Open AccessDiagnosing Hip Microinstability: an international consensus study using the Delphi methodology
Author(s) -
Khanduja Vikas,
Darby Nicholas,
O’Donnell John,
Bonin Nicolas,
Safran Marc R.,
Andrade A. J.,
Krych Aaron,
Malviya Ajay,
Stubbs Allston J,
Takla Amir,
Papavasiliou Athanasios,
Lund Bent,
McBryde Callum,
Nawabi Danyal,
Kohlrieser Dave,
Belzile Etienne L.,
Witt Johan,
Sunil Kumar Karadi Hari,
Enseki Keelan R,
Diamond Laura,
Ejnisman Leandro,
Bankes Marcus,
Wilson Matt,
Mohtadi Nicholas,
MarinPena Oliver,
Ayeni Olufemi,
Christofilopoulos Panayiotis,
Singh Parminder,
Field Richard,
Uchida Soshi,
Løken Sverre
Publication year - 2023
Publication title -
knee surgery, sports traumatology, arthroscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.806
H-Index - 125
eISSN - 1433-7347
pISSN - 0942-2056
DOI - 10.1007/s00167-022-06933-4
Subject(s) - delphi method , medicine , expert opinion , delphi , medical education , physical therapy , medical physics , computer science , artificial intelligence , intensive care medicine , operating system
Purpose Hip microinstability is a relatively new diagnosis which is increasingly being discussed in the literature and yet there are no clear guidelines for making a diagnosis. Microinstability has generally been defined as persistent excessive hip motion that has become symptomatic especially with pain. This aim of this Delphi study was to seek expert opinion to formulate a diagnostic criteria for hip microinstability. Methods A Delphi methodology was used for this consensus study. A literature search was conducted on PubMed up to March 2019 using the keywords ((hip) and (microinstability)) to identify relevant articles on this topic. All relevant criteria used for diagnosing hip microinstability were collated to create a questionnaire and further criterion suggested by the experts were included as well. Four rounds of questionnaires were delivered via an online survey platform. Between each round the authors acted as administrating intermediaries, providing the experts with a summary of results and synthesising the next questionnaire. The expert panel was comprised of 27 members: 24 (89%) orthopaedic surgeons and 3 (11%) physiotherapists from around the world. Results Expert panel participation in rounds 1–4 was: 27 (100%), 20 (74%), 21 (78%) and 26 (96%) respectively. A literature review by the authors identified 32 diagnostic criteria to populate the first questionnaire. Experts suggested amending three criteria and creating five new criteria. The panel converged on ranking 3 (8%) of criteria as “Not important”, 20 (54%) as “Minor Factors” and 14 (38%) as “Major Factors”. No criteria was ranked as “Essential”. Criteria were subcategorised into patient history, examination and imaging. Experts voted for a minimum requirement of four criteria in each subcategory, including at least six “Major factors”. The final diagnostic tool was approved by 20 (77%) of the final round panel. Conclusion This study describes the first known expert consensus on diagnosing hip microinstability. The relative complexity of the final diagnostic tool is illustrative of the difficulty clinicians’ face when making this diagnosis. Level of evidence V.