) measurements on the odds of MI diagnosis. Analyses were completed in RStudio using a two-sided level of significance of 0.05. Results Of the 802 hips, 240 (30%) were diagnosed with MI intraoperatively. Patients had an average age of 34.4 (+11.4) years (50.5% female). Beighton’s score was higher in those with MI (2.7 vs 1.2, OR 1.25, p<0.001). Hip flexion, as well as hip rotational arc (seated and prone) and internal rotation (IR) was statistically greater in MI patients (OR 1.02 – 1.04, all p<0.001). FABERE distance was less in MI (17.9 cm vs 21.3cm, OR 1.03, p <0.001) and log roll was greater in MI (37.6° vs 33.9°, OR 1.01, p=0.014). Impingement and scour maneuvers were more common in MI patients, but approximately 90% of patients with and without MI had these tests positive (p=0.004). Tests more frequently present in MI patients were Prone External Rotation (ER) (OR 1.65, p = 0.013, Accuracy = 64%), Abduction-Extension-ER test (ABEER) (OR 1.43, p<0.001, Accuracy 65.4%); Hyperextension ER test (HEER) (OR 1.99; p<0.001, Accuracy 64.1%) and Axial Distraction Test (OR 4.33, p=0.002, Accuracy 69.2%) Discussion and Conclusion This is the first multicenter study of surgically confirmed hip microinstability patients to ascertain which PE finding(s) correlate with the diagnosis of hip microinstability. Increased hip ROM, particularly flexion and internal rotation, as well as the combined arc of hip flexion plus rotational arc, are increased in patients with microinstability. Further, signs of hypermobility, such as Beighton’s and FABERE are present more often in patients with hip MI. The impingement test and scour maneuver are present in 90+% of patients with and without MI, and thus not helpful in differentiating the diagnosis, but helpful in determination of intra-articular pain. Several stress tests specifically touted for hip MI, prone ER test, ABEER, HEER and Axial Distraction tests were also more frequently present in patients with hip MI. However, based on the accuracy and area under the curve data, no PE finding, independently, is diagnostic of hip microinstability. Continued research is necessary to help in the clinical diagnosis of hip microinstability.
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Authors Marc Raymond Safran, Nicola Bonin, Mat Brick, Kinsley Pierre, Catherine Bacon, Xiaojing Wu
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Journal Journal of hip preservation surgery
Year 2026
DOI
10.1093/jhps/hnag043.144
URL
https://doi.org/10.1093/jhps/hnag043.144
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