Adhesive Capsulitis of the Hip

Abstract

It is postulated that adhesive capsulitis of the hip is more common than suggested in the published literature, which recounts only a few isolated cases, and that this condition shares many of the same characteristics seen in the shoulder. The purpose of this study was to investigate and report the findings of the first clinical case series on this condition. Clinical case series, retrospective review of prospectively collected data. Since 1993, all hip arthroscopy cases have been prospectively assessed with a 100-point rating system. In 1999, adhesive capsulitis was first recognized as a causative factor. Since then, 9 patients have been identified with this condition with at least 1 year of follow-up. There was 100% follow-up at an average of 17.3 months. The average age was 43.7 years. There were 8 women and 1 man. Radiographs were normal in 8 cases and revealed mild degenerative disease in the 1 male patient. Magnetic resonance imaging/arthrography failed to reveal evidence of adhesive capsulitis. Examination under anesthesia revealed an average loss of 25 degrees of rotational motion (19.4 external, 5.6 degrees internal). Full range of motion was regained with manipulation. Arthroscopy revealed characteristic findings of adhesive capsulitis in all cases and coexistent pathology in 6 cases (5 articular lesions, 3 labral tears, and 1 ruptured ligamentum teres). The 8 women with normal radiographs all improved with an average of 32 points (preoperative, 56.4; postoperative, 88.4). The 1 man with degenerative changes showed negligible improvement. There were no complications. Adhesive capsulitis of the hip is not as rare as suggested by the paucity of available literature. The clinical characteristics are similar to the shoulder, principally consisting of painful restricted motion and a clear predilection for middle aged women. It may occur with or without associated intra-articular pathology. Arthroscopy can be beneficial in the treatment of recalcitrant cases, but may assume less of a role with improved diagnostic skills essential to implementing a proper management strategy. Level IV.