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Conservative Physiotherapy Treatment of Femoroacetabular Impingement. ACTA MEDICA BULGARICA 2022. [DOI: 10.2478/amb-2022-0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Abstract
The femoro-acetabular impingement (FAI) syndrome is a motion-related disorder of the hip joint with premature contact between the acetabulum and the proximal femur. It is a relatively new clinical entity and no strict treatment protocols and guidelines have been established yet. Furthermore, patients are often misdiagnosed and not properly treated. We report a clinical case of a young adult female patient presenting with a bilateral FAI-CAM type deformity during the last 2 years. An individual progressive global elastic resistant training program was established which involved stimulation to all affected muscle groups using Pilates concept. Hip-specific and functional lower limb strengthening targeted the deep hip external rotators, abductors and flexors in the transverse, frontal, and sagittal planes. Improving the dynamic stability and Core stability was the main aim of the challenging physiotherapy treatment in this case. A good functional result was registered at 6 months follow up. All therapeutic activities were performed in a pain free range of motion which was of paramount importance for achieving excellent patient compliance and successful outcome respectively. The applied treatment strategy demonstrated to be reliable and could be a helpful tool in the armamentarium of contemporary physiotherapy when dealing with the FAI group of patients.
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Mid-term outcomes of exercise therapy for the non-surgical management of femoroacetabular impingement syndrome: are short-term effects persisting? Phys Ther Sport 2022; 55:168-175. [DOI: 10.1016/j.ptsp.2022.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 04/08/2022] [Accepted: 04/08/2022] [Indexed: 11/17/2022]
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Meinders E, Pizzolato C, Gonçalves B, Lloyd DG, Saxby DJ, Diamond LE. Activation of the deep hip muscles can change the direction of loading at the hip. J Biomech 2022; 135:111019. [DOI: 10.1016/j.jbiomech.2022.111019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 01/27/2022] [Accepted: 02/21/2022] [Indexed: 11/28/2022]
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McGovern RP, Kivlan BR, Christoforetti JJ, Nho SJ, Wolff AB, Salvo JP, Matsuda D, Carreira DS. Risk of intra-articular hip injury in adolescent athletes: a five-year multicentre cohort study. INTERNATIONAL ORTHOPAEDICS 2020; 44:1965-1969. [PMID: 32591961 DOI: 10.1007/s00264-020-04598-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 04/27/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE The purpose of the current study was to establish a risk stratification for hip injury by presenting the classification of sports among adolescent athletes undergoing hip arthroscopy. METHODS A multicentre registry was queried to examine the incidence of adolescent athletes undergoing hip arthroscopy. Patients were identified and grouped according to their sport-specific risk classification (level I-III). Chi-square analysis was performed to determine the relationship of classification of sport and gender in adolescent athletes to hip arthroscopy. A second chi-square analysis was performed to determine the relationship of classification of sport and number of sports the adolescent athlete was participating in prior to arthroscopic hip surgery. RESULTS A total of 297 adolescent athletes were included in the study with 129 (43.4%) participating in level I sports compared with 84 (28.3%) in level II and 84(28.3%) in level III sports. Chi-square testing demonstrated a significant effect on gender and sport classification, X2 (2, N = 297) = 31.18, p < 0.01. There was a greater percentage of athletes participating in a single sport (65.3%) compared with multiple sports (34.6%), but was not statistically significant, X2 (1, N = 297) = 1.88, p = 0.17. CONCLUSION The current study was successful in stratifying a large, multicentre cohort of adolescent athletes requiring hip arthroscopy based on classification levels of sport. There were more male athletes participating in level I sports, while more female athletes participated in level II and level III sports.
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Affiliation(s)
- Ryan P McGovern
- Department of Orthopaedic Surgery, Texas Health Sports Medicine, Dallas/Fort Worth, TX, USA.
- Allegheny Health Network, Pittsburgh, PA, USA.
| | - Benjamin R Kivlan
- Department of Physical Therapy, Duquesne University, Pittsburgh, PA, USA
| | - John J Christoforetti
- Department of Orthopaedic Surgery, Texas Health Sports Medicine, Dallas/Fort Worth, TX, USA
- Allegheny Health Network, Pittsburgh, PA, USA
| | - Shane J Nho
- Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, IL, USA
| | - Andrew B Wolff
- Department of Orthopaedic Surgery, Washington Orthopaedics and Sports Medicine, Washington, DC, USA
| | - John P Salvo
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Dean Matsuda
- Department of Orthopaedic Surgery, DISC Sports and Spine Center, Newport Beach, CA, USA
| | - Dominic S Carreira
- Department of Orthopaedic Surgery, Peachtree Orthopedics, Atlanta, GA, USA
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Haselhorst A, Rho M. Musculoskeletal Issues and Care Specific to the Female Athlete. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2020. [DOI: 10.1007/s40141-020-00279-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Hoit G, Whelan DB, Dwyer T, Ajrawat P, Chahal J. Physiotherapy as an Initial Treatment Option for Femoroacetabular Impingement: A Systematic Review of the Literature and Meta-analysis of 5 Randomized Controlled Trials. Am J Sports Med 2020; 48:2042-2050. [PMID: 31774704 DOI: 10.1177/0363546519882668] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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 is a common and debilitating source of hip pain in young adults. Although physiotherapy is used as a mainstay of nonoperative care for femoroacetabular impingement, the evidence regarding different physiotherapy practices is poorly understood. PURPOSE To collect and synthesize the best available evidence and arrive at a summary estimate of treatment effect for the utility of physiotherapy in the management of femoroacetabular impingement. STUDY DESIGN Meta-analysis. METHODS A systematic review was performed on February 2, 2019, of PubMed, EMBASE, and Cochrane Library databases using "femoroacetabular impingement OR hip pain" and "physiotherapy OR nonoperative management" and their synonyms as search terms. Central treatment themes were identified across protocols, and pooled analyses were conducted to assess for differences in patient-reported outcome measures across these themes. RESULTS A total of 5 randomized controlled trials met our inclusion criteria. The studies included 124 patients with a mean age of 35 years, of whom 24% were male. The average follow-up was 9.4 weeks (range, 6-12 weeks), and the follow-up rate across all participants was 86%. Among these 5 studies, 4 studies used a physiotherapy protocol that focused on core strengthening versus no core strengthening, 4 studies compared active strengthening versus passive modalities, and 3 studies compared supervised versus unsupervised physiotherapy. Pooled analysis across all studies demonstrated improved outcomes in the treatment groups compared with the controls (standardized mean difference [SMD], 0.76; 95% CI, 0.38-1.13; P < .0001). Core strengthening (SMD, 0.82; 95% CI, 0.39-1.26; P = .0002), active physiotherapy (SMD, 0.70; 95% CI, 0.29-1.10; P = .0008), and supervised physiotherapy (SMD, 0.58; 95% CI, 0.14-1.03; P = .01) were found to result in statistically significant improvements in functional outcomes compared with no core strengthening, passive modalities, and unsupervised care, respectively. CONCLUSION Supervised physiotherapy programs focusing on active strengthening and core strengthening are more effective than unsupervised, passive, and non-core focused programs. Future studies with longer term follow-up and validated femoroacetabular impingement specific outcome measures are required to determine prognostic factors for success with nonoperative care as well as to determine the ideal patient profile and structured rehabilitation protocol.
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Affiliation(s)
- Graeme Hoit
- University of Toronto Orthopaedic Sports Medicine (UTOSM), Women's College Hospital, Toronto, Ontario, Canada
| | - Daniel B Whelan
- University of Toronto Orthopaedic Sports Medicine (UTOSM), Women's College Hospital, Toronto, Ontario, Canada.,St Michael's Hospital, Toronto, Ontario, Canada
| | - Tim Dwyer
- University of Toronto Orthopaedic Sports Medicine (UTOSM), Women's College Hospital, Toronto, Ontario, Canada.,Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Prabjit Ajrawat
- University of Toronto Orthopaedic Sports Medicine (UTOSM), Women's College Hospital, Toronto, Ontario, Canada
| | - Jaskarndip Chahal
- University of Toronto Orthopaedic Sports Medicine (UTOSM), Women's College Hospital, Toronto, Ontario, Canada.,University Health Network, Toronto, Ontario, Canada
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Resende RA, Jardim SHO, Filho RGT, Mascarenhas RO, Ocarino JM, Mendonça LDM. Does trunk and hip muscles strength predict performance during a core stability test? Braz J Phys Ther 2020; 24:318-324. [PMID: 30954371 PMCID: PMC7351961 DOI: 10.1016/j.bjpt.2019.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 02/18/2019] [Accepted: 03/13/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND A better understanding about the relationship between trunk and hip muscles strength and core stability may improve evaluation and interventions proposed to improve core stability. OBJECTIVES To investigate if trunk and hip muscles strength predict pelvic posterior rotation during the bridge test with unilateral knee extension. METHODS This is a cross-sectional study. Sixty-one healthy individuals of both sexes (age, 28±6.4 years, weight, 66.5±10.9kg, height, 167±9.5cm) performed the bridge test with unilateral knee extension. The pelvic posterior rotation during the bridge test was obtained with two-dimensional video analysis. Isometric strength of the trunk extensors and rotators, and hip abductors, external and internal rotators and extensors were measured with a hand-held dynamometer. Multiple linear regression analysis was performed to identify if the strength variables could explain the pelvic posterior rotation during the test. RESULTS Muscle strength predicted pelvic posterior rotation during the bridge test (r=0.54; p=0.003). Strength of the trunk rotators (p=0.045) and hip internal rotators (p=0.015) predicted reduced magnitude of pelvic posterior rotation during the bridge test, and strength of the hip extensors (p=0.003) predicted increased magnitude of pelvic posterior rotation. CONCLUSIONS Trunk rotators and hip internal rotators and extensors strength predict 29% of the performance during the bridge test with unilateral knee extension. The strength of these muscles should be evaluated in individuals with increased pelvic posterior rotation during the bridge test with unilateral knee extension.
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Affiliation(s)
- Renan Alves Resende
- School of Physical Education, Physical Therapy and Occupational Therapy, Department of Physical Therapy, Rehabilitation Sciences Program, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil.
| | - Samuel Henrique Oliveira Jardim
- Graduate Program in Rehabilitation and Funcional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Minas Gerais, Brazil
| | - Renato Guilherme Trede Filho
- Graduate Program in Rehabilitation and Funcional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Minas Gerais, Brazil
| | - Rodrigo Oliveira Mascarenhas
- Graduate Program in Rehabilitation and Funcional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Minas Gerais, Brazil
| | - Juliana Melo Ocarino
- School of Physical Education, Physical Therapy and Occupational Therapy, Department of Physical Therapy, Rehabilitation Sciences Program, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Luciana De Michelis Mendonça
- Graduate Program in Rehabilitation and Funcional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Minas Gerais, Brazil
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Mendis MD, Wilson SJ, Hayes DA, Hides JA. Hip muscle atrophy in patients with acetabular labral joint pathology. Clin Anat 2020; 33:538-544. [DOI: 10.1002/ca.23429] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 06/30/2019] [Indexed: 12/15/2022]
Affiliation(s)
- M. Dilani Mendis
- School of Allied Health SciencesGriffith University Brisbane Queensland Australia
- Physiotherapy DepartmentMater Health Services South Brisbane Queensland Australia
| | - Stephen J. Wilson
- School of Information Technology and Electrical EngineeringThe University of Queensland Brisbane Queensland Australia
| | - David A. Hayes
- Brisbane Orthopaedic & Sports Medicine Centre Brisbane Queensland Australia
| | - Julie A. Hides
- School of Allied Health SciencesGriffith University Brisbane Queensland Australia
- Mater Back Stability Research ClinicMater Health Services South Brisbane Queensland Australia
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Hip muscle strength asymmetries and their associations with hip morphology and symptoms are sex-specific in patients with femoroacetabular impingement syndrome. Phys Ther Sport 2020; 42:131-138. [DOI: 10.1016/j.ptsp.2020.01.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 01/15/2020] [Accepted: 01/16/2020] [Indexed: 01/19/2023]
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McGovern RP, Martin RL, Phelps AL, Kivlan BR, Nickel B, Christoforetti JJ. Conservative management acutely improves functional movement and clinical outcomes in patients with pre-arthritic hip pain. J Hip Preserv Surg 2020; 7:95-102. [PMID: 32382435 PMCID: PMC7195924 DOI: 10.1093/jhps/hnz075] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 12/26/2019] [Accepted: 12/27/2019] [Indexed: 01/09/2023] Open
Abstract
Conservative management for individuals with pre-arthritic hip pain is commonly prescribed prior to consideration of surgical management. The purpose of this study is to determine if patients with pre-arthritic hip pain will improve their functional movement control and clinical outcome measures following the implementation of physical therapy and a home-exercise programme. Information was retrospectively collected on consecutive patients and included: demographics, diagnosis, initial and follow-up evaluation of the single leg squat test (SLST) and step-down test (SDT), and patient-reported outcome measures. An independent t-test and one-way analysis of covariance were performed for continuous patient-reported outcome measures and a Fisher’s exact test was performed for patient satisfaction. Forty-six patients (31 female and 15 male) diagnosed with pre-arthritic hip pain were included. A total of 30 patients improved their functional movement control during performance of the SLST, whereas 31 patients improved performance of the SDT. There was a statistically significant difference between patients that improved and did not improve (P ≤ 0.017). Patients with pre-arthritic hip pain who improved their functional movement control following a prescribed rehabilitation intervention are likely to report less pain and greater functional ability in their daily and sports-related activities. This study supports conservative management to acutely improve outcomes for patients with pre-arthritic hip pain.
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Affiliation(s)
- Ryan P McGovern
- Department of Orthopaedics and Sports Medicine, Texas Health Sports Medicine, Allegheny Health Network, 1120 Raintree Circle, Suite 280, Allen, TX 75013, USA
| | - RobRoy L Martin
- Department of Physical Therapy, Duquesne University, University of Pittsburgh Center for Sports Medicine, 600 Forbes Ave., Pittsburgh, PA 15282, USA
| | - Amy L Phelps
- Palumbo Donahue School of Business, Duquesne University, 600 Forbes Ave., Pittsburgh, PA 15282, USA
| | - Benjamin R Kivlan
- Department of Physical Therapy, Duquesne University, 600 Forbes Ave., Pittsburgh, PA 15282, USA
| | - Beth Nickel
- Department of Orthopaedic Surgery, Allegheny Health Network, 4800 Friendship Avenue, Pittsburgh, PA 15224, USA
| | - John J Christoforetti
- Department of Orthopaedics and Sports Medicine, Texas Health Sports Medicine, Allegheny Health Network, 1120 Raintree Circle, Suite 280, Allen, TX 75013, USA
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Dwyer T, Whelan D, Shah PS, Ajrawat P, Hoit G, Chahal J. Operative Versus Nonoperative Treatment of Femoroacetabular Impingement Syndrome: A Meta-analysis of Short-Term Outcomes. Arthroscopy 2020; 36:263-273. [PMID: 31864588 DOI: 10.1016/j.arthro.2019.07.025] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 07/10/2019] [Accepted: 07/16/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the outcomes of patients with femoroacetabular impingement (FAI) syndrome treated with hip arthroscopy versus those treated with physical therapy alone. METHODS The PubMed, Embase, and Cochrane Library databases were searched from inception to February 15, 2019. All randomized controlled trials (RCTs) that compared operative versus nonoperative treatment in the management of FAI for a minimum 6-month follow-up period were included. The primary outcome was the International Hip Outcome Tool 33. The CLEAR NPT (Checklist to Evaluate a Report of a Nonpharmacological Trial) was used to evaluate the methodologic quality of included studies. RESULTS Three RCTs (Level I) were included with a total of 650 patients (323 randomized to surgery and 327 randomized to physical therapy), follow-rate of 90% (583 patients, 295 operative and 288 nonoperative), and average of 11.5 months' follow-up. Regarding participation, 222 of 350 patients (63%) in the FAIT (Femoroacetabular Impingement Trial) study, 348 of 648 (54%) in the FASHIoN (Full UK RCT of Arthroscopic Surgery for Hip Impingement Versus Best Conservative Care) study, and 80 of 104 (77%) in the study by Mansell et al. agreed to participate. The mean age was 35 years, and 51.5% of patients were male patients. All 3 RCTs represented high methodologic quality and a low risk of bias. The frequency-weighted mean follow-up period was 10 months. A meta-analysis of the 3 randomized trials showed that patients treated with operative management had improved preoperative-to-postoperative change scores on the International Hip Outcome Tool 33 compared with the nonoperative group (standardized mean difference, 3.46; 95% confidence interval, 0.07-6.86; P < .05). One study reported on the achievement of clinically relevant outcomes at the individual level, with 51% of the operative group and 32% of the nonoperative group achieving the minimal clinically important difference and with 48% and 19%, respectively, achieving the patient acceptable symptomatic state for the Hip Outcome Score-Activities of Daily Living. CONCLUSIONS The results of this meta-analysis show that patients with FAI syndrome treated with hip arthroscopy have statistically superior hip-related outcomes in the short term compared with those treated with physical therapy alone. LEVEL OF EVIDENCE Level I, meta-analysis of Level I RCTs.
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Affiliation(s)
- Tim Dwyer
- Young Adult Hip Innovation Program, University of Toronto Orthopaedic Sports Medicine, Women's College Hospital, University of Toronto, and Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Paediatrics, University of Toronto, and Mount Sinai Hospital, Toronto, Ontario, Canada.
| | - Daniel Whelan
- Young Adult Hip Innovation Program, University of Toronto Orthopaedic Sports Medicine, Women's College Hospital, University of Toronto, and Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Prakesh S Shah
- Department of Paediatrics, University of Toronto, and Mount Sinai Hospital, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, and Mount Sinai Hospital, Toronto, Ontario, Canada; University of Toronto, and Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Prabjit Ajrawat
- Young Adult Hip Innovation Program, University of Toronto Orthopaedic Sports Medicine, Women's College Hospital, University of Toronto, and Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Graeme Hoit
- Young Adult Hip Innovation Program, University of Toronto Orthopaedic Sports Medicine, Women's College Hospital, University of Toronto, and Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Jaskarndip Chahal
- Young Adult Hip Innovation Program, University of Toronto Orthopaedic Sports Medicine, Women's College Hospital, University of Toronto, and Mount Sinai Hospital, Toronto, Ontario, Canada
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Nonoperative Management Prior to Hip Arthroscopy for Femoroacetabular Impingement Syndrome: An Investigation Into the Utilization and Content of Physical Therapy. J Orthop Sports Phys Ther 2019; 49:593-600. [PMID: 31092124 DOI: 10.2519/jospt.2019.8581] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND There has been a significant increase in surgeries for femoroacetabular impingement syndrome in recent years, but little is known about the use of physical therapy prior to surgery. OBJECTIVES To investigate the use of physical therapy prior to hip arthroscopy for femoroacetabular impingement syndrome, by assessing the number of visits and use of exercise. A secondary objective was to evaluate whether comorbidities prior to surgery were associated with the use of physical therapy. METHODS In this retrospective observational cohort study, eligible participants between the ages of 18 and 50 years undergoing hip arthroscopy between 2004 and 2013 in the Military Health System were included. Patients were categorized based on whether they saw a physical therapist for their hip in the year prior to surgery. For physical therapy patients, dosing variables were identified, including total number of visits and visits that included an exercise therapy procedure code. RESULTS Of 1870 participants, 1106 (59.1%) did not see a physical therapist for their hip prior to surgery. For those who did, the median number of visits was 2. Only 220 (11.8%) had 6 or more unique visits with an exercise therapy procedure code. Exercise was coded in 43.4% to 63.0% of the total visits in each individual course of care (mean, 52.3%). There was an association between substance abuse and exercise utilization. No other comorbidities were associated with physical therapy or exercise therapy utilization. CONCLUSION Physical therapy was not commonly used before undergoing arthroscopic hip surgery by patients seeking care in the Military Health System. Further research is needed to understand the reasons for poor utilization and better define failed nonoperative management. LEVEL OF EVIDENCE Therapy, level 2b. J Orthop Sports Phys Ther 2019;49(8):593-600. Epub 15 May 2019. doi:10.2519/jospt.2019.8581.
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Casartelli NC, Bizzini M, Maffiuletti NA, Sutter R, Pfirrmann CW, Leunig M, Naal FD. Exercise Therapy for the Management of Femoroacetabular Impingement Syndrome: Preliminary Results of Clinical Responsiveness. Arthritis Care Res (Hoboken) 2019; 71:1074-1083. [PMID: 30133164 DOI: 10.1002/acr.23728] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 08/14/2018] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To investigate the responsiveness to exercise therapy of patients with femoroacetabular impingement syndrome (FAIS), and to investigate differences in hip function, strength, and morphology between responders versus nonresponders. METHODS Patients with FAIS underwent 12 weeks of semi-standardized and progressive exercise therapy. A good therapy outcome (responders) versus a poor therapy outcome (nonresponders) was determined at week 18 with the Global Treatment Outcome questionnaire for hip pain. Hip function was evaluated using the Hip Outcome Score (HOS) activities of daily living (ADL) and Sport at baseline, and at weeks 6, 12, and 18. Hip muscle strength and dynamic pelvic control were evaluated using dynamometry and video analysis, respectively, at baseline, week 12, and week 18. Hip morphology was evaluated with imaging at baseline. RESULTS Thirty-one patients (mean age 24 years) were included. Sixteen patients (52%) were responsive and 15 patients (48%) were not responsive to exercise therapy. Only responders improved HOS ADL and HOS Sport by 10 points (95% confidence interval [95% CI] 7, 14; P < 0.001) and by 20 points (95% CI 15, 25; P < 0.001), respectively, and hip abductor strength by 0.27 Nm/kg (95% CI 0.18, 0.36; P < 0.001). The prevalence of patients showing good dynamic pelvic control only increased in responders (44%; P = 0.029). The prevalence of severe cam morphology was higher in nonresponders than in responders (40% versus 6%; P = 0.037). CONCLUSION Half of patients with FAIS benefit from exercise therapy in the short term. Responsiveness to hip abductor strength and dynamic pelvic control improvements is associated with a good therapy outcome, whereas the presence of severe cam morphology is associated with a poor therapy outcome.
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Affiliation(s)
- Nicola C Casartelli
- Schulthess Clinic and Laboratory of Exercise and Health, Swiss Federal Institute of Technology, Zurich, Switzerland
| | | | | | - Reto Sutter
- Orthopaedic University Hospital Balgrist and University of Zurich, Zurich, Switzerland
| | - Christian W Pfirrmann
- Orthopaedic University Hospital Balgrist and University of Zurich, Zurich, Switzerland
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Editorial Commentary: Do Patients With Femoroacetabular Impingement Syndrome Already Show Hip Muscle Atrophy? Arthroscopy 2019; 35:1454-1456. [PMID: 31054724 DOI: 10.1016/j.arthro.2019.02.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 02/17/2019] [Indexed: 02/02/2023]
Abstract
Muscle atrophy, fatty degeneration, and strength deficits of the hip abductors, flexors, and even external rotators are well-known clinical and radiologic findings in patients with advanced hip osteoarthritis. More recently, in the context of prearthritic hip diseases, the role of hip muscle function in femoroacetabular impingement syndrome (FAIS) has gained greater focus for hip surgeons. Several studies have shown that patients with FAIS present with activation deficits of the hip muscles, which may result in hip muscle weakness. Nevertheless, previous studies have yet to determine whether young and mainly active patients with FAIS already show hip muscle atrophy. Future research is required to further characterize hip muscle function in patients with FAIS. Of particular interest is the investigation of whether both qualitative (muscle fatty degeneration) and quantitative (muscle atrophy) morphologic alterations of the hip muscles are present in patients with FAIS, as well as whether these alterations are sex specific and/or related to the underlying hip morphology.
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McGovern RP, Christoforetti JJ, Martin RL, Phelps AL, Kivlan BR. Evidence for Reliability and Validity of Functional Performance Testing in the Evaluation of Nonarthritic Hip Pain. J Athl Train 2019; 54:276-282. [PMID: 30829535 DOI: 10.4085/1062-6050-33-18] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT The single-legged-squat test (SLST) and step-down test (SDT) are 2 functional performance tests commonly used to evaluate active people with nonarthritic hip pain and dysfunction. However, evidence to support the use of the SLST and SDT in this population is lacking. OBJECTIVE To offer evidence of reliability and validity for the SLST and SDT in evaluating patients with nonarthritic hip pain. DESIGN Cross-sectional study. SETTING Orthopaedic surgeon's clinical office. PATIENTS OR OTHER PARTICIPANTS Forty-five patients (27 female and 18 male participants; age = 28.5 ± 10 years, height = 171.6 ± 10.1 cm, weight = 73.9 ± 15.2 kg, and body mass index = 25 ± 4.1) diagnosed with nonarthritic hip pain. MAIN OUTCOME MEASURE(S) Participants performed the SLST and SDT. Interrater reliability and validity of passive internal rotation of the hip, visual analog scale (VAS) scores, and hip outcome scores (HOSs) for limitations in activities of daily living and sport-related activities (SRAs) were collected. RESULTS Interrater reliability was moderate to excellent for both the SLST (0.603-0.939) and SDT (0.745-0.943). Participants who passed or failed the SLST and SDT differed on the following measures: VAS for the SLST (F1,43 = 16.21, P < .001); VAS for the SDT (F1,43 = 13.41, P = .001); HOS-activities of daily living for the SLST (F1,40 = 5.15, P = .029); HOS-SRAs for the SLST (F1,40 = 7.48, P = .009); and HOS-SRAs for the SDT (F1,40 = 6.42, P = .015). CONCLUSIONS Our study offers evidence for the use of the SLST and SDT as reliable and valid functional performance tests in the evaluation of physical function for patients with nonarthritic hip pain.
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Affiliation(s)
- Ryan P McGovern
- Rangos School of Health Sciences, Duquesne University, Pittsburgh, PA.,Allegheny Health Network, Pittsburgh, PA
| | - John J Christoforetti
- Allegheny Health Network, Pittsburgh, PA.,Drexel University School of Medicine, Philadelphia, PA.,Duquesne University, Pittsburgh, PA
| | - RobRoy L Martin
- Duquesne University, Pittsburgh, PA.,University of Pittsburgh Center for Sports Medicine, PA
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Mansell NS, Rhon DI, Meyer J, Slevin JM, Marchant BG. Arthroscopic Surgery or Physical Therapy for Patients With Femoroacetabular Impingement Syndrome: A Randomized Controlled Trial With 2-Year Follow-up. Am J Sports Med 2018; 46:1306-1314. [PMID: 29443538 DOI: 10.1177/0363546517751912] [Citation(s) in RCA: 138] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Arthroscopic hip surgery has risen 18-fold in the past decade; however, there is a dearth of clinical trials comparing surgery with nonoperative management. PURPOSE To determine the comparative effectiveness of surgery and physical therapy for femoroacetabular impingement syndrome. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS Patients were recruited from a large military hospital after referral to the orthopaedic surgery clinic and were eligible for surgery. Of 104 eligible patients, 80 elected to participate, and the majority were active-duty service members (91.3%). No patients withdrew because of adverse events. The authors randomly selected patients to undergo either arthroscopic hip surgery (surgery group) or physical therapy (rehabilitation group). Patients in the rehabilitation group began a 12-session supervised clinic program within 3 weeks, and patients in the surgery group were scheduled for the next available surgery at a mean of 4 months after enrollment. Patient-reported outcomes of pain, disability, and perception of improvement over a 2-year period were collected. The primary outcome was the Hip Outcome Score (HOS; range, 0-100 [lower scores indicating greater disability]; 2 subscales: activities of daily living and sport). Secondary measures included the International Hip Outcome Tool (iHOT-33), Global Rating of Change (GRC), and return to work at 2 years. The primary analysis was on patients within their original randomization group. RESULTS Statistically significant improvements were seen in both groups on the HOS and iHOT-33, but the mean difference was not significant between the groups at 2 years (HOS activities of daily living, 3.8 [95% CI, -6.0 to 13.6]; HOS sport, 1.8 [95% CI, -11.2 to 14.7]; iHOT-33, 6.3 [95% CI, -6.1 to 18.7]). The median GRC across all patients was that they "felt about the same" (GRC = 0). Two patients assigned to the surgery group did not undergo surgery, and 28 patients in the rehabilitation group ended up undergoing surgery. A sensitivity analysis of "actual surgery" to "no surgery" did not change the outcome. Twenty (33.3%) patients who underwent surgery and 4 (33.3%) who did not undergo surgery were medically separated from military service at 2 years. CONCLUSION There was no significant difference between the groups at 2 years. Most patients perceived little to no change in status at 2 years, and one-third of military patients were not medically fit for duty at 2 years. Limitations include a single hospital, a single surgeon, and a high rate of crossover. Registration: NCT01993615 ( ClinicalTrials.gov identifier).
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Affiliation(s)
- Nancy S Mansell
- Department of Outpatient Rehabilitation, Swedish Medical Center, Seattle, Washington, USA
| | - Daniel I Rhon
- Center for the Intrepid, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
- Doctoral Program in Physical Therapy, Baylor University, Waco, Texas, USA
| | - John Meyer
- Department of Athletic Medicine, University of Southern California, Los Angeles, California, USA
| | - John M Slevin
- Department of Orthopaedics, Madigan Army Medical Center, Joint Base Lewis-McChord, Washington, USA
| | - Bryant G Marchant
- Department of Orthopaedics, Madigan Army Medical Center, Joint Base Lewis-McChord, Washington, USA
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Clinical Rating of Movement-Pattern Quality in Patients With Femoroacetabular Impingement Syndrome: A Methodological Study. J Orthop Sports Phys Ther 2018; 48:260-269. [PMID: 29548274 DOI: 10.2519/jospt.2018.7840] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Cross-sectional study. Objectives To evaluate intrarater and interrater agreement among physical therapists with different clinical experience in performing a visual rating of movement-pattern quality of patients with femoroacetabular impingement (FAI) syndrome using a semi-quantitative scale. Background Visual rating of movement patterns in patients with FAI syndrome is of interest, because poor control of dynamic hip motion is frequently noted. Methods A video camera was used to record the performance of 34 patients with FAI syndrome performing single-limb standing, squat, frontal lunge, hop lunge, bridge, and plank. Visual rating of movement, as recorded on video, was performed by a highly experienced, a moderately experienced, and a novice physical therapist on 2 occasions using a semi-quantitative scale. Hip abductor strength was assessed using dynamometry, and hip pain and function were assessed with a patient-reported questionnaire. Intrarater and interrater agreement among physical therapists was evaluated using Gwet's agreement coefficient 1. Construct validity was evaluated as the association between physical therapists' rating and patients' hip abductor strength, pain, and function. Results Good intrarater and interrater agreement was observed in the highly experienced and moderately experienced physical therapists when rating single-limb standing, bridge, and plank. Poor to moderate intrarater and interrater agreement was found when they rated squat, frontal lunge, and hop lunge. Poor performers, as rated by the highly experienced physical therapist only, demonstrated lower hip abductor strength (P<.05), and similar hip pain and hip function compared to those of good performers. Conclusion Movement-pattern quality of patients with FAI syndrome should be rated by a highly experienced physical therapist. J Orthop Sports Phys Ther 2018;48(4):260-269. doi:10.2519/jospt.2018.7840.
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Casartelli NC, Bizzini M, Kemp J, Naal FD, Leunig M, Maffiuletti NA. What treatment options exist for patients with femoroacetabular impingement syndrome but without surgical indication? Br J Sports Med 2017; 52:552-553. [PMID: 28935688 DOI: 10.1136/bjsports-2017-098059] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2017] [Indexed: 02/02/2023]
Affiliation(s)
- Nicola C Casartelli
- Human Performance Lab, Schulthess Clinic, Zurich, Switzerland.,Laboratory of Exercise and Health, ETH Zurich, Zurich, Switzerland
| | - Mario Bizzini
- Human Performance Lab, Schulthess Clinic, Zurich, Switzerland
| | - Joanne Kemp
- La Trobe Sports Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Florian D Naal
- Department of Orthopaedic Surgery, Schulthess Clinic, Zurich, Switzerland
| | - Michael Leunig
- Department of Orthopaedic Surgery, Schulthess Clinic, Zurich, Switzerland
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Griffin DR, Dickenson EJ, O'Donnell J, Agricola R, Awan T, Beck M, Clohisy JC, Dijkstra HP, Falvey E, Gimpel M, Hinman RS, Hölmich P, Kassarjian A, Martin HD, Martin R, Mather RC, Philippon MJ, Reiman MP, Takla A, Thorborg K, Walker S, Weir A, Bennell KL. The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. Br J Sports Med 2017; 50:1169-76. [PMID: 27629403 DOI: 10.1136/bjsports-2016-096743] [Citation(s) in RCA: 595] [Impact Index Per Article: 85.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2016] [Indexed: 12/29/2022]
Abstract
The 2016 Warwick Agreement on femoroacetabular impingement (FAI) syndrome was convened to build an international, multidisciplinary consensus on the diagnosis and management of patients with FAI syndrome. 22 panel members and 1 patient from 9 countries and 5 different specialties participated in a 1-day consensus meeting on 29 June 2016. Prior to the meeting, 6 questions were agreed on, and recent relevant systematic reviews and seminal literature were circulated. Panel members gave presentations on the topics of the agreed questions at Sports Hip 2016, an open meeting held in the UK on 27-29 June. Presentations were followed by open discussion. At the 1-day consensus meeting, panel members developed statements in response to each question through open discussion; members then scored their level of agreement with each response on a scale of 0-10. Substantial agreement (range 9.5-10) was reached for each of the 6 consensus questions, and the associated terminology was agreed on. The term 'femoroacetabular impingement syndrome' was introduced to reflect the central role of patients' symptoms in the disorder. To reach a diagnosis, patients should have appropriate symptoms, positive clinical signs and imaging findings. Suitable treatments are conservative care, rehabilitation, and arthroscopic or open surgery. Current understanding of prognosis and topics for future research were discussed. The 2016 Warwick Agreement on FAI syndrome is an international multidisciplinary agreement on the diagnosis, treatment principles and key terminology relating to FAI syndrome.Author note The Warwick Agreement on femoroacetabular impingement syndrome has been endorsed by the following 25 clinical societies: American Medical Society for Sports Medicine (AMSSM), Association of Chartered Physiotherapists in Sports and Exercise Medicine (ACPSEM), Australasian College of Sports and Exercise Physicians (ACSEP), Austian Sports Physiotherapists, British Association of Sports and Exercise Medicine (BASEM), British Association of Sport Rehabilitators and Trainers (BASRaT), Canadian Academy of Sport and Exercise Medicine (CASEM), Danish Society of Sports Physical Therapy (DSSF), European College of Sports and Exercise Physicians (ECOSEP), European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA), Finnish Sports Physiotherapist Association (SUFT), German-Austrian-Swiss Society for Orthopaedic Traumatologic Sports Medicine (GOTS), International Federation of Sports Physical Therapy (IFSPT), International Society for Hip Arthroscopy (ISHA), Groupo di Interesse Specialistico dell'A.I.F.I., Norwegian Association of Sports Medicine and Physical Activity (NIMF), Norwegian Sports Physiotherapy Association (FFI), Society of Sports Therapists (SST), South African Sports Medicine Association (SASMA), Sports Medicine Australia (SMA), Sports Doctors Australia (SDrA), Sports Physiotherapy New Zealand (SPNZ), Swedish Society of Exercise and Sports Medicine (SFAIM), Swiss Society of Sports Medicine (SGMS/SGSM), Swiss Sports Physiotherapy Association (SSPA).
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Affiliation(s)
- D R Griffin
- Warwick Medical School, University of Warwick, Coventry, UK University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
| | - E J Dickenson
- Warwick Medical School, University of Warwick, Coventry, UK University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
| | - J O'Donnell
- Hip Arthroscopy Australia, Melbourne, Victoria, Australia St Vincents Private Hospital, East Melbourne, Victoria, Australia
| | - R Agricola
- Department of Orthopaedics, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - T Awan
- Medsport, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - M Beck
- Department of Clinic of Orthopaedic and Trauma Surgery, Luzerner Kantonspital, Luzern, Switzerland
| | - J C Clohisy
- Department of Orthopaedic Surgery, Washington University School of Medicine St. Louis, St. Louis, Missouri, USA
| | - H P Dijkstra
- Aspetar, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - E Falvey
- Sports Surgery Clinic, Dublin, Ireland Department of Medicine, University College Cork, Cork, Ireland
| | | | - R S Hinman
- Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - P Hölmich
- Aspetar, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar Department of Orthopaedic Surgery, Sports Orthopaedic Research Center (SORC-C), Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - A Kassarjian
- Corades, LLC, Brookline, Massachusetts, USA Medical Service, Madrid Open Tennis, Madrid, Spain
| | - H D Martin
- Hip Preservation Center, Baylor University Medical Center at Dallas, Dallas, Texas, USA
| | - R Martin
- Rangos School of Health Sciences, Physical Therapy, Duquesne University, Pittsburgh, Pennsylvania, USA UPMC Center for Sports Medicine, Pittsburgh, Pennsylvania, USA
| | - R C Mather
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - M J Philippon
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - M P Reiman
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - A Takla
- Hip Arthroscopy Australia, Melbourne, Victoria, Australia Australian Sports Physiotherapy Department of Physiotherapy, The University of Melbourne, Centre for Health, Exercise and Sports Medicine, Melbourne, Victoria, Australia Bond University
| | - K Thorborg
- Department of Orthopaedic Surgery, Sports Orthopaedic Research Center (SORC-C), Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | | | - A Weir
- Aspetar, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar Amsterdam Centre for Evidence-based Sports Medicine, Academic Medical Centre, Amsterdam, The Netherlands
| | - K L Bennell
- Department of Physiotherapy, The University of Melbourne, Centre for Health, Exercise and Sports Medicine, Melbourne, Victoria, Australia
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Wall PD, Dickenson EJ, Robinson D, Hughes I, Realpe A, Hobson R, Griffin DR, Foster NE. Personalised Hip Therapy: development of a non-operative protocol to treat femoroacetabular impingement syndrome in the FASHIoN randomised controlled trial. Br J Sports Med 2017; 50:1217-23. [PMID: 27629405 PMCID: PMC5036255 DOI: 10.1136/bjsports-2016-096368] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2016] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Femoroacetabular impingement (FAI) syndrome is increasingly recognised as a cause of hip pain. As part of the design of a randomised controlled trial (RCT) of arthroscopic surgery for FAI syndrome, we developed a protocol for non-operative care and evaluated its feasibility. METHODS In phase one, we developed a protocol for non-operative care for FAI in the UK National Health Service (NHS), through a process of systematic review and consensus gathering. In phase two, the protocol was tested in an internal pilot RCT for protocol adherence and adverse events. RESULTS The final protocol, called Personalised Hip Therapy (PHT), consists of four core components led by physiotherapists: detailed patient assessment, education and advice, help with pain relief and an exercise-based programme that is individualised, supervised and progressed over time. PHT is delivered over 12-26 weeks in 6-10 physiotherapist-patient contacts, supplemented by a home exercise programme. In the pilot RCT, 42 patients were recruited and 21 randomised to PHT. Review of treatment case report forms, completed by physiotherapists, showed that 13 patients (62%) received treatment that had closely followed the PHT protocol. 13 patients reported some muscle soreness at 6 weeks, but there were no serious adverse events. CONCLUSION PHT provides a structure for the non-operative care of FAI and offers guidance to clinicians and researchers in an evolving area with limited evidence. PHT was deliverable within the National Health Service, is safe, and now forms the comparator to arthroscopic surgery in the UK FASHIoN trial (ISRCTN64081839). TRIAL REGISTRATION NUMBER ISRCTN 09754699.
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Affiliation(s)
- Peter Dh Wall
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - David Robinson
- Southbank Hospital Worcester, Spire Healthcare, Worcester, UK
| | - Ivor Hughes
- University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Alba Realpe
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Rachel Hobson
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Damian R Griffin
- University Hospitals of Coventry and Warwickshire NHS Trust and Warwick Medical School, University of Warwick, Coventry, UK
| | - Nadine E Foster
- Arthritis Research UK Primary Care Centre, Research Institute of Primary Care and Health Sciences NIHR Professor of Musculoskeletal Health in Primary Care, Keele University, Keele, UK
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