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Hugenberg G, Stallons J, Smith C, Brockhoff K, Gingras M, Yardley D, Ayeni O, Almasri M. Clinical Commentary: A Criteria-Based Testing Protocol for Return to Sport Post Hip Arthroscopy for Impingement. Int J Sports Phys Ther 2023; 18:1218-1229. [PMID: 37795325 PMCID: PMC10547071 DOI: 10.26603/001c.87629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 08/09/2023] [Indexed: 10/06/2023] Open
Abstract
Overall, 84%-87% of athletes will return to sport following hip arthroscopy; however, some literature suggests that only 57% of athletes return to their preinjury level, and only 16.9% report optimal performance. This discrepancy may be due to a lack of consistency within the definition of return to sport as well as a lack of consistency within rehabilitation programs when determining return to sport readiness. Athletes who are returning to sport must demonstrate adequate range of motion, strength, and the ability to perform multi-directional movements without the risk of reinjury. There has yet to be a comprehensive, criteria-based, return to sport testing protocol that utilizes objective measures to ensure athletes are ready for return to sport. The goal of the authors was to create a criteria-based testing protocol for return to sport following hip arthroscopy utilizing components best supported in the literature. The following parameters were identified as key areas to assess for within a return to sport testing protocol: range of motion, strength, functional testing, self-reported outcomes including psychological readiness and time. The purpose of this clinical commentary is to propose a criteria-based testing protocol to be used following hip arthroscopy for impingement from early rehabilitation through return to previous level of sport. Criteria are presented clearly to promote objective progression through rehabilitation while still being mindful of the biological healing time required for safe and efficient progression. It is the authors' hope that in identifying and establishing a criteria-based testing protocol a higher percentage of athletes will be able to return to sport. Level of Evidence 5.
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Affiliation(s)
| | | | | | | | | | | | | | - Mahmoud Almasri
- Orthopedic Surgery Mercy Health
- Cincinnati SportsMedicine Research & Educational Foundation
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2
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Hanish S, Muhammed M, Kelly S, DeFroda S. Postoperative Rehabilitation for Arthroscopic Management of Femoroacetabular Impingement Syndrome: a Contemporary Review. Curr Rev Musculoskelet Med 2023; 16:381-391. [PMID: 37310616 PMCID: PMC10427582 DOI: 10.1007/s12178-023-09850-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/31/2023] [Indexed: 06/14/2023]
Abstract
PURPOSE OF REVIEW Femoroacetabular impingement syndrome (FAIS) is a common cause of hip pain that may potentially lead to osteoarthritis. Operative management of FAIS seeks to arthroscopically reshape the abnormal hip morphology and repair the labrum. For rehabilitation following operative management, a structured physical therapy program is unanimously recommended for the patient to return to their previous level of physical activity. Yet, despite this unanimous recommendation, significant heterogeneity exists among the current recommendations for postoperative physical therapy programs. RECENT FINDINGS A four-phase postoperative physical therapy protocol is favored among current literature, with each phase being comprised of its own goals, restrictions, precautions, and rehabilitation techniques. Phase 1 aims to protect the integrity of the surgically repaired tissues, reduce pain and inflammation, and regain ~ 80% of full ROM. Phase 2 guides a smooth transition to full weightbearing, so the patient may regain functional independence. Phase 3 helps the patient become recreationally asymptomatic and restores muscular strength and endurance. Finally, phase 4 culminates in the pain-free return to competitive sports or recreational activity. At this time, there exists no single, unanimously agreed upon postoperative physical therapy protocol. Among the current recommendations, variation exists regarding specific timelines, restrictions, precautions, exercises, and techniques throughout the four phases. It is imperative to reduce ambiguity in current recommendations and more specifically define postoperative physical therapy following operative management of FAIS to more expeditiously return patients to functional independence and physical activity.
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Affiliation(s)
- Stefan Hanish
- Department of Orthopaedic Surgery, University of Missouri School of Medicine, Columbia, MO, USA
| | - Maaz Muhammed
- Department of Orthopaedic Surgery, University of Missouri School of Medicine, Columbia, MO, USA
| | - Shayne Kelly
- Department of Orthopaedic Surgery, University of Missouri School of Medicine, Columbia, MO, USA
| | - Steven DeFroda
- Department of Orthopaedic Surgery, University of Missouri School of Medicine, Columbia, MO, USA.
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3
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Hemstock R, Mulhall D, Didyk J, Ogborn D, Lemmex D. Postoperative weight-bearing restrictions and rehabilitation protocols after hip arthroscopy for femoroacetabular impingement: a systematic review. J Hip Preserv Surg 2023; 10:220-227. [PMID: 38162279 PMCID: PMC10757416 DOI: 10.1093/jhps/hnad023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/24/2023] [Accepted: 07/11/2023] [Indexed: 01/03/2024] Open
Abstract
Despite recent increased interest in hip arthroscopy for the management of femoroacetabular impingement (FAI), there is little evidence to guide weight-bearing recommendations and rehabilitation postoperatively. The primary objective of this study was to determine if sufficient evidence exists to recommend specific weight-bearing restrictions postoperatively. This study was registered with PROSPERO (CRD42021247741). PubMed, MEDLINE and Embase were searched on 3 March 2023 for Level I-IV studies including patients over the age of 18 years, with a minimum 1-year follow-up and reporting of a weight-bearing status, a patient-reported outcome measure (PROM) and a clinical outcome. Meta-analysis was precluded due to heterogeneity in the included studies, and a descriptive analysis was undertaken. Methodological quality and risk of bias were assessed with the methodological index for non-randomized studies (MINORS). Twenty-four studies including 2231 patients who underwent hip arthroscopy for treatment of FAI were included (follow-up interval 33.2 ± 24.7 months). Most articles (62.5%) were case series. There were seven terms describing weight-bearing recommendations, with 83% being some variation of 'partial weight-bearing'. Eight PROMs were reported, with 83% using the modified Harris Hip Score and 87.5% of studies reporting reoperation rates. Only 75% of studies reported rehabilitation protocols. The average MINORS score was 11.07 ± 1.10 out of 16 for non-comparative studies and 18.22 ± 1.48 out of 24 for comparative studies. The reporting of weight-bearing status, clinical outcomes, PROMs and rehabilitation parameters remains poor. At present, sufficient comparative evidence does not exist to make specific weight-bearing recommendation postoperatively.
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Affiliation(s)
- Riley Hemstock
- Department of Surgery, Orthopedic Section, University of Manitoba, Canada AE101-820 Sherbrook Street, Winnipeg, Manitoba R3A 1R9, Canada
| | - Drew Mulhall
- Department of Surgery, Orthopedic Section, University of Manitoba, Canada AE101-820 Sherbrook Street, Winnipeg, Manitoba R3A 1R9, Canada
| | - Janine Didyk
- Department of Physical Therapy, University of Manitoba, Canada R106 - 771 McDermot Avenue, Winnipeg, Manitoba R3E 0T6, Canada
| | - Dan Ogborn
- Department of Physical Therapy, University of Manitoba, Canada R106 - 771 McDermot Avenue, Winnipeg, Manitoba R3E 0T6, Canada
- Pan Am Clinic Foundation, 75 Poseidon Bay, Winnipeg, Manitoba R3M 3E4, Canada
| | - Devin Lemmex
- Pan Am Clinic Foundation, 75 Poseidon Bay, Winnipeg, Manitoba R3M 3E4, Canada
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4
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Johnson AH, Brennan JC, Stock LA, Levermore SB, Maley A, Turcotte JJ, Petre BM. Change in Postoperative Weightbearing Protocol Does Not Increase Postoperative Complications Following Hip Arthroscopy for Femoroacetabular Impingement Syndrome. Cureus 2023; 15:e40859. [PMID: 37489196 PMCID: PMC10363374 DOI: 10.7759/cureus.40859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2023] [Indexed: 07/26/2023] Open
Abstract
Background Postoperative rehabilitation protocols, including weightbearing restrictions following hip arthroscopy (HA) for femoracetabular impingement syndrome (FAIS), vary widely among surgeons, from complete non-weightbearing to immediate weightbearing as tolerated; it is unclear if weightbearing restrictions affect short-term outcomes in patients undergoing HA. The purpose of this study is to evaluate patients undergoing hip arthroscopy for FAIS before and after a change in weightbearing protocol, from partial weightbearing with crutches for three weeks to weightbearing and weaning from crutches as tolerated, by examining postoperative outcomes. We hypothesize that the change in weightbearing protocol will have no significant effect on patient outcomes. Methods A retrospective review was conducted of 211 patients undergoing hip arthroscopy by a single high-volume surgeon. The change in weightbearing was implemented in February 2022; previously, all patients were toe-touch weightbearing with crutches for the first three weeks postoperatively. Following this change, patients were allowed to weightbear as tolerated with crutches immediately and wean from crutches as tolerated. The patients were divided into two groups: 119 patients pre-implementation (January 2021 to January 2022) and 92 patients post-implementation (February 2022 to December 2022). The primary endpoint was any complication in the first six weeks postoperatively, divided into complications at two and six weeks, emergency department returns in the first 90 days, reoperations in the first 30 days, and pain at six weeks. We also compared patient-reported outcomes at six weeks. Results There were no significant differences in demographics between groups. There were no significant differences in postoperative outcomes between patients that had weightbearing restrictions and those that did not when looking at 30 day return to operating room (0 vs 0%, p=1.000), 90-day return to emergency department (8.4 vs. 13.0%, p=0.386), two-week complications (2.5 vs. 6.5%, p=0.279), six-week complications (1.7 vs. 1.1%, p=1.000), pain score at six weeks postoperatively (0.34 vs. 0.33, p=0.971), any pain at six weeks postoperatively 37.8 vs. 32.6%, p=0.523), and six-week Patient-Reported Outcomes Measurement Information System (PROMIS) physical function (PF) score (36.0 vs. 34.5, p=0.330). Conclusion Patients undergoing HA after the discontinuation of a mandatory period of protected weightbearing did not experience any significant increase in complications or continued pain, and patient-reported outcomes were similar. Routine postoperative weightbearing restrictions may not be necessary for patients undergoing hip arthroscopy for femoroacetabular impingement syndrome. Further study is required to validate these findings and determine the optimal postoperative protocol for this patient population.
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Affiliation(s)
| | - Jane C Brennan
- Orthopedic Research, Anne Arundel Medical Center, Annapolis, USA
| | - Laura A Stock
- Orthopedic Research, Anne Arundel Medical Center, Annapolis, USA
| | | | - Alyssa Maley
- Orthopedic Surgery, Anne Arundel Medical Center, Annapolis, USA
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5
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Hirata K, Murata Y, Hatakeyama A, Takahashi M, Quinn PM, Uchida S. Biomechanical Analysis of Hip Braces after Hip Arthroscopic Surgery for Femoroacetabular Impingement Syndrome: An Observational Study. Biomimetics (Basel) 2023; 8:225. [PMID: 37366820 DOI: 10.3390/biomimetics8020225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/26/2023] [Accepted: 05/25/2023] [Indexed: 06/28/2023] Open
Abstract
Currently, hip braces are recommended and typically worn by femoroacetabular impingement (FAI) patients after hip arthroscopic surgery. However, there is currently a lack of literature regarding the biomechanical effectiveness of hip braces. The purpose of this study was to investigate the biomechanical effect of hip braces after hip arthroscopic surgery for FAI. Overall, 11 patients who underwent arthroscopic FAI correction and labral preservation surgery were included in the study. Standing-up and walking tasks in unbraced and braced conditions were performed at 3 weeks postoperatively. For the standing-up task, videotaped images of the hip's sagittal plane were recorded while patients stood from a seated position. After each motion, the hip flexion-extension angle was calculated. For the walking task, acceleration of the greater trochanter was measured using a triaxial accelerometer. For the standing-up motion, the mean peak hip flexion angle was found to be significantly lower in the braced condition than in the unbraced condition. Furthermore, the mean peak acceleration of the greater trochanter was significantly lower in the braced condition than in the unbraced condition. Patients undergoing arthroscopic FAI correction surgery would benefit from usage of a hip brace in terms of protecting repaired tissues during early postoperative recovery.
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Affiliation(s)
- Kai Hirata
- Research and Development Department, Nippon Sigmax Co., Ltd., Tokyo 160-0023, Japan
| | - Yoichi Murata
- Department of Orthopaedic Surgery, Wakamatsu Hospital of University of Occupational and Environmental Health, Kitakyushu 808-0024, Japan
| | | | - Makoto Takahashi
- Department of Rehabilitation Medicine, Wakamatsu Hospital of University of Occupational and Environmental Health, Kitakyushu 808-0024, Japan
| | - Patrick M Quinn
- Department of Orthopaedic Surgery, Wakamatsu Hospital of University of Occupational and Environmental Health, Kitakyushu 808-0024, Japan
| | - Soshi Uchida
- Department of Orthopaedic Surgery, Wakamatsu Hospital of University of Occupational and Environmental Health, Kitakyushu 808-0024, Japan
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6
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Day T, Pasic N, Churchill L, Bryant D, Degen R. A scoping review of postoperative return to sport criteria and protocols for patients with femoroacetabular impingement syndrome. PHYSICIAN SPORTSMED 2023; 51:97-106. [PMID: 34836488 DOI: 10.1080/00913847.2021.2011628] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To identify the objective criteria and guidelines utilized to determine if patients diagnosed with FAIS can safely return to sport following hip arthroscopy. METHODS The electronic databases MEDLINE Ovid, EMBASE Ovid, and CINAHL were searched to identify eligible studies. Details of study design, sample size, primary diagnosis, and return to sport protocol, duration, and rate were collected by two reviewers, independently. RESULTS Sixty-two studies were selected for full text review of which 14 were included in the final analysis. Of these, nine were clinical commentaries and five were retrospective cohort studies. Three types of rehabilitation guidelines are currently utilized postoperatively: 4-phase, 5-phase, and 6-phase protocols. Although all 14 studies recommend using various types of outcome measures to evaluate a patient's ability to return to sport, only eleven outlined the specific outcome criteria they must achieve to do so. The most utilized outcome measures are the hip outcome score, active and passive range of motion tests, gait analysis, single- and double-leg squat tests, and the Vail hip sports test. Criteria across all three types of protocols was variable, but they all evaluated the same international classification of disability and function constructs described by the World Health Organization: body function, body structure limitations, and activity capacity limitations. CONCLUSIONS There is no consensus on the optimal methods of evaluating a patient's readiness to return to sport after undergoing hip arthroscopy, with most criteria focused on expert opinion. Performance-based return to sport outcome criteria is not clearly defined, and validated outcome measures are not being used for FAIS patients post hip arthroscopy. Lastly, well-conducted prospective cohort studies using validated outcome measures and objective definitions of return to sport are needed to consistently identify signs that are prognostic of safe return to sport.
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Affiliation(s)
- Trevor Day
- Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
- Faculty of Health Sciences, School of Physical Therapy, Western University, London, Ontario, Canada
| | - Nicholas Pasic
- Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
- Schulich School of Medicine & Dentistry, Department of Surgery, Western University, London, Ontario, Canada
| | - Laura Churchill
- Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
- Faculty of Health Sciences, School of Physical Therapy, Western University, London, Ontario, Canada
| | - Dianne Bryant
- Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
- Faculty of Health Sciences, School of Physical Therapy, Western University, London, Ontario, Canada
- Schulich School of Medicine & Dentistry, Department of Surgery, Western University, London, Ontario, Canada
- Faculty of Medicine, Michael G. DeGroote School of Medicine, Department of Health Research Methods, Evidence, and Impact (Formerly Clinical Epidemiology & Biostatistics), McMaster University, Hamilton, Ontario, Canada
| | - Ryan Degen
- Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
- Schulich School of Medicine & Dentistry, Department of Surgery, Western University, London, Ontario, Canada
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7
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Naessig S, Kucharik M, Meek W, Eberlin C, Martin S. Prehabilitation and Rehabilitation Program for Patients Undergoing Arthroscopic Acetabular Labral Repair: A Comprehensive 5-Phase Patient-Guided Program. Orthop J Sports Med 2022; 10:23259671211071073. [PMID: 35155708 PMCID: PMC8829742 DOI: 10.1177/23259671211071073] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/07/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Many of the current rehabilitation programs for patients undergoing hip arthroscopy fail to consider the progression of soft tissue healing and inflammation that can be heightened due to aggressive therapy to the operative hip in the immediate postoperative period. Hypothesis: It was hypothesized that introducing conservative physical therapy (PT) preoperatively along with a slow progression to return to activity using a structured, patient-guided postoperative program would improve patient outcomes. Study Design: Case series; Level of evidence, 4. Methods: The authors conducted a retrospective review of patients who received a hip arthroscopy, were at least 18 years old, and who had completed the following patient-reported outcomes (PROs) at 1-year follow-up: modified Harris Hip Score (mHHS), Hip Outcome Score, Nonarthritic Hip Score, International Hip Outcome Tool-33, and Lower Extremity Functional Scale. Patients who underwent previous surgery on the ipsilateral hip and those with cartilage erosion down to exposed subchondral bone (Outerbridge grade 4) were excluded. Paired-samples t tests were used to compare the change in PRO scores at 3-month, 6-month, and 1-year follow-up, and the percentage of patients who achieved minimal clinically important difference (MCID) and substantial clinical benefit (SCB) thresholds on the mHHS were stratified according to their Outerbridge grade (0-3). Results: Overall, 202 patients (53% female, 47% male) were included in the analysis. Significant improvement was seen from 3 to 6 months on all PRO measures and from 6 months to 1 year on all but the mHHS (P < .05 for all except the mHHS). A significantly smaller percentage of patients with Outerbridge grade 3 cartilage damage achieved the MCID and SCB on the mHHS compared with those with grade 0, both at 6 months (grade 3 vs 0: 20% vs 63.2% [MCID]; 18.0% vs 52.6% [SCB]; both P = .03) and 1 year (grade 3 vs 0: 22.0% vs 57.9% [MCID]; 14.0% vs 52.6% [SCB]; both P < .05). Conclusion: A structured, patient-guided PT protocol after arthroscopic acetabular labral repair can significantly improve postoperative outcomes.
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Affiliation(s)
- Sara Naessig
- Sports Medicine Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Mass General Brigham, Boston, Massachusetts, USA
| | - Michael Kucharik
- Sports Medicine Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Mass General Brigham, Boston, Massachusetts, USA
| | - Wendy Meek
- Sports Medicine Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Mass General Brigham, Boston, Massachusetts, USA
| | - Christopher Eberlin
- Sports Medicine Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Mass General Brigham, Boston, Massachusetts, USA
| | - Scott Martin
- Sports Medicine Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Mass General Brigham, Boston, Massachusetts, USA
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8
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Silva AMD, Nakatake FM, Xavier VB, Alves VLDS, Polesello GC. Correlation between the range of rotation of the hip and the radiographic signs of cam and pincer morphology in femoroacetabular impingement syndrome. Radiol Bras 2022; 55:24-30. [PMID: 35210661 PMCID: PMC8864682 DOI: 10.1590/0100-3984.2021.0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 04/13/2021] [Indexed: 11/22/2022] Open
Abstract
Objective To determine whether hip rotation correlates with the radiographic signs of cam or pincer
deformity after hip arthroscopy in patients with femoroacetabular impingement syndrome. Materials and Methods This was a single-center retrospective study of data collected between 2014 and 2017. The
study sample included 65 patients between 18 and 55 years of age who underwent hip arthroscopy
for the treatment of unilateral femoroacetabular impingement. The following data were
collected for the periods prior to and six months after surgery range of medial and lateral
rotation of the hip; measures on anteroposterior X-rays of the pelvis obtained in the standing
position and on ateral X-rays in the Ducroquet profile view; and score on the 33-item
International Hip Outcome Tool. Results Mean preoperative and postoperative values were as follows: 19.26 ± 10.39° and 30.95
± 3.52°, respectively, for medial rotation of the hip (p < 0.001);
73.85 ± 6.62° and 68.12 ± 5.04°, respectively, for the anteroposterior alpha
angle (p < 0.001); 56.97 ± 6.09° and 50.61 ± 5.39°,
respectively, for the lateral alpha angle (p < 0.001); and 0.17 ±
0.11 and 0.07 ± 0.08, respectively, for the acetabular retroversion index
(p < 0.001). The crossover sign was identified in 75.4% of the patients
before surgery and in 44.6% after (p < 0.001). Although there was an
increase in the range of hip rotation and an improvement in radiographic parameters after
arthroscopy, we detected no direct correlation between the two. Conclusion Hip arthroscopy can improve medial rotation of the hip, as well as reducing cam and pincer
deformities, in patients with femoroacetabular impingement syndrome. However, those findings
do not appear to be directly correlated.
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9
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Campbell A, Thompson K, Pham H, Pickell M, Begly J, Wolfson T, Youm T. The incidence and pattern of iliopsoas tendinitis following hip arthroscopy. Hip Int 2021; 31:542-547. [PMID: 32093507 DOI: 10.1177/1120700020908845] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Iliopsoas tendinitis is a known source of extra-articular hip pain and it has been shown to be a common cause of continued hip pain following total hip arthroplasty. While iliopsoas tendinitis after hip arthroscopy is a well-known phenomenon amongst hip arthroscopists, its presentation, course, and treatment has yet to be elucidated. METHODS An IRB-approved chart review was performed of patients undergoing hip arthroscopy for femoroacetabular impingement (FAI) between March 2015 and July 2017. No cases of dysplasia were included. All patients had combined cam/pincer impingement as well as labral pathology. Tendinitis patients were identified. Patient demographics, surgical data, time to onset/diagnosis of iliopsoas tendinitis, treatment (oral anti-inflammatories, corticosteroid injection, physical therapy), and resolution of symptoms were recorded. These cases were age- and sex-matched to a control group that did not develop postoperative iliopsoas tendinitis for comparison. Patient outcomes were measured with the modified Harris Hip Score (mHHS) and Nonarthritic Hip Score (NAHS) recorded from the preoperative and 1-year postoperative visits. RESULTS Of 258 hip arthroscopy cases, 18 cases (7.0%) of postoperative iliopsoas tendinitis were diagnosed under high resolution ultrasound. On average, iliopsoas tendinitis was diagnosed 2.8 ± 1.8 months after surgery. There were no significant differences in age, sex, and BMI between patients that developed IP tendinitis compared to those that did not. No specific procedures were found to be significantly associated with incidence of postoperative IP tendinitis, including capsular closure.18 patients were treated with corticosteroid injection, which provided mild to moderate improvement for 5 (27.8%) patients and completely resolved symptoms for 13 patients (72.2%). Of all 18 patients with postoperative iliopsoas tendinitis confirmed by response to a diagnostic injection, 10 (55.6%) had symptoms improve within 3 months of diagnosis, 2 (11.1%) between 3 and 6 months, 4 (22.2%) between 6 and 12 months, and 2 (11.1%) after 1 year. No patients went on to have surgery for this problem. Patients with iliopsoas tendinitis had lower MHHS (p = 0.04) and NAHS (p = 0.09) scores at their 1-year postoperative visits. CONCLUSIONS Iliopsoas tendinitis is a common source of pain following arthroscopic hip surgery and can be effectively diagnosed and treated with ultrasound-guided injection. Therefore, surgeons performing arthroscopic procedures of the hip must remain aware of and include it in their differential when encountering patients with hip flexion pain after surgery. Research should be continued to further evaluate the long-term outcomes and return to sport rates of these patients.
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Affiliation(s)
- Abigail Campbell
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | - Kamali Thompson
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | - Hien Pham
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | - Michael Pickell
- Orthopaedic Surgery, University of Ottawa, Ottawa, ON, Canada
| | - John Begly
- Steadman-Philippon Research Institute, Vail, CO, USA
| | - Theodore Wolfson
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | - Thomas Youm
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
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10
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Takla A, O'Donnell J, Voight M, Byrd T, Dienst M, Martin RR, Philippon MJ, Enseki K, Andrade T, Safran M, Christoforetti JJ, Martin H, Grant L, Campbell A, Ryan M, Tyler T, McGovern RP, Bizzini M, Kohlrieser D. The 2019 International Society of Hip Preservation (ISHA) physiotherapy agreement on assessment and treatment of femoroacetabular impingement syndrome (FAIS): an international consensus statement. J Hip Preserv Surg 2021; 7:631-642. [PMID: 34377507 PMCID: PMC8349584 DOI: 10.1093/jhps/hnaa043] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/30/2020] [Accepted: 08/15/2020] [Indexed: 12/11/2022] Open
Abstract
The 2019 International Society of Hip Preservation (ISHA) physiotherapy agreement on femoroacetabular impingement syndrome (FAIS) was intended to build an international physiotherapy consensus on the assessment, non-surgical physiotherapy treatment, pre-/post-operative management, and return to sport decisions for those patients with FAIS. The panel consisted of 11 physiotherapists and 8 orthopaedic surgeons. There is limited evidence regarding the use of physiotherapy in the overall management of those with FAIS. Therefore, a group of ISHA member physiotherapists, who treat large numbers of FAIS patients and have extensive experience in this area, constructed a consensus statement to guide physiotherapy-related decisions in the overall management of those with FAIS. The consensus was conducted using a modified Delphi technique. Six major topics were the focus of the consensus statement: (i) hip assessment, (ii) non-surgical physiotherapy management, (iii) pre-habilitation prior to hip arthroscopy, (iv) post-operative physiotherapy rehabilitation, (v) stages of post-operative rehabilitation and (vi) return to sports criteria/guidelines after surgery.
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Affiliation(s)
- Amir Takla
- Swinburne University of Technology - Hawthorn Campus, Health Science, Hawthorn, VIC, Australia.,Australian Sports Physiotherapy - Ivanhoe, 3079, Australia.,Hip Arthroscopy Australia, Melbourne, Richmond, VIC 3121, Australia
| | - John O'Donnell
- Hip Arthroscopy Australia, Melbourne, Richmond, VIC 3121, Australia.,Orthopaedic, St Vincent's Melbourne, East Melbourne, VIC 3054, Australia
| | - Michael Voight
- Physical Therapy, Nashville Hip Institute, Nashville, TN 37203, USA.,Physical Therapy, Belmont University, Nashville, TN 37212-3757, USA
| | - Thomas Byrd
- Surgery, Nashville Sports Medicine Foundation, Nashville, TN, USA
| | - Michael Dienst
- OCM Orthopädische Chirurgie München, Steinerstr. 6, Munich, 81369, Germany
| | - Rob Roy Martin
- Physical Therapy, Duquesne University, Pittsburgh, PA 15282-0001, USA
| | - Marc J Philippon
- Steadman Philippon Research Institute, COOR, Vail, CO 81657-5242, USA
| | - Keelan Enseki
- University of Pittsburgh Medical Center, Rooney Sports Complex, Pittsburgh, PA, USA
| | - Tony Andrade
- Reading Orthopaedic Centre, Circle Reading Hospital, Reading RG2 0NE, UK.,Trauma and Orthopaedic Department, Royal Berkshire NHS Foundation Trust, Reading RG1 5AN, UK
| | - Marc Safran
- Orthopaedic Surgery, Stanford University, Redwood City, CA 94063, USA
| | | | - Hal Martin
- Hip Preservation Center, Baylor University Medical Center at Dallas, Dallas, TX 75246-2088, USA
| | | | - Ashley Campbell
- Physical Therapy, Belmont University, Nashville, TN 37212-3757, USA
| | - Mark Ryan
- University of Pittsburgh Medical Center, Rooney Sports Complex, Pittsburgh, PA, USA
| | - Tim Tyler
- Physiotherapy, Pro Sports Physical Therapy, New York, USA
| | - Ryan P McGovern
- Texas Health Sports Medicine, Sports Medicine Research, Allen, TX 15013, USA
| | - Mario Bizzini
- Physiotherapy, Schulthess Klinik, Zurich, Switzerland
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Di Benedetto P, Vidi D, Buttironi MM, Mancuso F, Ricciarelli M, Causero A. Outcomes in arthroscopic surgery and proposal rehabilitative treatment in femoral acetabular impingement syndrome. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021575. [PMID: 35604246 PMCID: PMC9437672 DOI: 10.23750/abm.v92is3.12710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 01/18/2022] [Indexed: 11/28/2022]
Abstract
Background and aim of the work Femural Acetabular impingement syndrome (FAIS) is a patologic condition that can lead to hip pain, functional limitation and stiffness. In the last few decades orthopedics and physiotherapists have improved both surgery and riabilitative treatment leading to a better and better treatment. The target of this paper il to verify the efficiency of an early and multimodal physiotherapic treatment after and arthroscopic surgery of the FAIS Materials and Methods We performed arthroscopic treatment and rehabilitation on 19 patients with mean age of 37±8,3 years, 12 males and 7 females. Each patient has been evaluated preoperatively (T0), postoperatively after 6 week (T1) and after 3 months of follow up (T2), the assessment was carried out by: administration of the VAS and WOMAC score for pain and function and joint examination of active hip movement through an inertial sensor system. Results VAS score shows a decrease of pain after 6 week (mean decrease was 36%) and after 3 months (mean decrease was 33%). WOMAC score shows an increase of the funcional performance of the hip after 3 weeks and after 3 months (in both phases the mean score increase of the 44%) At last, the analysis of the active movement and of the hip joint showed a generalized increase in all movements both 6 weeks and 3 months after surgery, in particular for flexion (with the knee flexed) and internal rotation movements. of the hip. Conclusion The results of this study are in line with the current scientific literature and the protocol used represents a valid tool to complete the surgical treatment. The proposal of an early, intensive treatment combined with hydrokinesitherapy seems to be safe and effective, however further studies are needed (increasing the sample size) to investigate the results.
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Affiliation(s)
- Paolo Di Benedetto
- Clinics of Orthopedics ASU FC, Udine, Italy;,Medical Department, University of Udine, Italy
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Mumbleau AM, Schilaty ND, Hewett TE. HIP MUSCLE INHIBITION AFTER HIP ARTHROSCOPY: A ROLE FOR NEUROMUSCULAR ELECTRICAL STIMULATION. Int J Sports Phys Ther 2020; 15:1222-1228. [PMID: 33344037 PMCID: PMC7727436 DOI: 10.26603/ijspt20201222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2024] Open
Abstract
BACKGROUND/PURPOSE The number of hip arthroscopies (HAs) performed in the United States is increasing exponentially. Previous authors have shown improvements in short- and mid-term functional outcomes after HA. Despite established overall improvements, functional and objective impairments may persist. In particular, preliminary work demonstrates differences in hip strength between patients who undergo HA when compared to healthy controls at 12- and 24-months post-operative. The purpose of this clinical commentary is to highlight the persistent hip muscle strength and neuromuscular deficits that occur after HA, as well as propose the utilization of neuromuscular electrical stimulation (NMES) as an adjunct to strengthening exercises in early post-operative rehabilitation to address deficits. DESCRIPTION OF TOPIC Arthrogenic muscle inhibition (AMI), drives neuromuscular dysfunction and has been shown to occur in peripheral joints. The knee and hip have historically benefited from NMES to aid in improved muscular function, such as in those who have undergone anterior cruciate ligament reconstruction, total hip or knee arthroplasties. Improving muscular strength is a hallmark component of rehabilitation after HA, however, current post-operative HA rehabilitation protocols do not include NMES as a standard treatment intervention. Therapeutic intervention strategies to target muscular inhibition after HA, in particular with the goal to address neural reflex inhibition, have not been thoroughly investigated. This absence of understanding of this important problem yields a critical gap in the treatment of post-operative muscular deficits in patients after HA. DISCUSSION The consequence of hip muscle inhibition is likely to include deficits in strength and function, similar to that seen in other muscular groups. Filling the void of current knowledge with regard to muscle inhibition and strength deficits after hip arthroscopy is critical to establish standardized post-operative rehabilitation protocols, as well as to provide targeted training to address muscular inhibition. Ultimately, these strategies could produce improved outcomes guided by robust evidence-based protocols. LEVEL OF EVIDENCE 5.
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Perez JE, Schmidt MA, Narvaez A, Welsh LK, Diaz R, Castro M, Ansari K, Cason RW, Bilezikian JA, Hope W, Guerron AD, Yoo J, Levinson H. Evolving concepts in ventral hernia repair and physical therapy: prehabilitation, rehabilitation, and analogies to tendon reconstruction. Hernia 2020; 25:1-13. [PMID: 32959176 DOI: 10.1007/s10029-020-02304-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 09/02/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE The abdominal wall and musculoskeletal tendons share many anatomic, physiologic, and functional characteristics. This review aims to highlight these similar characteristics and to present a rationale why the treatment principles of successful musculoskeletal tendon reconstruction, including principles of surgical technique and physical therapy, can be used in the treatment of complex abdominal wall reconstruction or ventral hernia repair. METHODS The MEDLINE/PubMed database was used to identify published literature relevant to the purpose of this review. CONCLUSIONS There are several anatomical and functional similarities between the linea alba and musculoskeletal tendons. Because of this reason, many of the surgical principles for musculoskeletal tendon repair and ventral hernia repair overlap. Distribution of tension is the main driving principle for both procedures. Suture material and configuration are chosen to maximize tension distribution among the tissue edges, as seen in the standard of care multistrand repairs for musculoskeletal tendons, as well as in the small bites for laparotomy technique described in the STITCH trial. Physical therapy is also one of the mainstays of tendon repair, but surprisingly, is not routine in ventral hernia repair. The evidence surrounding physical therapy prehabilitation and rehabilitation protocols in other disciplines is significant. This review challenges the fact that these protocols are not routinely implemented for ventral hernia repair, and presents the rationale and feasibility for the routine practice of physical therapy in ventral hernia repair.
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Affiliation(s)
- J E Perez
- Division of Metabolic and Weight Loss Surgery, Department of Surgery, Duke University, Durham, NC, 27704, US
| | - M A Schmidt
- Department of Physical Therapy and Occupational Therapy, Duke University, Durham, NC, 27710, US
| | - A Narvaez
- Division of Metabolic and Weight Loss Surgery, Department of Surgery, Duke University, Durham, NC, 27704, US
| | - L K Welsh
- Division of Metabolic and Weight Loss Surgery, Department of Surgery, Duke University, Durham, NC, 27704, US
| | - R Diaz
- Division of Metabolic and Weight Loss Surgery, Department of Surgery, Duke University, Durham, NC, 27704, US
| | - M Castro
- Division of Metabolic and Weight Loss Surgery, Department of Surgery, Duke University, Durham, NC, 27704, US
| | - K Ansari
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University, Durham, NC, 27710, US
| | - R W Cason
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University, Durham, NC, 27710, US
| | - J A Bilezikian
- Department of General Surgery, New Hanover Regional Medical Center, Wilmington, NC, 28403, US
| | - W Hope
- General Surgery Specialists, New Hanover Regional Medical Center, Wilmington, NC, 28403, US
| | - A D Guerron
- Division of Metabolic and Weight Loss Surgery, Department of Surgery, Duke University, Durham, NC, 27704, US
| | - J Yoo
- Division of Metabolic and Weight Loss Surgery, Department of Surgery, Duke University, Durham, NC, 27704, US
| | - H Levinson
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University, Durham, NC, 27710, US. .,Director of Innovation and Entrepreneurship, Associate Professor of Plastic and Reconstructive Surgery, Pathology, Dermatology and Surgical Sciences, Departments of Dermatology, Pathology, and Surgery, Duke University Medical Center, DUMC 3181, Durham, NC, 27710, US.
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There Is Limited and Inconsistent Reporting of Postoperative Rehabilitation for Femoroacetabular Impingement Syndrome: A Scoping Review of 169 Studies. J Orthop Sports Phys Ther 2020; 50:252-258. [PMID: 32272028 DOI: 10.2519/jospt.2020.9189] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate the reporting of rehabilitation guidelines in studies of postoperative outcomes of patients with femoroacetabular impingement (FAI) syndrome and/or labral tear. DESIGN Scoping review. LITERATURE SEARCH A computer-assisted literature search was conducted of the MEDLINE, CINAHL, and Embase databases on June 17, 2018. Using key words related to FAI syndrome/labral tear and both open and arthroscopic surgical outcomes, we identified 169 studies that included 16 675 patients. Separate authors calculated and verified the prevalence of reported outcomes. STUDY SELECTION CRITERIA We included intervention and observational studies that were prospective or retrospective in design. Studies must have included patients with a primary diagnosis of FAI syndrome and/or labral tear. DATA SYNTHESIS We calculated the mean ± SD prevalence for continuous variables, where possible. RESULTS Hip arthroscopy was the primary surgical procedure (76% of studies). The mean ± SD age of participants was 34.8 ± 9.2 years and the mean ± SD follow-up time was 27 ± 15.3 months. Of the 169 included studies, 74 (44%) discussed phases of rehabilitation, 49 (29%) reported details on goals between phases, 1 in 3 described details on rehabilitation progression, and fewer than 1 in 10 reported sufficient detail to replicate the rehabilitation protocol. Weight-bearing and range-of-motion restrictions were poorly reported and variable in duration. CONCLUSION Surgical outcome studies do not provide sufficient detail or consistency for practicing clinicians to replicate a postoperative rehabilitation protocol for patients with FAI syndrome/labral tear. J Orthop Sports Phys Ther 2020;50(5):252-258. doi:10.2519/jospt.2020.9189.
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Mosler AB, Kemp J, King M, Lawrenson PR, Semciw A, Freke M, Jones DM, Casartelli NC, Wörner T, Ishøi L, Ageberg E, Diamond LE, Hunt MA, Di Stasi S, Reiman MP, Drew M, Friedman D, Thorborg K, Leunig M, Bizzini M, Khan KM, Crossley KM, Agricola R, Bloom N, Dijkstra HP, Griffin D, Gojanovic B, Harris-Hayes M, Heerey JJ, Hölmich P, Impellizzeri FM, Kassarjian A, Warholm KM, Mayes S, Moksnes H, Risberg MA, Scholes MJ, Serner A, van Klij P, Lewis CL. Standardised measurement of physical capacity in young and middle-aged active adults with hip-related pain: recommendations from the first International Hip-related Pain Research Network (IHiPRN) meeting, Zurich, 2018. Br J Sports Med 2019; 54:702-710. [DOI: 10.1136/bjsports-2019-101457] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2019] [Indexed: 01/12/2023]
Abstract
Hip-related pain can significantly impact quality of life, function, work capacity, physical activity and family life. Standardised measurement methods of physical capacity of relevance to young and middle-aged active adults with hip-related pain are currently not established. The aim of this consensus paper was to provide recommendations for clinical practice and research on standardised measurement methods of physical capacity in young and middle-aged active adults with hip-related pain. Four areas of importance were identified: (1) clinical measures (range of motion, muscle strength, functional impairments), (2) laboratory-based measures (biomechanics and muscle function (muscle activity, size and adiposity)), (3) physical activity, and (4) return to sport/performance. The literature was reviewed, and a summary circulated to the working group to inform discussion at the consensus meeting. The working group developed clinical and research recommendations from the literature review, which were further discussed and modified within the working group at the consensus meeting. These recommendations were then presented to all 38 International Hip-related Pain Research Network (IHiPRN) participants for further discussion, refinement and consensus voting. Therefore, the recommendations voted on were based on a combination of current evidence and expert opinion. The consensus meeting voted on 13 recommendations, six of which were clinically orientated, and seven more research specific. We recommended that clinicians working with young and middle-aged active adults with hip-related pain assess strength using objective methods of measurement, and clinically assess performance of functional tasks, including walking and running. Physical activity should be quantified using both self-reported and objective measures, and patient expectations of recovery should be quantified prior to treatment. It was recommended that return to physical activity (including sport and occupation) be quantified, and sport-specific activities should be assessed prior to return to sport. The IHiPRN participants were uncertain regarding recommendations for range of motion assessment. Research recommendations were that the measurement properties of range of motion, strength and functional performance tests be investigated, reported and improved in both clinical and research settings. Reporting of movement-related parameters (biomechanics and muscle function) should be standardised and the relationship among movement-related parameters, symptoms, function, quality of life, and intra-articular and imaging findings should be investigated. Quantification of return to physical activity (including sport and occupational demands) is required in future research, and the return to sport continuum should be used. Future research is required to determine the best criteria for rehabilitation progression and return to physical activity following hip-related pain management.
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Return to Sport Rates in Physically Active Individuals 6 Months After Arthroscopy for Femoroacetabular Impingement Syndrome. J Sport Rehabil 2019; 28:570-575. [PMID: 29651906 DOI: 10.1123/jsr.2017-0138] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 03/08/2018] [Accepted: 03/14/2018] [Indexed: 11/18/2022]
Abstract
CONTEXT Six months is the expected time frame to return to sport (RTS) after hip arthroscopy for femoroacetabular impingement syndrome (FAIS). OBJECTIVE The primary aims of this study were to (1) report the RTS rate of physically active individuals 6 months after arthroscopic surgery for FAIS and (2) compare the self-reported hip function between those who were able to RTS against those who had not. DESIGN Cohort study. SETTING The Ohio State University Wexner Medical Center. PATIENTS A total of 42 physically active individuals scheduled for hip arthroscopy for FAIS. MAIN OUTCOME MEASURES Self-reported function, including preinjury and current activity levels and ability to participate in sport, were collected on 42 individuals with FAIS prior to surgery and at 6-month follow-up. Participants were allocated into 2 groups based on self-reported RTS status at 6-month follow-up. Separate 2-way analyses of variance were used to test the interaction of groups (those who did/did not RTS). Main effects were reported in the absence of statistically significant interactions (P ≤ .05). RESULTS Altogether, 28 of 42 participants (66%) returned for 6-month follow-up; 5 of the 14 participants (35.7%) lost to follow-up underwent contralateral hip surgery within the study time frame. At the 6-month follow-up, 16 of the remaining 28 participants (57.1%) reported that they had returned to sport, 5 of whom returned at their prior level of participation. There was no statistically significant interaction of group and time for either hip outcome score subscale (P ≥ .20). Self-reported hip function improved over time, regardless of group (P ≤ .001). Participants in the yRTS group demonstrated higher hip outcome score-sport scores than did the nRTS group, regardless of time (P = .04). CONCLUSIONS Though just over half of participants returned to sport 6 months after hip arthroscopy for FAIS, only 18% returned to their previous level of sports participation. Participants who returned to sport reported better function than those who did not, but self-reported hip function improved over time regardless of group. The most commonly reported reasons for not returning to sport were weakness (69.6%), fear (65.2%), and pain (56.5%).
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Wilson KW, Kannan AS, Kopacko M, Vyas D. Rehabilitation and Return to Sport After Hip Arthroscopy. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.oto.2019.100739] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Freke MD, Crossley K, Sims K, Russell T, Weinrauch P, Gamboa G, Semciw A. Acute and Subacute Changes in Hip Strength and Range of Movement After Arthroscopy to Address Chondrolabral Pathology. Am J Sports Med 2019; 47:1939-1948. [PMID: 31157975 DOI: 10.1177/0363546519850816] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hip pain is associated with reduced muscle strength, range of movement (ROM), and function. Hip arthroscopy is undertaken to address coexistent intra-articular pathologies with the aim of reducing pain and improving function. PURPOSE To evaluate changes in strength and ROM in a cohort with chondrolabral pathology before surgery to 3 and 6 months after hip arthroscopy. STUDY DESIGN Case series; Level of evidence, 4. METHODS Sixty-seven individuals with hip pain who were scheduled for hip arthroscopy were matched with 67 healthy controls. Hip strength and ROM were collected preoperatively and at 3 and 6 months postoperatively. Repeated measures analysis of variance evaluated whether strength and ROM differed between limbs and among time points. Bonferroni post hoc tests determined differences in hip strength and ROM among testing times and between the hip pain group and matched controls. RESULTS Hip extension, internal rotation (IR), external rotation (ER), and adduction (P < .040) strength were greater at 3 months after surgery; all directions, including flexion, abduction, and squeeze, were greater at 6 months (P < .015). Hip flexion ROM was greater at 3 months after surgery (P = .013). Flexion, IR, and ER ROM was greater at 6 months (P < .041). At 6 months, IR ROM (P = .003) and flexion, IR, and ER strength (P < .005) remained less than matched controls. CONCLUSION With the exception of squeeze and flexion, all directions of hip strength and hip flexion ROM are significantly improved 3 months after arthroscopy to address chondrolabral pathology. By 6 months after arthroscopy, strength in all directions and flexion and rotation ROM are significantly improved in both limbs, but hip flexion, IR, and ER strength and IR ROM remain significantly less than that of healthy matched controls in both limbs.
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Affiliation(s)
- Matthew D Freke
- Enoggera Health Centre, Gallipoli Barracks, Enoggera, Brisbane, Australia.,School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, Brisbane, Australia
| | - Kay Crossley
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Melbourne, Australia
| | - Kevin Sims
- School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, Brisbane, Australia
| | - Trevor Russell
- School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, Brisbane, Australia
| | | | - Gauguin Gamboa
- Brisbane Private Hospital, Spring Hill, Brisbane, Australia
| | - Adam Semciw
- School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, Brisbane, Australia.,School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Melbourne, Australia
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Similar views on rehabilitation following hip arthroscopy among physiotherapists and surgeons in Scandinavia: a specialized care survey. Knee Surg Sports Traumatol Arthrosc 2018; 26:2519-2526. [PMID: 28808740 PMCID: PMC6061773 DOI: 10.1007/s00167-017-4676-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 08/01/2017] [Indexed: 11/13/2022]
Abstract
PURPOSE The rising number of hip arthroscopies (HA) is leading to increasing numbers of patients requiring post-surgical rehabilitation; however, evidence regarding post-operative rehabilitation is currently limited. The purpose of the study was to describe and compare current rehabilitation strategies and views among surgeons and physiotherapists in Scandinavia. METHODS Scandinavian surgeons and physiotherapists experienced with HA and post-surgical rehabilitation were asked to complete an online survey. Ninety clinicians (28 surgeons, 62 physiotherapists) responded. RESULTS Both professions mostly rated physiotherapy as very or extremely important in the rehabilitation process. The majority advocated criteria-based or combined criteria- and time-based progression. Expected rehabilitation timelines were reported with large intra-professional variation but general inter-professional agreement. However, compared with physiotherapists surgeons expected fewer weeks on crutches and faster return to competitive sport. Surgeons more often reported use of evidence-based self-reported outcomes while physiotherapists more often evaluated readiness for return to play. CONCLUSIONS Among surgeons and physiotherapists, physiotherapy is considered very important following HA. Generally, very similar views were held between professions. Surgeons expected reduced time on crutches and to return to competitive sports than physiotherapists. Surgeons also used evidence-based self-reported outcomes to a higher degree than physiotherapists. Being the first study to provide an overview on currently applied rehabilitation strategies following HA, results of this study may guide much needed, future research on the rehabilitation process following HA. LEVEL OF EVIDENCE IV.
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Shaw KA, Jacobs JM, Evanson JR, Pniewski J, Dickston ML, Mueller T, Bojescul JA. FUNCTIONAL OUTCOMES OF HIP ARTHROSCOPY IN AN ACTIVE DUTY MILITARY POPULATION UTILIZING A CRITERION-BASED EARLY WEIGHT BEARING PROGRESSION. Int J Sports Phys Ther 2017; 12:840-847. [PMID: 29181261 PMCID: PMC5685403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
INTRODUCTION Hip arthroscopy allows surgeons to address intra-articular pathology of the hip while avoiding more invasive open surgical dislocation. However the post-operative rehabilitation protocols have varied greatly in the literature, with many having prolonged periods of limited motion and weight bearing. PURPOSE The purpose of this study was to describe a criterion-based early weight bearing protocol following hip arthroscopy and investigate functional outcomes in the subjects who were active duty military. METHODS Active duty personnel undergoing hip arthroscopy for symptomatic femoroacetabular impingement were prospectively assessed in a controlled environment for the ability to incorporate early postoperative weight-bearing with the following criteria: no increased pain complaint with weight bearing and normalized gait pattern. Modified Harris Hip (HHS) and Hip Outcome score (HOS) were performed preoperatively and at six months post-op. Participants were progressed with a standard hip arthroscopy protocol. Hip flexion was limited to not exceed 90 degrees for the first three weeks post-op, with progression back to running beginning at three months. Final discharge was dependent upon the ability to run two miles at military specified pace and do a single leg broad jump within six inches of the contralateral leg without an increase in pain. RESULTS Eleven participants met inclusion criteria over the study period. Crutch use was discontinued at an average of five days following surgery based on established weight bearing criteria. Only one participant required continued crutch use at 15 days. Participants' functional outcome was improved postoperatively, as demonstrated by significant increases in HOS and HHS. At the six month follow up, eight of 11 participants were able to take and complete a full Army Physical Fitness Test. CONCLUSIONS Following completion of the early weight bearing rehabilitation protocol, 81% of participants were able to progress to full weight bearing by four days post-operative, with normalized pain-free gait patterns. Active duty personnel utilizing an early weight bearing protocol following hip arthroscopy demonstrated significant functional improvement at six months. LEVEL OF EVIDENCE Level 4, Case-series.
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Affiliation(s)
- K. Aaron Shaw
- Dwight David Eisenhower Army Medical Center, Ft Gordon, GA, USA
| | | | | | - Josh Pniewski
- Dwight David Eisenhower Army Medical Center, Ft Gordon, GA, USA
| | | | - Terry Mueller
- Dwight David Eisenhower Army Medical Center, Ft Gordon, GA, USA
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Kuhns BD, Weber AE, Batko B, Nho SJ, Stegemann C. A FOUR-PHASE PHYSICAL THERAPY REGIMEN FOR RETURNING ATHLETES TO SPORT FOLLOWING HIP ARTHROSCOPY FOR FEMOROACETABULAR IMPINGEMENT WITH ROUTINE CAPSULAR CLOSURE. Int J Sports Phys Ther 2017; 12:683-696. [PMID: 28900574 PMCID: PMC5534158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
UNLABELLED Hip preservation surgery has become more common over the past decade and is now a preferred treatment modality for an increasingly diverse array of pathology in the young, active patient with hip pain. In particular, hip arthroscopy has become an increasingly popular treatment choice for active patients diagnosed with femoroacetabular impingement (FAI). Appropriate postoperative rehabilitation is critical for overall patient success and optimal long-term outcome. As surgical techniques continue to evolve, rehabilitation protocols must adapt to accommodate changes in the surgical procedure and ultimately provide the safest and fastest recovery of function for the patient. One such surgical modification has been the incorporation of routine capsular closure as part of the treatment of FAI in the young, active patient. The purpose of this clinical commentary is to present a four-phase rehabilitation protocol for returning to sport following arthroscopic correction of FAI with routine capsular closure. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- Benjamin D. Kuhns
- Department of Orthopaedics & Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
| | - Alexander E. Weber
- Hip Preservation Center, Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, IL, USA
| | - Brian Batko
- Hip Preservation Center, Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, IL, USA
| | - Shane J. Nho
- Hip Preservation Center, Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, IL, USA
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Cunningham DJ, Lewis BD, Hutyra CA, Mather RC, Olson SA. Early recovery after hip arthroscopy for femoroacetabular impingement syndrome: a prospective, observational study. J Hip Preserv Surg 2017; 4:299-307. [PMID: 29250338 PMCID: PMC5721367 DOI: 10.1093/jhps/hnx026] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 04/21/2017] [Accepted: 06/19/2017] [Indexed: 12/14/2022] Open
Abstract
The early post-operative course after hip arthroscopy for femoroacetabular impingement syndrome has not been thoroughly characterized or correlated to factors that may influence recovery. The aim of this study was to report on early pain, function and attitudes towards rehabilitation and to determine predictors of early recovery after hip arthroscopy. Sixty-two patients reported pre-operative pain, iHOT-12 (hip functional score), psychological status and other baseline characteristics. Pain, iHOT-12, hip flexion and several other outcomes were measured through 6 weeks post-operative. Baseline characteristics were correlated with outcomes using univariate and multivariable models. Pain relief started on post-operative day 1 and consistently improved throughout the 6 weeks of follow-up. The average patient’s pain was reduced from a pre-operative level of 5/10 to 2/10 by 6 weeks post-operative. Similarly, iHOT-12 improved from 33/100 to 57/100 whereas hip flexion increased by 9° by 6 weeks post-operative. At 2 weeks post-operative, pre-operative anti-inflammatory usage was associated with greater improvement in pain and swelling; pre-operative opioid usage with poorer patient-reported helpfulness of and adherence to rehabilitation; and higher ASA (American Society of Anesthesiologists) score and lower procedure time with improvement of the pre-operative pain complaint. At 6 weeks, greater depression was associated with lower post-operative pain reduction but greater pre-operative pain complaint improvement. Continuous passive motion usage was associated with increased hip flexion. Pain improved from pre-operative by Day 1 after hip arthroscopy, and early functional improvements were seen by 6 weeks post-operative. Pre-operative anti-inflammatory and opioid usage, depression, race, ASA score, procedure time and continuous passive motion usage were significantly associated with study outcomes.
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Affiliation(s)
- D J Cunningham
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27703, USA
- Correspondence to: D. J. Cunningham. E-mail:
| | - B D Lewis
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27710, USA
| | - C A Hutyra
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27710, USA
| | - R C Mather
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27710, USA
| | - S A Olson
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27710, USA
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Using Mobile Tracking Technology to Visualize the Trajectory of Recovery After Hip Arthroscopy: a Case Report. HSS J 2017; 13:194-200. [PMID: 28690471 PMCID: PMC5481265 DOI: 10.1007/s11420-017-9544-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 01/17/2017] [Indexed: 02/07/2023]
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Does treatment by a specialist physiotherapist change pain and function in young adults with symptoms from femoroacetabular impingement? A pilot project for a randomised controlled trial. Physiotherapy 2017; 103:201-207. [DOI: 10.1016/j.physio.2016.02.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Indexed: 11/18/2022]
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Kraeutler MJ, Anderson J, Chahla J, Mitchell JJ, Thompson-Etzel R, Mei-Dan O, Pascual-Garrido C. Return to running after arthroscopic hip surgery: literature review and proposal of a physical therapy protocol. J Hip Preserv Surg 2017. [PMID: 28630733 PMCID: PMC5467407 DOI: 10.1093/jhps/hnx012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The number of hip arthroscopy procedures has significantly increased in the last several years, thereby necessitating individualized rehabilitation protocols for patients following hip arthroscopy. The purpose of this article is to review the literature on rehabilitation protocols for patients following hip arthroscopy and to describe a new protocol specifically designed for patients to return to running following hip arthroscopy. A search of PubMed was performed through October 2016 to locate studies of rehabilitation protocols for patients wishing to return to sport/general activity following hip arthroscopy. Patients at our institution who desired to return to running following hip arthroscopy underwent a set of return to running guidelines which are based on goal achievement within a three-phase system that begins with a walking program and finishes with return to distance running. Rehabilitation protocols for patients following hip arthroscopy frequently use a four-phase system in which Phase I focuses on regaining hip range of motion and protection of surgically repaired tissues, and Phase IV involves a pain-free return to sports. Rehabilitation protocols vary in timing in that some include a timeline with each phase taking a certain number of weeks while others are based on goal achievement. There is an overall lack of published outcomes based on patients adhering to various post-hip arthroscopy rehabilitation protocols.
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Affiliation(s)
- Matthew J Kraeutler
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Joy Anderson
- University of Colorado Sports Physical Therapy, Denver, CO 80222, USA
| | - Jorge Chahla
- Steadman Philippon Research Institute, Vail, CO 81657, USA
| | - Justin J Mitchell
- Department of Sports Medicine, Gundersen Health System, La Crosse, WI 54601, USA
| | | | - Omer Mei-Dan
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO 80045, USA
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Rath E, Sharfman ZT, Paret M, Amar E, Drexler M, Bonin N. Hip arthroscopy protocol: expert opinions on post-operative weight bearing and return to sports guidelines. J Hip Preserv Surg 2017. [PMID: 28630722 PMCID: PMC5467404 DOI: 10.1093/jhps/hnw045] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The objectives of this study are to survey the weight-bearing limitation practices and delay for returning to running and impact sports of high volume hip arthroscopy orthopedic surgeons. The study was designed in the form of expert survey questionnaire. Evidence-based data are scares regarding hip arthroscopy post-operative weight-bearing protocols. An international cross-sectional anonymous Internet survey of 26 high-volume hip arthroscopy specialized surgeons was conducted to report their weight-bearing limitations and rehabilitation protocols after various arthroscopic hip procedures. The International Society of Hip Arthroscopy invited this study. The results were examined in the context of supporting literature to inform the studies suggestions. Four surgeons always allow immediate weight bearing and five never offer immediate weight bearing. Seventeen surgeons provide weight bearing depending on the procedures performed: 17 surgeons allowed immediate weight bearing after labral resection, 10 after labral repair and 8 after labral reconstruction. Sixteen surgeons allow immediate weight bearing after psoas tenotomy. Twenty-one respondents restrict weight bearing after microfracture procedures for 3–8 weeks post-operatively. Return to running and impact sports were shorter for labral procedures and bony procedures and longer for cartilaginous and capsular procedures. Marked variability exists in the post-operative weight-bearing practices of hip arthroscopy surgeons. This study suggests that most surgeons allow immediate weight bearing as tolerated after labral resection, acetabular osteoplasty, chondroplasty and psoas tenotomy. For cartilage defect procedures, 6 weeks or more non-weight bearing is suggested depending on the area of the defect and lateral central edge angle. Delayed return to sports activities is suggested after microfracture procedures. The level of evidence was Level V expert opinions.
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Affiliation(s)
- Ehud Rath
- Department of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine,Tel Aviv University, Tel Aviv, Israel
| | - Zachary T Sharfman
- Department of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine,Tel Aviv University, Tel Aviv, Israel
| | - Matan Paret
- Department of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine,Tel Aviv University, Tel Aviv, Israel
| | - Eyal Amar
- Department of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine,Tel Aviv University, Tel Aviv, Israel
| | - Michael Drexler
- Department of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine,Tel Aviv University, Tel Aviv, Israel
| | - Nicolas Bonin
- Lyon Ortho Clinic, Clinique de la sauvegarde, 25 B avenue des sources, Lyon 69009, France
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Yu HC, Al-Shehri M, Johnston KD, Endersby R, Baghirzada L. Anesthesia for hip arthroscopy: a narrative review. Can J Anaesth 2016; 63:1277-90. [PMID: 27530361 DOI: 10.1007/s12630-016-0718-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 06/19/2016] [Accepted: 08/03/2016] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Hip arthroscopy is a minimally invasive surgical procedure indicated for the treatment of specific hip disorders. In this narrative review, we aim to examine the key components in providing anesthesia for this procedure. SOURCE MEDLINE(®), PubMed, and EMBASE™ databases were searched for peer-reviewed articles discussing the anesthetic management of patients undergoing hip arthroscopy. PRINCIPAL FINDINGS The primary anesthetic regimen used for hip arthroscopy should balance patient factors, preferences of the surgeon, and the demands of the procedure itself. Both general and neuraxial anesthetic techniques are well suited for this mostly ambulatory surgical procedure. There is a lack of current literature specifically comparing the benefits and risks of the two techniques in this setting. Postoperative pain management consists mainly of intravenous and oral opioids; however, a variety of regional anesthesia techniques, such as lumbar plexus block and fascia iliaca block, can be performed pre- or postoperatively. Overall, hip arthroscopy is safe, although positioning-related difficulties, extravasation of irrigation fluid, hypothermia, infections, and thromboembolic events are potential perioperative complications that warrant specific monitoring and prompt treatment. CONCLUSIONS Until now, the anesthetic technique for hip arthroscopy has not been well studied. Thus, increasing emphasis should be directed towards examining relevant clinical outcomes that can better inform evidence-based decision-making in the anesthetic management of hip arthroscopy patients. In the meantime, awareness of potential complications and vigilant monitoring are paramount in providing safe anesthetic care for patients undergoing hip arthroscopy.
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Affiliation(s)
- Hai Chuan Yu
- University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Mohammed Al-Shehri
- Division of Orthopedics, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Kelly D Johnston
- Division of Hip & Knee Reconstruction, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Ryan Endersby
- Department of Anesthesiology, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Leyla Baghirzada
- Department of Anesthesiology, University of Calgary Cumming School of Medicine, Calgary, AB, Canada. .,Department of Anesthesia, South Health Campus, 4448 Front Street, SE, Calgary, AB, T3M 1M4, Canada.
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29
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Pendulum Exercises After Hip Arthroscopy: A Video Technique. Arthrosc Tech 2016; 5:e897-e900. [PMID: 27709055 PMCID: PMC5040594 DOI: 10.1016/j.eats.2016.04.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Accepted: 04/19/2016] [Indexed: 02/03/2023] Open
Abstract
Advanced hip joint-preserving arthroscopic techniques have been shown to improve patient-reported functional outcomes with low rates of postoperative complications. Prior work has shown that formation of adhesive scar is a potential source of persistent pain and cause for revision surgery. As resources for postoperative in-studio physical therapy become scarce, a home-based strategy to avoid scar formation without adding formal therapy cost may be beneficial. The purpose of this technical note is to introduce a patient-centered educational video technique for home-caregiver delivery of manual hip pendulum exercises in the postoperative setting. This video technique offers access to our method for pendulum exercise as part of early recovery after advanced hip arthroscopy.
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Yeung M, Memon M, Simunovic N, Belzile E, Philippon MJ, Ayeni OR. Gross Instability After Hip Arthroscopy: An Analysis of Case Reports Evaluating Surgical and Patient Factors. Arthroscopy 2016; 32:1196-1204.e1. [PMID: 27013107 DOI: 10.1016/j.arthro.2016.01.011] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 11/19/2015] [Accepted: 01/06/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE Gross hip instability is a rare complication after hip arthroscopy, and there is limited literature surrounding this topic. This systematic review investigates cases of gross hip instability after arthroscopy and discusses the risk factors associated with this complication. METHODS A systematic search was performed in duplicate for studies investigating gross hip instability after hip arthroscopy up to October 2015. Study parameters including sample size, mechanism and type of dislocation, surgical procedure details, patient characteristics, postoperative rehabilitation protocol, and level of evidence were analyzed. RESULTS The systematic review identified 9 case reports investigating gross hip instability after hip arthroscopy (10 patients). Anterior dislocation occurred in 66.7% of patients, and most injuries occurred with a low-energy mechanism. Common surgical factors cited included unrepaired capsulotomy (77.8%) and iliopsoas release (33.3%), whereas patient factors included female gender (77.8%), acetabular dysplasia (22.2%), and general ligamentous laxity (11.1%). Postoperative restrictions and protocols were variable and inconsistently reported, and their relation to post-arthroscopy instability was difficult to ascertain. CONCLUSIONS This systematic review discussed various patient, surgical, and postoperative risk factors of gross hip instability after arthroscopy. Patient characteristics such as female gender, hip dysplasia, and ligamentous laxity may be risk factors for post-arthroscopy dislocation. Similarly, surgical risk factors for iatrogenic hip instability may include unrepaired capsulotomies and iliopsoas debridement, although the role of capsular closure in iatrogenic instability is not clear. The influences of postoperative restrictions and protocols on dislocation are also unclear in the current literature. Surgeons should be cognizant of these risk factors when performing hip arthroscopy and be mindful that these factors appear to occur in combination. LEVEL OF EVIDENCE Level IV, systematic review of Level IV studies.
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Affiliation(s)
- Marco Yeung
- Division of Orthopedic Surgery, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Muzammil Memon
- Division of Orthopedic Surgery, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Nicole Simunovic
- Division of Orthopedic Surgery, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Etienne Belzile
- Department of Orthopedic Surgery, Laval University, Quebec, Quebec, Canada
| | | | - Olufemi R Ayeni
- Division of Orthopedic Surgery, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
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31
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Malloy P, Gray K, Wolff AB. Rehabilitation After Hip Arthroscopy: A Movement Control-Based Perspective. Clin Sports Med 2016; 35:503-521. [PMID: 27343399 DOI: 10.1016/j.csm.2016.02.012] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Adequate control of movement is essential for patients to return to unrestricted function after hip arthroscopic surgery. Mobility, muscle performance and stability, and neuromuscular control are vital aspects addressed in rehabilitation to help re-establish control of movement for function. Initial joint protection is a hallmark for all patients after hip arthroscopy to prevent intra-articular and extra-articular soft tissue irritation of healing tissues. It is essential to tailor exercises of each phase to patients' specific functional demands. Each phase of rehabilitation should be monitored so that patients are not advanced too quickly, which can lead to setbacks and delays in return to normal function.
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Affiliation(s)
- Philip Malloy
- Department of Physical Therapy, Marquette University, 604 North 16th Street, Milwaukee, WI 53233, USA.
| | - Kim Gray
- SMARTherapy, Washington Orthopaedics and Sports Medicine, 2021 K Street Northwest, Washington, DC 20006, USA
| | - Andrew B Wolff
- Department of Orthopedic Surgery, Washington Orthopaedics and Sports Medicine, 2021 K Street Northwest, Washington, DC 20006, USA
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32
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Tijssen M, van Cingel REH, Staal JB, Teerenstra S, de Visser E, Nijhuis-van der Sanden MWG. Physical therapy aimed at self-management versus usual care physical therapy after hip arthroscopy for femoroacetabular impingement: study protocol for a randomized controlled trial. Trials 2016; 17:91. [PMID: 26883504 PMCID: PMC4756499 DOI: 10.1186/s13063-016-1222-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 02/06/2016] [Indexed: 11/10/2022] Open
Abstract
Background Femoroacetabular impingement has been recognized as a common cause of hip pain and dysfunction, especially in athletes. Femoroacetabular impingement can now be better treated by hip arthroscopy but it is unclear what postoperative rehabilitation of hip arthroscopy should look like. Several rehabilitation protocols have been described, but none presented clinical outcome data. These protocols also differ in frequency, duration and level of supervision. We developed a rehabilitation protocol with supervised physical therapy which showed good clinical results and is considered usual care in our treatment center. However, it is unknown whether, due to the relatively young age and low complication rate of hip arthroscopy patients, rehabilitation based on self-management might lead to similar results. The aims of this pilot study are (1) to determine feasibility and acceptability of the self-management intervention, (2) to obtain a preliminary estimate of the difference in effect between physical therapy aimed at self-management versus usual care physical therapy in patients who undergo hip arthroscopy for femoroacetabular impingement. Methods/Design Thirty participants (aged 18–50 years) scheduled for hip arthroscopy will be included and randomized (after surgery) to either self-management or usual care physical therapy in this assessor-blinded randomized controlled trial. After surgery, the self-management group will perform a home-based exercise program three times a week and will receive physical therapy treatment once every 2 weeks for 14 weeks. The usual care group will receive physical therapy treatment twice a week for 14 weeks and will perform an additional home-based exercise program once a week. Assessment will occur preoperatively and at 6, 14, 26 and 52 weeks after surgery. Primary outcomes are feasibility, acceptability and preliminary effectiveness. Feasibility and acceptability will be determined by the willingness to enroll, recruitment rate, adherence to treatment, patient satisfaction, drop-out rate and adverse events. Preliminary effectiveness will be determined using the following outcomes: the International Hip Outcome Tool 33 and hip functional performance as measured with the Single Leg Squat Test 14 weeks after surgery. Discussion The results of this study will be used to help decide on the need, feasibility and acceptability of a large-scale randomized controlled trial. Trial registration This protocol was registered with the Dutch Trial Registry (NTR5168) on 8 May 2015. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1222-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M Tijssen
- Sports Medical Center Papendal, Scientific Institute for Health Sciences, IQ Healthcare, Papendallaan 7, 6816 VD, Arnhem, The Netherlands.
| | - R E H van Cingel
- Radboud University Medical Center, Scientific Institute for Health Sciences, IQ Healthcare, PO Box 9101, 114 IQ, 6500 HB, Nijmegen, The Netherlands.
| | - J B Staal
- HAN University of Applied Sciences, Research Group Musculoskeletal Rehabiliation, PO Box 6960, 6503 GL, Nijmegen, The Netherlands.
| | - S Teerenstra
- Department for Health Evidence, Radboud Institute for Health Sciences, Section Biostatistics, Radboud University Medical Center, PO Box 9101, 133 HEV, 6500 HB, Nijmegen, The Netherlands.
| | - E de Visser
- Rijnstate Hospital Arnhem, Wagnerlaan 55, 6815 AD, Arnhem, The Netherlands.
| | - M W G Nijhuis-van der Sanden
- Scientific Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, PO Box 9101, 114 IQ, 6500 HB, Nijmegen, The Netherlands.
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33
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Schröder JH, Bizzini M, Fickert S, Hölmich P, Krüger J, Kopf S. „Return to sports“ nach femoroazetabulärer Impingement-Operation. ARTHROSKOPIE 2016. [DOI: 10.1007/s00142-015-0060-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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34
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Adler KL, Cook PC, Geisler PR, Yen YM, Giordano BD. Current Concepts in Hip Preservation Surgery: Part II--Rehabilitation. Sports Health 2016; 8:57-64. [PMID: 26733593 PMCID: PMC4702152 DOI: 10.1177/1941738115577621] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
CONTEXT Successful treatment of nonarthritic hip pain in young athletic individuals remains a challenge. A growing fund of clinical knowledge has paralleled technical innovations that have enabled hip preservation surgeons to address a multitude of structural variations of the proximal femur and acetabulum and concomitant intra-articular joint pathology. Often, a combination of open and arthroscopic techniques are necessary to treat more complex pathomorphologies. Peri- and postoperative recovery after such procedures can pose a substantial challenge to the patient, and a dedicated, thoughtful approach may reduce setbacks, limit morbidity, and help optimize functional outcomes. EVIDENCE ACQUISITION PubMed and CINAHL databases were searched to identify relevant scientific and review articles through December 2014 using the search terms hip preservation, labrum, surgical dislocation, femoroacetabular impingement, postoperative rehabilitation, peri-acetabular osteotomy, and rotational osteotomy. Reference lists of included articles were reviewed to locate additional references of interest. STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Level 4. RESULTS Hip preservation procedures and appropriate rehabilitation have allowed individuals to return to a physically active lifestyle. CONCLUSION Effective postoperative rehabilitation must consider modifications and precautions specific to the particular surgical techniques used. Proper postoperative rehabilitation after hip preservation surgery may help optimize functional recovery and maximize clinical success and patient satisfaction.
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Affiliation(s)
- Kelly L Adler
- Department of Orthopaedics & Rehabilitation, Division of Sports Medicine, Hip Preservation Program, University of Rochester Medical Center, Rochester, New York
| | - P Christopher Cook
- Department of Orthopaedics & Rehabilitation, Division of Sports Medicine, Hip Preservation Program, University of Rochester Medical Center, Rochester, New York
| | - Paul R Geisler
- Department of Exercise & Sport Science, Athletic Training Education Program, Ithaca College, Ithaca, New York
| | - Yi-Meng Yen
- Department of Orthopaedic Surgery, Division of Sports Medicine, Children's Hospital, Boston, The Adolescent and Young Hip Unit, Boston, Massachusetts
| | - Brian D Giordano
- Department of Orthopaedics & Rehabilitation, Division of Sports Medicine, Hip Preservation Program, University of Rochester Medical Center, Rochester, New York
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Joseph R, Pan X, Cenkus K, Brown L, Ellis T, Di Stasi S. Sex Differences in Self-Reported Hip Function Up to 2 Years After Arthroscopic Surgery for Femoroacetabular Impingement. Am J Sports Med 2016; 44:54-9. [PMID: 26546302 PMCID: PMC5142445 DOI: 10.1177/0363546515610535] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Femoroacetabular impingement (FAI) is a significant cause of disability in young adults. Hip arthroscopic surgery restores bony congruence and improves function in the majority of patients, but recent evidence indicates that women may experience worse pre- and postoperative function than men. PURPOSE/HYPOTHESIS The purpose of this study was to identify whether self-reported hip function differed between men and women with symptomatic FAI. The hypothesis was that mean self-reported hip function scores would improve after arthroscopic surgery but that women would report poorer function than men both before and up to 2 years after arthroscopic surgery. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS A total of 229 patients (68.4% women; mean [±SD] age, 31.6 ± 10.8 years; mean [±SD] body mass index, 26.8 ± 11.9 kg/m(2)) underwent hip arthroscopic surgery for unilateral symptomatic FAI. All eligible and consenting patients with radiologically and clinically confirmed FAI completed the International Hip Outcome Tool (iHOT-33) and the Hip Outcome Score activities of daily living subscale (HOS-ADL) before hip arthroscopic surgery and at 3, 6, 12, and 24 months after arthroscopic surgery. A linear mixed model for repeated measures was used to test for differences in self-reported hip function between men and women over the study period (P ≤ .05). RESULTS There were no significant time × sex interactions for either the HOS-ADL (P = .12) or iHOT-33 (P = .64), but both measures showed significant improvements between the preoperative time point and each of the 4 follow-up points (P < .0001); however, self-reported hip function did not improve between 6 and 24 months after arthroscopic surgery (P ≥ .11). Post hoc independent t tests indicated that women reported poorer hip function than did men before surgery (P ≤ .003) both on the HOS-ADL (mean ± standard error of the mean [SEM], 67.4 ± 1.9 [men] vs 60.5 ± 1.3 [women]) and iHOT-33 (mean ± SEM, 38.0 ± 1.9 [men] vs 30.9 ± 1.3 [women]); scores were not different between sexes at any other time point. CONCLUSION These findings indicate improvements in self-reported hip function in patients with FAI, regardless of sex, until 6 months after hip arthroscopic surgery. Although women reported poorer preoperative function than did men, the differences were not significant 2 years after surgery.
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Affiliation(s)
- Roody Joseph
- Orthopedic Physical Therapy Residency Program, OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,Outpatient Rehabilitation Center, Memorial Hospital Miramar, Miramar, Florida, USA
| | - Xueliang Pan
- Center for Biostatistics, The Ohio State University, Columbus, Ohio, USA
| | - Kathleen Cenkus
- Department of Plastic Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Lindsey Brown
- Division of Physical Therapy, The Ohio State University, Columbus, Ohio, USA.,School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, USA
| | | | - Stephanie Di Stasi
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, USA.,Sports Health and Performance Institute, OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,Department of Orthopaedics, The Ohio State University, Columbus, Ohio, USA.,Address correspondence to Stephanie Di Stasi, PT, PhD, Department of Orthopaedics, The Ohio State University, 2050 Kenny Road, Columbus, OH 43221, USA ()
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36
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Gupta A, Suarez-Ahedo C, Redmond JM, Gerhardt MB, Hanypsiak B, Stake CE, Finch NA, Domb BG. Best Practices During Hip Arthroscopy: Aggregate Recommendations of High-Volume Surgeons. Arthroscopy 2015; 31:1722-7. [PMID: 25980403 DOI: 10.1016/j.arthro.2015.03.023] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 02/23/2015] [Accepted: 03/17/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To survey surgeons who perform a high volume of hip arthroscopy procedures regarding their operative technique, type of procedure, and postoperative management. METHODS We conducted a cross-sectional survey of 27 high-volume orthopaedic surgeons specializing in hip arthroscopy to report their preferences and practices related to their operative practice and postoperative rehabilitation protocol. All participants completed the survey in person in an anonymous fashion during a meeting of the American Hip Institute. RESULTS All surgeons perform hip arthroscopy with the patient in the supine position, accessing the central compartment of the hip initially, using intraoperative fluoroscopy. All surgeons perform labral repair (100%), with the majority performing labral reconstructions (77.8%) and gluteus medius repairs (81.5%). There is variability in the type of anchors used during labral repair. Most surgeons perform capsular closure in most cases (88.9%), inject either intra-articular cortisone or platelet-rich plasma at the conclusion of the procedure (59%), and prescribe a postoperative hip brace for some or all patients (59%). There is considerable variability in rehabilitation protocols. All surgeons routinely prescribe postoperative heterotopic ossification prophylaxis to their patients, with most surgeons (88.9%) prescribing a nonsteroidal anti-inflammatory medication for 3 weeks. Forty percent of the respondents use the modified Harris Hip Score as the most important outcome measure. CONCLUSIONS Consistent practices such as use of intraoperative fluoroscopy, heterotopic ossification prophylaxis, and labral repair skills were identified by surveying 27 hip arthroscopy surgeons at high-volume centers. Most of the surgeons performed routine capsular closure unless underlying conditions precluded capsular release or plication. The survey identified higher variability between surgeons regarding postoperative rehabilitation protocols and use of intra-articular pharmacologic injections at the end of the procedure. These data may provide surgeons with a set of aggregate trends that may help guide training, clinical practice, and research in the evolving field of hip arthroscopy.
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Affiliation(s)
| | | | | | - Michael B Gerhardt
- Santa Monica Orthopaedic and Sports Medicine Group, Santa Monica, California, U.S.A
| | | | | | | | - Benjamin G Domb
- American Hip Institute, Westmont, Illinois, U.S.A.; Hinsdale Orthopaedics, Westmont, Illinois, U.S.A.; Loyola University Chicago Stritch School of Medicine, Chicago, Illinois, U.S.A..
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37
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Cheatham SW, Kolber MJ. REHABILITATION AFTER HIP ARTHROSCOPY AND LABRAL REPAIR IN A HIGH SCHOOL FOOTBALL ATHLETE: A 3.6 YEAR FOLLOW-UP WITH INSIGHT INTO POTENTIAL RISK FACTORS. Int J Sports Phys Ther 2015; 10:530-539. [PMID: 26347196 PMCID: PMC4527200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND Hip arthroscopy is a common surgical technique for the correction of intraarticular pathology. While surgical success is often determined by anatomical correction, post-operative rehabilitation serves an essential role in restoring pre-morbid activity levels. A paucity of long-term post-operative rehabilitation outcomes exists in the literature lending uncertainty to the long-standing efficacy of interventions and associated risk for future injury. CASE DESCRIPTION This case report describes the progress of a male subject 3.6 years after left hip arthroscopy with labral repair. Detailed clinical measures and insight into potential risk factors are presented as a follow-up to a previously published case report. OUTCOME A 3.6-year follow-up assessment revealed potential risk factors that may have predisposed the subject to future pathology. The most profound finding was the subject's complaint of contralateral right hip pain and examination findings suggesting intraarticular pathology. His left surgical hip presented with no reported problems or significant findings. The examination also revealed an anterior tilted pelvis, muscle length deficits, and hip muscle weakness which may have contributed to his right hip pain or may be risk factors for future pathology in both hips. It appeared that these impairments affected his gait and performance on functional tests. DISCUSSION This case report describes the 3.6 year follow-up for a young adult male subject after unilateral left hip arthroscopy and acetabular labral repair. The re-examination findings and risk factors identified at the follow-up may provide insight into the need for long-term surveillance among post-surgical individuals. Detailed reporting of the long-term effects of a post-operative program after hip arthroscopy is non-existent in the literature and the current findings suggest the potential need for mitigating risk in the non-surgical hip. Future longitudinal studies are needed to develop a consensus on the best interventions for these patients. LEVEL OF EVIDENCE 4-Case Report.
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38
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Grzybowski JS, Malloy P, Stegemann C, Bush-Joseph C, Harris JD, Nho SJ. Rehabilitation Following Hip Arthroscopy - A Systematic Review. Front Surg 2015; 2:21. [PMID: 26075208 PMCID: PMC4443726 DOI: 10.3389/fsurg.2015.00021] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 05/10/2015] [Indexed: 11/18/2022] Open
Abstract
Context Rehabilitation following hip arthroscopy is an integral component of the clinical outcome of the procedure. Given the increase in quantity, complexity, and diversity of procedures performed, a need exists to define the role of rehabilitation following hip arthroscopy. Objectives (1) To determine the current rehabilitation protocols utilized following hip arthroscopy in the current literature, (2) to determine if clinical outcomes are significantly different based on different post-operative rehabilitation protocols, and (3) to propose the best-available evidence-based rehabilitation program following hip arthroscopy. Data sources Per PRISMA guidelines and checklist, Medline, SciVerse Scopus, SportDiscus, and Cochrane Central Register of Controlled Trials were searched. Study selection Level I–IV evidence clinical studies with minimum 2-year follow-up reporting outcomes of hip arthroscopy with post-operative rehabilitation protocols described were included. Data extraction All study, subject, and surgery parameters were collected. All elements of rehabilitation were extracted and analyzed. Descriptive statistics were calculated. Study methodological quality was analyzed using the modified Coleman methodology score. Results Eighteen studies were included (2,092 subjects; 52% male, mean age 35.1 ± 10.6 years, mean follow-up 3.2 ± 1.0 years). Labral tear and femoroacetabular impingement were the most common diagnoses treated and labral debridement and femoral/acetabular osteochondroplasty the most common surgical techniques performed. Rehabilitation protocol parameters (weight-bearing, motion, strengthening, and return to sport) were poorly reported. Differences in clinical outcomes were unable to be assessed given heterogeneity in study reporting. Time-, phase-, goal-, and precaution-based guidelines were extracted and reported. Conclusion The current literature of hip arthroscopy rehabilitation lacks high-quality evidence to support a specific protocol. Heterogeneity in study, subject, and surgical demographics precluded assimilation of protocols and/or outcomes to generate evidence-based guidelines. Strengths and limitations in the literature were identified. Future studies should recognize and report the essentials of rehabilitation following hip arthroscopy.
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Affiliation(s)
- Jeffrey S Grzybowski
- Hip Preservation Center, Department of Orthopedic Surgery, Rush University Medical Center , Chicago, IL , USA
| | - Philip Malloy
- Department of Physical Therapy, Marquette University College of Health Sciences , Milwaukee, WI , USA
| | - Catherine Stegemann
- Hip Preservation Center, Department of Orthopedic Surgery, Rush University Medical Center , Chicago, IL , USA
| | - Charles Bush-Joseph
- Hip Preservation Center, Department of Orthopedic Surgery, Rush University Medical Center , Chicago, IL , USA
| | | | - Shane J Nho
- Hip Preservation Center, Department of Orthopedic Surgery, Rush University Medical Center , Chicago, IL , USA
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Hip muscle strength recovery after hip arthroscopy in a series of patients with symptomatic femoroacetabular impingement. Hip Int 2015; 24:387-93. [PMID: 24817399 DOI: 10.5301/hipint.5000131] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/24/2013] [Indexed: 02/04/2023]
Abstract
PURPOSE The aim of the study was to prospectively evaluate hip muscle strength in a series of patients with symptomatic FAI after hip arthroscopy. METHODS Hip muscle strength of eight patients (age: 29 ± 10 years) was evaluated preoperatively and 2.5 years after hip arthroscopy, and was compared to eight matched controls. Maximal voluntary contraction (MVC) strength was measured for all hip muscle groups. At follow-up, we used the symptom-specific well-being outcome to assess the acceptability of the health state related to the hip. RESULTS Patients showed MVC strength increases for all hip muscles (9-59%, P<.05). At follow-up, only hip flexor MVC strength was lower for patients than controls (-18%, P<.05). At follow-up, four patients (out of eight) were "neither satisfied nor dissatisfied" with the health state of their operated hip. CONCLUSIONS Patients with symptomatic FAI recovered their hip muscle strength to normal levels 2.5 years after hip arthroscopy, except for hip flexors. Although all patients showed good hip muscle strength at follow-up, half of them were not completely satisfied with their health state related to the hip.
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Wahoff M, Dischiavi S, Hodge J, Pharez JD. Rehabilitation after labral repair and femoroacetabular decompression: criteria-based progression through the return to sport phase. Int J Sports Phys Ther 2014; 9:813-26. [PMID: 25383249 PMCID: PMC4223290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
UNLABELLED Rehabilitation following hip arthroscopy for femoroacetabular impingement (FAI) and labral-chondral dysfunction has evolved rapidly over the past 15 years. There have been multiple commentaries published on rehabilitation following hip arthroscopy without any published standardized objective criteria to address the advancement of the athlete through the phases of rehabilitation. The purpose of this clinical commentary is to describe a criteria driven algorithm for safe integration and return to sport rehabilitation following hip arthroscopy. The criteria based program allows for individuality of the athlete while providing guidance from early post-operative phases through late return to sport phases of rehabilitation. Emphasis is placed on the minimum criteria to advance including healing restraints, patient reported outcomes, range of motion, core and hip stability, postural control, symmetry with functional tasks and gait, strength, power, endurance, agility, and sport-specific tasks. Evidence to support the criteria will be offered as available. Despite limitations, this clinical commentary will offer a guideline for safe return to sport for the athlete while identifying areas for further investigation. LEVEL OF EVIDENCE 5.
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Enseki KR, Kohlrieser D. Rehabilitation following hip arthroscopy: an evolving process. Int J Sports Phys Ther 2014; 9:765-73. [PMID: 25383245 PMCID: PMC4223286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
The utilization of hip arthroscopy to treat non-arthritic pain in athletes continues to grow in popularity. Though numerous protocols have been described in the literature, there is no current evidence-based consensus regarding the postoperative management of patients undergoing hip arthroscopy. Intraoperative findings determine the specific surgical procedure and subsequently play a role in postoperative rehabilitation. Current protocols are primarily based on tissue healing properties, patient tolerance, and clinician experience. General recommendations regarding range-of-motion initiation, weight bearing progression, and strength activities exist. Though relatively uncommon, postoperative complications have been described. Clinicians should be aware of factors, both surgical and rehabilitation-related, that may affect a patient's postoperative progression. In order to assess patients' postoperative improvement, clinicians must utilize outcome measures that effectively assess the functional status level of active individuals following hip arthroscopy. The development of criteria-based programs may improve the consistency of rehabilitation and potentially aid in providing patients a safe, efficient return to athletics.
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Affiliation(s)
- Keelan R. Enseki
- Centers for Rehab Services/University of Pittsburgh Medical Center, Department of Physical Therapy, Pittsburgh, PA, USA
| | - David Kohlrieser
- The Ohio State University, Wexner Medical Center, Columbus, OH, USA
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Domb BG, Stake CE, Finch NA, Cramer TL. Return to sport after hip arthroscopy: aggregate recommendations from high-volume hip arthroscopy centers. Orthopedics 2014; 37:e902-5. [PMID: 25275978 DOI: 10.3928/01477447-20140924-57] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 02/20/2014] [Indexed: 02/03/2023]
Abstract
Hip arthroscopy is a minimally invasive surgical technique often performed in athletes who want an expeditious return to sport. To the authors' knowledge, no studies in the literature provide a time frame or criteria for return to sport after hip arthroscopy. The purpose of this study was to develop an aggregate recommendation for return to sport after hip arthroscopy based on data assimilated from high-volume hip arthroscopy centers. Twenty-seven orthopedic surgeons from high-volume hip arthroscopy centers completed a survey regarding return to sport after hip arthroscopy. The questionnaire asked surgeons to give a time frame for return to sport and to choose meaningful criteria that an athlete must meet prior to return to sport. Surgeons were asked to categorize various common sports as high, medium, or low risk with regard to the hip. The aggregate results were used to create standardized recommendations for time, criteria, and risk for return to competitive sports. Regarding time frame for return to sport, 70% of surgeons recommended 12 to 20 weeks. In addressing criteria for return to sport, 85% of surgeons recommended that patients need to be able to reproduce all motions involved in their sport without pain. A majority of surgeons recommended criteria of pain-free running, jumping, lateral agility drills, and single-leg squats. Finally, surgeons categorized sports requiring the most movement and impact of the hip joint (football, basketball, wrestling, and martial arts) as high-risk sports. Sports with less impact on the hip, such as golf, were ranked as low risk.
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Dippmann C, Thorborg K, Kraemer O, Winge S, Palm H, Hölmich P. Hip arthroscopy with labral repair for femoroacetabular impingement: short-term outcomes. Knee Surg Sports Traumatol Arthrosc 2014; 22:744-9. [PMID: 24497058 DOI: 10.1007/s00167-014-2885-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Accepted: 01/26/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to examine the progression of clinical outcomes 3, 6 and 12 months after hip arthroscopy with labral repair for femoroacetabular impingement (FAI). METHODS From May 2009 to December 2011, 87 consecutive patients [55 females (median age 38, range 17-63) and 32 males (median age 38, range 15-59)] underwent hip arthroscopy and labral repair, by the same experienced surgeon. Standardised, but unstructured, post-operative rehabilitation instructions were provided. Function and pain were evaluated using modified Harris Hip Score (mHHS) and visual analogue scale (VAS) pre-operatively and post-operatively at 3, 6, and 12 months. RESULTS A main effect of time was seen for mHHS and pain (VAS) at 3, 6, and 12 months (p < 0.001). Mean (SE) mHHS improved significantly from 59.9 (1.9) pre-operatively to 74.5 (1.9) after 3 months (p < 0.001), and again from 3 to 6 months from 74.5 (1.9) to 80.1 (1.9) (p = 0.004), with no additional changes from 6 to 12 months [80.1 (1.9)-78.7 (1.9), (n.s.)]. Also, the mean (SE) VAS improved significantly from pre-operative 57.9 (2.6) to 30.0 (2.6) after 3 months (p < 0.001), and from 30.0 (2.6) to 22.6 (2.6) (p = 0.017), after 6 months with no additional changes from 6 to 12 months [22.6 (2.6)-27.9 (2.6), (n.s.)]. CONCLUSIONS Improvements in function (mHHS) and pain (VAS) were seen in patients after hip arthroscopy with labral repair for FAI at 3, 6, and 12 months. While significant improvements occurred from 3 to 6 months, no further improvements were seen from 6 to 12 months.
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Affiliation(s)
- Christian Dippmann
- Arthroscopic Center Amager, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark,
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Bennell KL, O'Donnell JM, Takla A, Spiers LN, Hunter DJ, Staples M, Hinman RS. Efficacy of a physiotherapy rehabilitation program for individuals undergoing arthroscopic management of femoroacetabular impingement - the FAIR trial: a randomised controlled trial protocol. BMC Musculoskelet Disord 2014; 15:58. [PMID: 24571824 PMCID: PMC3941691 DOI: 10.1186/1471-2474-15-58] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Accepted: 02/19/2014] [Indexed: 11/10/2022] Open
Abstract
Background Femoroacetabular impingement is a common cause of hip/groin symptoms and impaired functional performance in younger sporting populations and results from morphological abnormalities of the hip in which the proximal femur abuts against the acetabular rim. Many people with symptomatic femoroacetabular impingement undergo arthroscopic hip surgery to correct the bony abnormalities. While many case series over the past decade have reported favourable surgical outcomes, it is not known whether formal rehabilitation is needed as part of the management of patients undergoing this surgical procedure. This randomised controlled trial will investigate the efficacy of a progressive physiotherapist-supervised rehabilitation program (Takla-O’Donnell Protocol) in improving health-related quality of life, physical function and symptoms in individuals undergoing arthroscopic management of femoroacetabular impingement. Methods/design 100 people aged 16–35 years undergoing hip arthroscopy for symptomatic femoroacetabular impingement will be recruited from surgical practices in Melbourne, Australia and randomly allocated to either a physiotherapy or control group. Both groups will receive written information and one standardised post-operative physiotherapy visit whilst in hospital as per usual care. Those in the physiotherapy group will also receive seven individual 30-minute physiotherapy sessions, including one pre-operative visit (within 2 weeks of surgery) and six post-operative visits at fortnightly intervals (commencing two weeks after surgery). The physiotherapy intervention will incorporate education and advice, manual techniques and prescription of a progressive rehabilitation program including home, aquatic and gym exercises. The control group will not receive additional physiotherapy management. Measurements will be taken at baseline (2 weeks pre-operatively) and at 14 and 24 weeks post-surgery. Primary outcomes are the International Hip Outcome Tool and the sports subscale of the Hip Outcome Score at 14 weeks post-surgery. Secondary outcomes include the Copenhagen Hip and Groin Outcome Score, the activities of daily living subscale of the Hip Outcome Score, the Heidelberg Sports Activity Score, a modified Tegner Activity Scale and participant-perceived overall change. Discussion The findings from this randomised controlled trial will provide evidence for the efficacy of a specific physiotherapist-supervised rehabilitation program in improving outcomes following arthroscopic management of symptomatic femoroacetabular impingement. Trial registration Australian New Zealand Clinical Trials Registry reference number: ACTRN12613000282785.
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Affiliation(s)
- Kim L Bennell
- The University of Melbourne, Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Melbourne, Vic, Australia.
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Tranovich MJ, Salzler MJ, Enseki KR, Wright VJ. A review of femoroacetabular impingement and hip arthroscopy in the athlete. PHYSICIAN SPORTSMED 2014; 42:75-87. [PMID: 24565824 DOI: 10.3810/psm.2014.02.2050] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Femoroacetabular impingement (FAI) is increasingly recognized as a pathological condition of the hip in athletes. Although it is not always symptomatic, the bone structure leading to FAI and its associated pathology can result in significant pain and performance decline in athletes. Recognition of athletes with symptomatic FAI is of the utmost importance, as prompt treatment is necessary in order to maintain desired sports activity levels and preserve joint function. This review explores the recent evidence on the evaluation, recognition, and treatment of femoroacetabular impingement, and discusses conservative management, postoperative rehabilitation, and treatment in the pediatric and master athlete populations.
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Affiliation(s)
- Michael J Tranovich
- Research Fellow, Department of Orthopaedic Surgery; University of Pittsburgh, Pittsburgh, PA
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Malloy P, Malloy M, Draovitch P. Guidelines and pitfalls for the rehabilitation following hip arthroscopy. Curr Rev Musculoskelet Med 2013; 6:235-41. [PMID: 23852421 PMCID: PMC4094008 DOI: 10.1007/s12178-013-9176-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Rehabilitation guidelines following hip arthroscopy have been presented in the literature with common themes consisting of initial protection, restoration of lumbo-pelvic stability, neuromuscular re-education, and return to sport training. The purpose of this review is to present hip arthroscopy guidelines in 4 phases and to address common pitfalls that may delay the rehabilitative process. The goal of phase 1 should be to protect healing tissues through activity modifications. Phase 2 intends to return the patient to pain-free community ambulation without compensation or irritation. A review of hip muscular actions during gait is presented to guide exercise progressions during this phase. Phase 3 should reestablish neuromuscular control through strength and endurance training to provide the foundation for return to functional activities or sports training progressions. The last phase of rehabilitation is dedicated to reestablishing power, speed, agility, and skill for advanced sports and advanced functions.
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Affiliation(s)
- Philip Malloy
- />Department of Exercise Science and Physical Therapy, Marquette University, College of Health Science, Cramer Hall 215, PO Box 1881, Milwaukee, WI 53201-1881 USA
| | - Molly Malloy
- />The University of Chicago Medical Center, MC 1081, W 109, 5841 South Maryland Ave, Chicago, IL 60637-1470 USA
| | - Peter Draovitch
- />Hospital for Special Surgery, 525 E. 71st St, New York, NY 10021 USA
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