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Tucker S, Heneghan NR, Alamrani S, Rushton A, Gardner A, Soundy A. Barriers and facilitators of physical function, activity, sports and exercise in children and adolescents with spinal pain: a protocol for a systematic review and meta-ethnography. BMJ Open 2023; 13:e063946. [PMID: 36927588 PMCID: PMC10030483 DOI: 10.1136/bmjopen-2022-063946] [Citation(s) in RCA: 1] [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] [Indexed: 03/18/2023] Open
Abstract
INTRODUCTION Spinal pain is one of the leading causes of disability, with the incidence of adolescent back pain estimated at 20%. Multiple barriers influence exercise participation in adolescents. However, there remains a lack of literature surrounding patients' choice to exercise, perceived barriers and facilitators of exercise, and their relationship to participant demographics. The aim of this systematic review with meta-ethnography will be to identify the barriers and facilitators of exercise participation among adolescents with thoracic or lower back pain (LBP). The secondary aim will be to identify any trends in barriers and facilitators of exercise between different demographic groups within children or adolescents under 18 years. METHODS AND ANALYSIS The seven-phase process identified by Noblit and Hare's meta-ethnography approach will be used. A comprehensive electronic search of databases (AMED, CINAHLplus, EMBASE, MEDLINE, SCOPUS, Nursing & Allied Health, PubMed, PsycINFO, SPORTDiscus, Social Science Database) will be completed during April 2022. Grey literature using reference lists, websites and search engines will also be searched in accordance with Peer Review of Electronic Search Strategies (PRESS) guidelines. Inclusion criteria include: (A) qualitative studies, (B) participants under 18 years experiencing thoracic or LBP, (C) identification of barriers and facilitators of exercise participation in exercise, sports or physical activity and (D) primary research. This systematic review with meta-ethnography review aims to generate theories of behaviours and interpret significance across multiple studies. This process aims to develop future physiotherapeutic behavioural interventions, inform service provision and identify possible future research questions. ETHICS AND DISSEMINATION No ethical approval was required due to the nature of using previously published work to form a systematic review paper. This systematic review and meta-ethnography will be disseminated through both conference presentations and journal publications. No funding was received for this review. PROSPERO REGISTRATION NUMBER CRD42022314796.
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Affiliation(s)
- Susanna Tucker
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Nicola R Heneghan
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Samia Alamrani
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Alison Rushton
- School of Physical Therapy, Western University Faculty of Health Sciences, London, Ontario, Canada
| | - Adrian Gardner
- Spinal Surgery, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Andrew Soundy
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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2
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Estberger A, Kemp JL, Thorborg K, Pålsson A, Ageberg E. Are Exercise Therapy Protocols For The Treatment of Hip-Related Pain Adequately Described? A Systematic Review of Intervention Descriptions. Int J Sports Phys Ther 2023; 18:38-54. [PMID: 36793572 PMCID: PMC9897011 DOI: 10.26603/001c.68069] [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: 06/28/2022] [Accepted: 12/23/2022] [Indexed: 02/04/2023] Open
Abstract
Background Hip-related pain is an umbrella term encompassing pain from non-arthritic hip joint pathologies, such as femoroacetabular impingement syndrome, hip dysplasia, and labral tears. Exercise therapy is commonly recommended for these conditions, but the reporting completeness of these interventions is currently unclear. Purpose The aim of this systematic review was to assess the reporting completeness of exercise therapy protocols for people with hip-related pain. Study design Systematic review according to PRISMA guidelines. Materials and Methods A systematic search was conducted, searching the MEDLINE, CINAHL, and Cochrane databases. The search results were independently screened by two researchers. Inclusion criteria were studies using exercise therapy in people with non-arthritic hip-related pain. Two independent researchers used the Cochrane risk of bias tool version 2 to analyze risk of bias, and the Consensus on Exercise Reporting Template (CERT) checklist and score (1-19) to synthesize reporting completeness. Results Fifty-two studies used exercise therapy for hip-related pain, but only 23 were included in the synthesis as 29 studies had no description of the intervention. CERT scores ranged from 1 to 17 (median 12, IQR 5-15). The most well-described items were tailoring (87%), and the least well-described items were motivation strategies (9%) and starting level (13%). Studies used exercise therapy alone (n=13), or in combination with hip arthroscopy (n=10). Conclusion Only 23 of 52 eligible studies reported sufficient details to be included in the CERT synthesis. The median CERT score was 12 (IQR 5-15), with no study reaching the maximum score of 19. Lack of reporting makes it difficult to replicate interventions in future research, and to draw conclusions on efficacy and dose-response to exercise therapy for hip-related pain. Level of evidence Level 1, systematic review.
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Affiliation(s)
| | - Joanne L Kemp
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport La Trobe University
| | - Kristian Thorborg
- Department of Health Sciences Lund University, Lund, Sweden
- Sports Orthopedic Research Center - Copenhagen (SORC-C), Departement of Orthopedic Surgery, Amager-Hvidovre Hospital, Institute for Clinical Medicine Copenhagen University, Copenhagen, Denmark
| | - Anders Pålsson
- Department of Health Sciences Lund University, Lund, Sweden
| | - Eva Ageberg
- Department of Health Sciences Lund University, Lund, Sweden
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McCormack TJ, Vopat ML, Rooker J, Tarakemeh A, Baker J, Templeton KJ, Mulcahey MK, Mullen SM, Schroeppel JP, Vopat BG. Sex-Based Differences in Outcomes After Hip Arthroscopic Surgery for Femoroacetabular Impingement: A Systematic Review. Orthop J Sports Med 2022; 10:23259671221137857. [PMID: 36452337 PMCID: PMC9703514 DOI: 10.1177/23259671221137857] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 08/30/2022] [Indexed: 07/24/2023] Open
Abstract
BACKGROUND While sex-based differences in outcomes after hip arthroscopic surgery for femoroacetabular impingement syndrome (FAIS) are often recorded, no studies have been dedicated to analyzing the literature as a whole. PURPOSE To investigate whether sex is a predictor of outcomes in studies evaluating hip arthroscopic surgery for FAIS. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A systematic review was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We searched the PubMed, Embase, Cochrane, Ovid, and PubMed Central databases for English-language studies that evaluated sex-specific outcomes in human populations. The search terms used were as follows: ("Hip Arthroscopy") AND ("Femoroacetabular Impingement" OR "FAI") AND ("Sex" OR "Gender" OR "Male" OR "Female"). Studies with evidence levels 2 through 4 were included. The studies were then screened, followed by data extraction. Modified Harris Hip Score (mHHS) outcomes and return-to-sport (RTS) rates were recorded. These were analyzed using random-effects meta-analysis. Heterogeneity was calculated using the I 2 statistic. RESULTS Of 256 full-text articles screened, 48 articles were included in this analysis; of these, 14 studies (29%) concluded that female sex was a negative predictor of postoperative outcomes, while 6 studies (13%) found female sex to be positive predictor. The remaining 28 studies (58%) found no sex-based differences in postoperative outcomes. Of 7 studies (416 male and 519 female) included in the mHHS analysis, 2 studies concluded that male patients had significantly higher postoperative mHHS scores. Of 6 studies (502 male and 396 female) included in the RTS analysis, 1 study concluded that male patients had a significantly higher RTS rate. CONCLUSION Almost one-third of the included studies determined that female sex was a negative predictor of postoperative outcomes, 13% found female sex to be a positive predictor, and 58% found no sex-based differences. Our study illustrates an insufficiency of high-level evidence supporting sex-specific differences in outcomes after hip arthroscopic surgery, but findings indicated that the postoperative mHHS score and RTS rate may be influenced by sex.
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Affiliation(s)
| | | | - Jacob Rooker
- Medical Center, University of Kansas, Kansas City, Kansas, USA
| | - Armin Tarakemeh
- Medical Center, University of Kansas, Kansas City, Kansas, USA
| | - Jordan Baker
- Medical Center, University of Kansas, Kansas City, Kansas, USA
| | | | - Mary K. Mulcahey
- School of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Scott M. Mullen
- Medical Center, University of Kansas, Kansas City, Kansas, USA
| | | | - Bryan G. Vopat
- Medical Center, University of Kansas, Kansas City, Kansas, USA
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4
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Davey MS, Hurley ET, Davey MG, Fried JW, Hughes AJ, Youm T, McCarthy T. Criteria for Return to Play After Hip Arthroscopy in the Treatment of Femoroacetabular Impingement: A Systematic Review. Am J Sports Med 2022; 50:3417-3424. [PMID: 34591697 DOI: 10.1177/03635465211038959] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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 common pathology in athletes that often requires operative management in the form of hip arthroscopy. PURPOSE To systematically review the rates and level of return to play (RTP) and the criteria used for RTP after hip arthroscopy for FAI in athletes. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A systematic review of the literature, based on the PRISMA guidelines, was performed using PubMed, Embase, and Scopus databases. Studies reporting outcomes after the use of hip arthroscopy for FAI were included. Outcomes analyzed were RTP rate, RTP level, and criteria used for RTP. Statistical analysis was performed using SPSS software. RESULTS Our review found 130 studies, which included 14,069 patients (14,517 hips) and had a mean methodological quality of evidence (MQOE) of 40.4 (range, 5-67). The majority of patients were female (53.7%), the mean patient age was 30.4 years (range, 15-47 years), and the mean follow-up was 29.7 months (range, 6-75 months). A total of 81 studies reported RTP rates, with an overall RTP rate of 85.4% over a mean period of 6.6 months. Additionally, 49 studies reported the rate of RTP at preinjury level as 72.6%. Specific RTP criteria were reported in 97 studies (77.2%), with time being the most commonly reported item, which was reported in 80 studies (69.2%). A total of 45 studies (57.9%) advised RTP at 3 to 6 months after hip arthroscopy. CONCLUSION The overall rate of reported RTP was high after hip arthroscopy for FAI. However, more than one-fourth of athletes who returned to sports did not return at their preinjury level. Development of validated rehabilitation criteria for safe return to sports after hip arthroscopy for FAI could potentially improve clinical outcomes while also increasing rates of RTP at preinjury levels.
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Affiliation(s)
- Martin S Davey
- Sports Surgery Clinic, Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Eoghan T Hurley
- Sports Surgery Clinic, Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland.,NYU Langone, New York, New York, USA
| | | | | | - Andrew J Hughes
- Sports Surgery Clinic, Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
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Filan D, Mullins K, Carton P. Hip Range of Motion Is Increased After Hip Arthroscopy for Femoroacetabular Impingement: A Systematic Review. Arthrosc Sports Med Rehabil 2022; 4:e797-e822. [PMID: 35494261 PMCID: PMC9042900 DOI: 10.1016/j.asmr.2021.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 12/08/2021] [Indexed: 01/22/2023] Open
Abstract
Purpose To investigate the impact of arthroscopic correction of symptomatic femoroacetabular impingement on postoperative hip range of motion (ROM), as an objectively measured postoperative clinically reported outcome. Methods A systematic review of the current literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, OVID/MEDLINE, EMBASE, and Cochrane databases were queried in November 2020. Studies not reporting pre- to postoperative ROM measurements were excluded. Methodologic quality was assessed using the MINORS assessment, and certainty of evidence was assessed using the GRADE approach. Effect size using standardized mean differences assessed magnitude of change between pre- and postoperative ROM. Results In total, 23 studies were included evaluating 2,332 patients. Mean age ranged from 18 to 44.2 years. Flexion, internal rotation (IR), and external rotation (ER) were the predominantly measured ROMs reported in 91%, 100% and 65% of studies, respectively. Observed change following hip arthroscopy was considered significant in 57.1% (flexion), 74% (IR), and 20% (ER). Effect size of change in significantly improved ROMs were weak (16.7% flexion, 33.3% ER), moderate (58.3% flexion, 29.4% IR), and large (25% flexion, 64.7% IR, 66.7% ER). For goniometric assessment mean observed changes ranged as follows: flexion: 0.1° to 12.2°; IR: 3.6° to 21.9°; ER: –2.6° to 12.8°. For computed tomography–simulated assessment, the mean observed change ranged as follows: flexion: 3.0° to 8.0°; IR 9.3° to 14.0°. Conclusions Outcome studies demonstrate overall increased range of flexion and IR post-hip arthroscopy, with a moderate and large effect respectively. Change in ER is less impacted following hip arthroscopy. Certainty of evidence to support this observation is low. Current research evaluating changes in this functional ability is limited by a lack of prospective studies and non-standardized measurement evaluation techniques. Level of Evidence Level IV, systematic review of Level II-IV studies.
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Affiliation(s)
- David Filan
- UPMC Whitfield, Waterford, Ireland
- Address correspondence to David Filan, Suite 5, UPMC Whitfield, Butlerstown North, Cork Road, Waterford, Ireland.
| | | | - Patrick Carton
- Hip and Groin Clinic, Waterford, Ireland
- UPMC Whitfield, Waterford, Ireland
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Kumar MV, Shanmugaraj A, Kay J, Simunovic N, Huang MJ, Wuerz TH, Ayeni OR. Bilateral hip arthroscopy for treating femoroacetabular impingement: a systematic review. Knee Surg Sports Traumatol Arthrosc 2022; 30:1095-1108. [PMID: 34165631 DOI: 10.1007/s00167-021-06647-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/18/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE Femoroacetabular impingement (FAI) is a hip disorder which can often present bilaterally. The purpose of this systematic review was to explore the current practices for bilateral hip arthroscopy in treating FAI as they relate to outcomes and complications. METHODS This review has been conducted according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). The electronic databases PubMed, MEDLINE, EMBASE, and CENTRAL (Cochrane Central Register of Controlled Trials) were searched from data inception to October 18th, 2020. The Methodological Index for Non-randomized Studies (MINORS) was used to assess study quality. Data are presented descriptively. RESULTS Overall, 19 studies were identified, comprising 957 patients (48.6% male) with a mean age of 27.9 ± 7.1 years and a mean follow-up of 31.7 ± 20.8 months. The majority of patients were treated with a staged bilateral hip arthroscopy (78.5%) with a mean duration between surgeries of 7.1 ± 4.0 months. Significant preoperative-to-postoperative improvements for clinical outcomes such as pain, hip function, and health-related daily living as well as radiographic outcomes were reported in six studies for staged procedures (p < 0.05) and three studies for simultaneous procedures (p < 0.02). Significant improvements in patient-reported outcomes (e.g., HOS-ADL, Pain, HOS-SS, mHHS, and NAHS) were found in favor of those undergoing a shorter delay between surgeries in three studies (i.e., < 3, 10 or 17 months) (p < 0.05) compared to those who had delayed surgeries (i.e., > 3, 10, or 17 months). The overall complication rate was 10.1% (97/957). CONCLUSIONS Bilateral surgery for FAI yields improved outcomes postoperatively and complication rates similar to unilateral surgery. The overall complication rate was 10.1% with the most common complication being revision surgery. Staged bilateral surgery is more commonly performed than simultaneous surgery. Clinicians should consider preoperative imaging, clinical history, and patient values when deciding between staged and simultaneous procedures for bilateral FAI surgery. Future studies are required to determine the optimal indications for simultaneous versus staged procedures, as well as the ideal timing between surgeries for the latter. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Mithilesh V Kumar
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Ajaykumar Shanmugaraj
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Jeffrey Kay
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Nicole Simunovic
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Michael J Huang
- Colorado Springs Orthopaedic Group, Colorado Springs, CO, USA
| | | | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada. .,McMaster University Medical Centre, 1200 Main St W, Room 4E15, Hamilton, ON, L8N 3Z5, Canada.
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7
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Bistolfi A, Guidotti C, Aprato A, Sabatini L, Artiaco S, Massè A, Ferracini R. Rehabilitation Protocol After Hip Arthroscopy: A 2015-2020 Systematic Review. Am J Phys Med Rehabil 2021; 100:958-965. [PMID: 33394594 DOI: 10.1097/phm.0000000000001677] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Although many rehabilitation protocols after hip arthroscopy have been described, there is still significant variability about duration, goals, restrictions, and techniques to apply by the physical therapy after the surgical procedure. The aim of the study was to systematically review rehabilitation after hip arthroscopy. DESIGN The data sources were PubMed, Scopus, and Cochrane Library. The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were used for the systematic review. Level I-IV evidence clinical studies and clinical reviews that focused on rehabilitation protocols after hip arthroscopy have been used as study eligibility criteria. Major limitations include the retrospective nature of most of the studies selected (level IV evidence) and the use of different clinical scores to report the outcomes. RESULTS This review showed that although a standardized guideline on rehabilitation after hip arthroscopy is still missing, the most recent studies and clinical trials are focusing on a four-phase program, which includes goals, recommendations, and a progression of exercises. CONCLUSIONS Rehabilitation after hip arthroscopy is strongly suggested, but different authors recommended different rehabilitation programs. There is not a defined program, but as of today, the current standard of care is composed of phase-based programs.
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Affiliation(s)
- Alessandro Bistolfi
- From the Department of Orthopaedics, Traumatology and Rehabilitation, C.T.O. Hospital, Turin, Italy (AB, AA, LS, SA, AM); University of Turin, Faculty of Medicine and Surgery, Turin, Italy (CG, AM); Department of Surgical Sciences and Integrated Diagnostics, University of Genova, Genova, Italy (RF); and Orthopaedics, Koelliker Hospital, Turin, Italy (RF)
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8
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Cohen D, Khan A, Kay J, Slawaska-Eng D, Almasri M, Simunovic N, Duong A, Safran MR, Ayeni OR. There is no definite consensus on the adequate radiographic correction in arthroscopic osteochondroplasty for femoroacetabular impingement: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2021; 29:2799-2818. [PMID: 34173836 DOI: 10.1007/s00167-021-06645-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/10/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The purpose of this study is to evaluate and define what is considered an adequate radiographic correction in arthroscopic osteochondroplasty for FAI and to secondarily assess how radiographic outcomes relate to patient reported outcomes and complications. METHODS The databases EMBASE, PubMed, and MEDLINE were searched for relevant literature from database inception until January 2021. Studies were screened by two reviewers independently and in duplicate for studies reporting on post-operative radiographic outcomes in arthroscopic osteochondroplasty for FAI. Data on radiographic outcomes as well as data reporting functional outcomes and complications were recorded. A meta-analysis was used to combine the mean pre- and post-operative radiographic outcomes using a random effects model. A risk of bias assessment was performed for all included studies using the MINORS score. RESULTS The most commonly reported radiographic outcome was the alpha angle with a pooled mean post-operative angle of 44° (95% CI 41°-46°), and mean pre- to post-surgical difference of - 19° (- 22 to - 16, I2 = 96%), followed by the LCEA with a pooled mean post-operative angle of 30° (95% CI 29-31) and mean difference after surgery of - 4° (- 6 to - 1, I2 = 97%,). Eleven studies reported on the correlation between radiographic and clinical outcomes with no consistent consensus correlation found amongst the included studies. Similarly, six studies correlated radiographic outcomes with conversion to THA with no consistent consensus correlation found amongst the included studies. CONCLUSION Based on this review, the main conclusion is that there is no consensus definition on the optimal radiographic correction for FAI and there was no consistent correlation between radiographic correction and functional outcomes. However, based on the uniform improvement in functional outcomes, this review suggests a post-operative alpha angle target of 44° with a correction target of 19° and LCEA target of 30° with a correction target of 3°. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Dan Cohen
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, McMaster University, 1200 Main St West, 4E15, Hamilton, ON, L8N 3Z5, Canada
| | - Abdullah Khan
- Faculty of Science, McMaster University, Hamilton, ON, Canada
| | - Jeffrey Kay
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, McMaster University, 1200 Main St West, 4E15, Hamilton, ON, L8N 3Z5, Canada
| | - David Slawaska-Eng
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, McMaster University, 1200 Main St West, 4E15, Hamilton, ON, L8N 3Z5, Canada
| | - Mahmoud Almasri
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, McMaster University, 1200 Main St West, 4E15, Hamilton, ON, L8N 3Z5, Canada.,Mercy Health-Cincinnati Sports Medicine and Orthopaedic Center, Cincinnati, OH, USA
| | - Nicole Simunovic
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Andrew Duong
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Marc R Safran
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA, USA
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, McMaster University, 1200 Main St West, 4E15, Hamilton, ON, L8N 3Z5, Canada. .,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
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9
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Browning RB, Clapp IM, Alter TD, Nwachukwu BU, Nho SJ. Pain Catastrophizing and Kinesiophobia Affect Return to Sport in Patients Undergoing Hip Arthroscopy for the Treatment of Femoroacetabular Impingement. Arthrosc Sports Med Rehabil 2021; 3:e1087-e1095. [PMID: 34430888 PMCID: PMC8365207 DOI: 10.1016/j.asmr.2021.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 03/30/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose To assess whether pain catastrophizing and kinesiophobia affect return to sport (RTS) or clinically significant outcome (CSO) achievement in patients undergoing hip arthroscopy for the treatment of femoroacetabular impingement (FAI). Methods Patients undergoing primary hip arthroscopy at a single institution between January 2017 and March 2017 were prospectively enrolled. Patients received the Tampa Scale of Kinesiophobia-11 (TSK-11) and Pain Catastrophizing Scale (PCS) questionnaires preoperatively, 3 weeks, 6 weeks, 3 months, 6 months, and 1 year postoperatively. Patients also received the Hip Outcome Score Sport-Specific (HOS-SS) questionnaire preoperatively and 1 year and 2 years' postoperatively. An RTS questionnaire was completed at final follow-up. Bivariate correlations were conducted between PCS and TSK-11 scores and RTS status and achievement of CSOs of HOS-SS, based on patient acceptable symptom state (PASS) and substantial clinical benefit (SCB). Results Fifty-eight patients with an average age of 31.9 ± 12.2 and body mass index of 24.0 ± 3.8 participated in sport prior to surgery and were included in the study. Forty-two (72.4%) patients returned to sport at 10.5 ± 7.1 months following surgery. There was a significant reduction in TSK-11 and PCS scores at 1-year follow-up (TSK-11, 26.1 ± 6.0 vs 18.6 ± 6.1, P < .001; PCS, 17.7 ± 10.5 vs 4.3 ± 6.8, P < .001) as well as a significant improvement in HOS-SS (P < .001). At 1 year, fair correlations were demonstrated between PCS (r = -0.446, P = .010) and TSK (r = -0.330, P = .029) scores and RTS. Patient who returned to sport had lower PCS (8.5 ± 11.7 vs 3.0 ± 3.7, P = .010) and TSK-11 (21.8 ± 8.5 vs 17.6 ± 4.8, P = .029) scores at 1 year. At 1-year follow-up, PCS (r = -0.572, P = .001) and TSK-11 (r = -0.441, P = .012) scores demonstrated fair correlations with achieving PASS for HOS-SS at 2-year follow-up. Conclusions Patient kinesiophobia and pain catastrophizing at 1-year follow-up were negatively correlated with RTS and achievement of a CSO in sport-related activities at 2-year follow-up. Level of Evidence III, prospective cohort study.
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Affiliation(s)
- Robert B Browning
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Ian M Clapp
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Thomas D Alter
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Benedict U Nwachukwu
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Shane J Nho
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, U.S.A
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10
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Parvaresh KC, Wichman DM, Alter TD, Clapp IM, Nho SJ. High rate of return to tennis after hip arthroscopy for patients with femoroacetabular impingement syndrome. Phys Ther Sport 2021; 51:45-49. [PMID: 34225058 DOI: 10.1016/j.ptsp.2021.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 06/21/2021] [Accepted: 06/25/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate return to sport (RTS) outcomes in tennis athletes following hip arthroscopy for femoroacetabular impingement syndrome (FAIS). It was hypothesized that there would be a high rate of return to tennis after hip arthroscopy. STUDY DESIGN Level IV, Retrospective Analysis. SETTING Outpatient sports medicine clinic at a single institution. PARTICIPANTS A total of 28 patients (60.8% female; mean age, 36.2 ± 9.2 years; mean BMI, 22.8 ± 2.1 kg/m2) with self reported tennis activity prior to hip arthroscopy. MAIN OUTCOME MEASURES A postoperative return to sport and minimum two-year patient reported outcomes. RESULTS There was a high rate of return to tennis, with 78% of patients eventually returning to tennis. An additional 9% of patients had the necessary hip function to return, but did not return due to lack of interest or resources. The patients returned to tennis at an average of 8.0 ± 3.3 months after surgery. The majority of athletes (66.7%) were able to continue competing at the same or higher levels following surgery. CONCLUSIONS Patients return to tennis 78% of the time at a mean of 8.0 ± 3.3 months following hip arthroscopy for FAIS.
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Affiliation(s)
- Kevin C Parvaresh
- 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
| | - Daniel M Wichman
- 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
| | - Thomas D Alter
- 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.
| | - Ian M Clapp
- 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
- 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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11
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Weber AE, Bolia IK, Mayfield CK, Ihn H, Kang HP, Bedi A, Nho SJ, Philippon MJ. Can We Identify Why Athletes Fail to Return to Sport After Hip Arthroscopy for Femoroacetabular Impingement Syndrome? A Systematic Review and Meta-analysis. Am J Sports Med 2021; 49:1651-1658. [PMID: 33017544 DOI: 10.1177/0363546520956292] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND No previous systematic review has focused on the athletes who fail to return to sport after hip arthroscopy for femoroacetabular impingement syndrome (FAIS). PURPOSE To review the literature on the athletes who fail to return to sport after hip arthroscopy for FAIS to determine the rate of nonreturning athletes and explore the reasons for their inability to return to sport after arthroscopic FAI surgery. STUDY DESIGN Systematic review and meta-analysis. METHODS Three electronic databases were searched for eligible articles. Two reviewers independently screened the titles, abstracts, and full-text articles using prespecified criteria. Eligible articles were those that clearly stated the rate of athletes who did not return to sport after hip arthroscopy for FAIS. Data collected were the rate of patients who did not return to sport, the level of competition (high level, recreational, or mixed), the type of sport, comments on patients who did not return to sport, the rate of subsequent hip surgeries (total hip replacement or revision hip arthroscopy) in nonreturning athletes, and the reported reason for not returning to sport. A random-effects model was used for meta-analysis. RESULTS Twenty studies were eligible for inclusion, and 1093 athletes were analyzed. The weighted rate of athletes who did not return to sport after hip arthroscopy for FAIS was 12.1% (95% CI, 7.7-17.4). Only 2 studies (2/20;10%) reported the age of the athletes who did not return, while sex was reported in 3 studies (3/20;15%). The estimated proportion of athletes who did not return to sport because of hip-related issues was significantly greater than the percentage of athletes who did not return for reasons unrelated to their hip (74.3% vs 22.3%; P < .0001). Persistent hip pain was the most commonly reported factor (52/110 patients; 47.2%) associated with failure to return to sport. Whether the nonreturning athletes underwent any subsequent hip procedure after hip arthroscopy for FAIS was reported in only 4 out of 20 studies (20%). There was evidence of publication bias and study heterogeneity. CONCLUSION The estimated rate of athletes who did not return to sport after hip arthroscopy for FAIS was 12%, with the majority of athletes being unable to return because of persistent hip pain. There is a severe lack of evidence on the athlete characteristics and clinical course of the nonreturning athletes, and the rate of subsequent hip procedures is unknown. The outcomes and reasons for athletes not returning to sport should be reported in detail to improve patient care.
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Affiliation(s)
- Alexander E Weber
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Ioanna K Bolia
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Cory K Mayfield
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Hansel Ihn
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Hyunwoo P Kang
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Asheesh Bedi
- Department of Orthopaedic Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Shane Jay Nho
- Midwest Orthopaedics at Rush, Chicago, Illinois, USA
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12
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Bovonratwet P, Boddapati V, Nwachukwu BU, Bohl DD, Fu MC, Nho SJ. Increased hip arthroscopy operative duration is an independent risk factor for overnight hospital admission. Knee Surg Sports Traumatol Arthrosc 2021; 29:1385-1391. [PMID: 32705297 DOI: 10.1007/s00167-020-06170-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/16/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to determine the association between operative duration and short-term complications as well as overnight hospital admission following hip arthroscopy. METHODS Hip arthroscopy cases from 2006 to 2016 were retrieved from the National Surgical Quality Improvement Program registry, which prospectively collects 30-day postoperative complications. Patients were stratified into the following groups based on procedure length: group 1 (< 60 min), group 2 (60-120 min), and group 3 (> 120 min). Preoperative characteristics were compared across the cohorts. Multivariate regressions were used to compare complication rates and overnight hospital admission between the three groups. Independent risk factors for overnight hospital admission were characterized. RESULTS A total of 2129 hip arthroscopy cases were identified. Average operative duration was 99.3 ± 55.7 min. As operative time increased, patients were more likely to be younger, male, and had lower American Society of Anesthesiologists (ASA) class (p < 0.001). Body mass index and comorbidity profiles were similar across the patient cohorts, with the exception of hypertension being more prevalent in the shorter operative time cohort (p < 0.001). Patients in group 3 were more likely to stay overnight in the hospital (26.0%) compared to patients in groups 1 (7.7%) and 2 (10.9%), p < 0.001). All postoperative complication rates were otherwise similar between the cohorts. Independent risk factors for overnight hospital admission included increasing operative time (most notably > 120 min relative to < 60 min, relative risk [RR] = 3.53, 95% CI 2.50-5.00, p < 0.001) and increasing ASA classification (most notably ASA III or IV relative to ASA I, RR = 1.64, 95% CI 1.18-2.27; p = 0.013). CONCLUSIONS Increasing operative duration was not associated with increased postoperative complications following hip arthroscopy. However, patients were more than three times likely to stay in the hospital overnight if their surgery was longer than 120 min, relative to cases that were less than 60 min. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Patawut Bovonratwet
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA.
| | - Venkat Boddapati
- Department of Orthopaedic Surgery, Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY, 10032, USA
| | - Benedict U Nwachukwu
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA
| | - Daniel D Bohl
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St, Suite 400, Chicago, IL, 60612, USA
| | - Michael C Fu
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St, Suite 400, Chicago, IL, 60612, USA
| | - Shane J Nho
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St, Suite 400, Chicago, IL, 60612, USA
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13
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Lindman I, Nikou S, Öhlin A, Senorski EH, Ayeni O, Karlsson J, Sansone M. Evaluation of outcome reporting trends for femoroacetabular impingement syndrome- a systematic review. J Exp Orthop 2021; 8:33. [PMID: 33893563 PMCID: PMC8065071 DOI: 10.1186/s40634-021-00351-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/08/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE The aim of this systematic review was to evaluate the trends in the literature regarding surgical treatment for femoroacetabular impingement syndrome (FAIS) and to present which patient-reported outcome-measures (PROMs) and surgical approaches are included. METHODS This systematic review was conducted with the PRISMA guidelines. The literature search was performed on PubMed and Embase, covering studies from 1999 to 2020. Inclusion criteria were clinical studies with surgical treatment for FAIS, the use of PROMs as evaluation tool and studies in English. Exclusion criteria were studies with patients < 18 years, cohorts with < 8 patients, studies with primarily purpose to evaluate other diagnoses than FAIS and studies with radiographs as only outcomes without using PROMs. Data extracted were author, year, surgical intervention, type of study, level of evidence, demographics of included patients, and PROMs. RESULTS The initial search yielded 2,559 studies, of which 196 were included. There was an increase of 2,043% in the number of studies from the first to the last five years (2004-2008)-(2016-2020). There were 135 (69%) retrospective, 55 (28%) prospective and 6 (3%) Randomized Controlled Trials. Level of evidence ranged from I-IV where Level III was most common (44%). More than half of the studies (58%) originated from USA. Arthroscopic surgery was the most common surgical treatment (85%). Mean follow-up was 27.0 months (± 17 SD), (range 1.5-120 months). Between 1-10 PROMs were included, and the modified Harris Hip Score (mHHS) was most commonly used (61%). CONCLUSION There has been a continuous increase in the number of published studies regarding FAIS with the majority evaluating arthroscopic surgery. The mHHS remains being the most commonly used PROM.
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Affiliation(s)
- Ida Lindman
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45, Gothenburg, Sweden.
| | - Sarantos Nikou
- Department of Orthopaedic Surgery, South Älvsborg Hospital, 501 82, Borås, Sweden
| | - Axel Öhlin
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45, Gothenburg, Sweden
| | - Eric Hamrin Senorski
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Olufemi Ayeni
- Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, L8N 3Z5, Canada
| | - Jon Karlsson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45, Gothenburg, Sweden
| | - Mikael Sansone
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45, Gothenburg, Sweden
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Abstract
BACKGROUND Although p values are standard for reporting statistical significance of patient-reported outcome measures (PROMs), the shift toward clinically important outcome values, including minimal clinically important difference (MCID) and substantial clinical benefit (SCB), necessitates re-evaluation of the current literature. QUESTIONS/PURPOSES We sought to answer two questions regarding studies on primary hip arthroscopy performed for the treatment of femoroacetabular impingement syndrome (FAIS). (1) Do such studies reporting statistical significance on common PROMs meet published MCID/SCB thresholds? (2) What proportion of such studies report both statistical and clinical significance? METHODS We identified four papers published in two journals defining MCID/SCB values on the modified Harris Hip Score (mHHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sport (HOS-Sport), international Hip Outcome Tool (iHOT-33), and its short version (iHOT-12) for different groups of FAIS patients undergoing hip arthroscopy. We reviewed these two journals from the dates of publication to the present to identify papers reporting changes in post-operative PROMs. The difference in pre- and post-operative scores on each PROM was calculated and compared to MCID/SCB thresholds. RESULTS Twelve studies were included. Ten studies (83%) evaluated mHHS (90% met MCID, 50% met SCB), seven (58%) evaluated HOS-ADL (100% met MCID/SCB) and HOS-Sport (100% met MCID, 57% met SCB), and one (8%) evaluated iHOT-33 (met MCID/SCB) and iHOT-12 (met MCID). Most studies met MCID and SCB at both 1- and 2-year timepoints. Of the studies evaluated, 50% reported clinical relevance. CONCLUSIONS Nearly all studies evaluated met MCID, while fewer met SCB. Only half discussed these clinical measures. It is proposed that all future studies report both statistical and clinical significance as standard best practice.
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15
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Low Self-Efficacy and High Kinesiophobia Are Associated With Worse Function in Patients With Femoroacetabular Impingement Syndrome. J Sport Rehabil 2020; 30:445-451. [PMID: 33027764 DOI: 10.1123/jsr.2019-0498] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 07/11/2020] [Accepted: 08/01/2020] [Indexed: 11/18/2022]
Abstract
CONTEXT Femoroacetabular impingement syndrome (FAIS) is a painfully debilitating hip condition disproportionately affecting active individuals. Mental health disorders are an important determinant of treatment outcomes for individuals with FAIS. Self-efficacy, kinesiophobia, and pain catastrophizing are psychosocial factors that have been linked to inferior outcomes for a variety of orthopedic conditions. However, these psychosocial factors and their relationships with mental health disorders, pain, and function have not been examined in individuals with FAIS. OBJECTIVE (1) To examine relationships between self-efficacy, kinesiophobia, pain catastrophizing, pain, and function in patients with FAIS and (2) to determine if these variables differ between patients with and without a self-reported depression and/or anxiety. DESIGN Cross-sectional. SETTING University health center. PARTICIPANTS Fifty-one individuals with FAIS (42 females/9 males; age 35.7 [11.6] y; body mass index 27.1 [4.9] kg/m2). MAIN OUTCOME MEASURES Participants completed the Pain Self-Efficacy Questionnaire, Tampa Scale for Kinesiophobia, Pain Catastrophizing Scale, visual analog scale for hip pain at rest and during activity, and the 12-item International Hip Outcome Tool. Self-reported depression and/or anxiety were recorded. The relationships between psychosocial factors, pain, and function were examined using Spearman rank-order correlations. Independent t tests and Mann-Whitney U tests were used to evaluate the effect of self-reported depression and/or anxiety on psychosocial factors, pain and function. RESULTS The 12-item International Hip Outcome Tool was correlated with pain during activity (ρ = -.57, P ≤ .001), Tampa Scale for Kinesiophobia (ρ = -.52, P ≤ .001), and Pain Self-Efficacy Questionnaire (ρ = .71, P ≤ .001). The Pain Self-Efficacy Questionnaire was also correlated with pain at rest (ρ = -.43, P = .002) and pain during activity (ρ = -.46, P = .001). Individuals with self-reported depression and/or anxiety (18/51; 35.3%) had worse self-efficacy and pain catastrophizing (P ≤ .01). CONCLUSION Self-reported depression and/or anxiety, low self-efficacy, and high kinesiophobia were associated with more hip pain and worse function for patients with FAIS. These findings warrant further examination including psychosocial treatment strategies to improve the likelihood of a successful clinical outcome for this at-risk population.
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16
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Chona DV, Bonano JC, Ayeni OR, Safran MR. Definitions of Return to Sport After Hip Arthroscopy: Are We Speaking the Same Language and Are We Measuring the Right Outcome? Orthop J Sports Med 2020; 8:2325967120952990. [PMID: 33015214 PMCID: PMC7509720 DOI: 10.1177/2325967120952990] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 03/09/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Return to sport is a commonly studied outcome of hip arthroscopy that is relevant to both patients and providers. There exists substantial variability in criteria used to define successful return to sport. Purpose: To review and evaluate the definitions used in the literature so as to establish a single standard to enable comparison of outcomes in future studies. Study Design: Systematic review; Level of evidence, 4. Methods: The PubMed, MEDLINE, and Embase databases were searched from inception to June 1, 2019, for studies relating to hip arthroscopy and return to sport. Articles included were those that met the following criteria: (1) contained 2 or more patients, (2) studied patients 18 years of age and older, (3) reported postoperative outcomes after hip arthroscopy, (4) clearly defined return to play, and (5) were written in English. Excluded articles (1) reported outcomes for nonoperative or open treatments, (2) did not clearly define return to play, or (3) were review articles, meta-analyses, or survey-based studies. Return-to-play definitions and additional metrics of postoperative performance and outcome were recorded. Results: A total of 185 articles were identified, and 28 articles were included in the final review, of which 18 involved elite athletes and 10 involved recreational athletes. Of articles studying elite athletes, 6 (33%) defined return to play as participation in regular or postseason competition, 3 (17%) extended the criteria to the preseason, and 2 (11%) used participation in sport-related activities and training. The remaining 7 (39%) reported rates of return to the preoperative level of competition but did not specify preseason versus regular season. All 10 articles evaluating recreational athletes defined return to play based on patient-reported outcomes. Four (40%) did so qualitatively, while 6 (60%) did so quantitatively. Conclusion: There exists significant variability in criteria used to define successful return to sport after hip arthroscopy, and these criteria differ among elite and recreational athletes. For elite athletes, return to the preoperative level of competition is most commonly used, but there exists no consensus on what type of competition—regular season, preseason, or training—is most appropriate. For recreational athletes, patient-reported data are most commonly employed, although there are clear differences between authors on the ways in which these are being used as well.
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Affiliation(s)
- Deepak V Chona
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| | - John C Bonano
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Marc R Safran
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
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17
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Parvaresh KC, Wichman D, Rasio J, Nho SJ. Return to Sport After Femoroacetabular Impingement Surgery and Sport-Specific Considerations: a Comprehensive Review. Curr Rev Musculoskelet Med 2020; 13:213-219. [PMID: 32147778 PMCID: PMC7251016 DOI: 10.1007/s12178-020-09617-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE OF REVIEW Recent advancements in surgical technology and techniques have improved functional results for operative treatment of femoroacetabular impingement syndrome (FAIS). Few studies have comprehensively evaluated the literature regarding return to sport criteria, timing, level, and rates. The purpose of this study was to review recent studies regarding return to play after surgical correction of FAIS. We will specifically evaluate the level of return to play and look to compare pre- and postoperative competition levels when available. We will also analyze timing of return to play from injury to surgery. Additionally, we will elucidate any sport-specific criteria that may determine readiness for return. RECENT FINDINGS Athletes with FAIS treated non-operatively have a low rate of return to sport and are often functionally limited in their level of performance. Surgical management of FAIS includes hip arthroscopy as well as open techniques. Current literature suggests a high rate of return to sport after contemporary surgery for FAIS at 87-93% overall. Rate of return to the same level of competition following surgery for FAIS is 55-83% in pooled studies. Limited evidence is available comparing postoperative rehabilitation protocols and timing of return among different sports. Operative treatment of FAIS results in high rates of return to sport and functional performance. The results of this study may help educate patients preoperatively in regard to the likelihood of functional return to sport and sport-specific considerations. Further research evaluating rehabilitation protocols and return criteria may better elucidate timing intervals for patients to maximize function while limiting complications.
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Affiliation(s)
- Kevin C Parvaresh
- Department of Orthopedic Surgery, Section of Young Adult Hip Surgery, Division of Sports Medicine, Rush Medical College of Rush University, Rush University Medical Center, Chicago, IL, USA
| | - Daniel Wichman
- Department of Orthopedic Surgery, Section of Young Adult Hip Surgery, Division of Sports Medicine, Rush Medical College of Rush University, Rush University Medical Center, Chicago, IL, USA
| | - Jonathan Rasio
- Department of Orthopedic Surgery, Section of Young Adult Hip Surgery, Division of Sports Medicine, Rush Medical College of Rush University, Rush University Medical Center, Chicago, IL, USA
| | - Shane J Nho
- Department of Orthopedic Surgery, Section of Young Adult Hip Surgery, Division of Sports Medicine, Rush Medical College of Rush University, Rush University Medical Center, Chicago, IL, USA.
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18
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Jones DM, Crossley KM, Ackerman IN, Hart HF, Dundules KL, O'Brien MJ, Mentiplay BF, Heerey JJ, Kemp JL. Physical Activity Following Hip Arthroscopy in Young and Middle-Aged Adults: A Systematic Review. SPORTS MEDICINE-OPEN 2020; 6:7. [PMID: 31993831 PMCID: PMC6987281 DOI: 10.1186/s40798-020-0234-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 01/02/2020] [Indexed: 01/31/2023]
Abstract
Background Hip arthroscopy is a common surgical intervention for young and middle-aged adults with hip-related pain and dysfunction, who have high expectations for returning to physical activity following surgery. The purpose of this review was to evaluate the impact of hip arthroscopy on physical activity post-arthroscopy. Methods A systematic search of electronic databases was undertaken in identifying studies from January 1st 1990 to December 5th 2019. The search included English language articles reporting physical activity as an outcome following hip arthroscopy in adults aged 18-50 years. Quality assessment, data extraction and synthesis of included studies were undertaken. Results Full text articles (n = 234) were assessed for eligibility following screening of titles and abstracts (n = 2086), yielding 120 studies for inclusion. The majority (86%) of the studies were level 4 evidence. One study reported objective activity data. The most frequently occurring patient-reported outcome measure was the Hip Outcome Score-sport-specific subscale (HOS-SS, 84% of studies). Post--arthroscopy improvement was indicated by large effect sizes for patient-reported outcome measures (standard paired difference [95% confidence interval] −1.35[−1.61 to −1.09] at more than 2 years post-arthroscopy); however, the majority of outcome scores for the HOS-SS did not meet the defined level for a patient-acceptable symptom state. Conclusion The current level of available information regarding physical activity for post arthroscopy patients is limited in scope. Outcomes have focused on patients’ perceived difficulties with sport-related activities with a paucity of information on the type, quality and quantity of activity undertaken. Level of Evidence Level IV, systematic review of Level 2 through to Level 4 studies
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Affiliation(s)
- Denise M Jones
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia.
| | - Kay M Crossley
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | | | - Harvi F Hart
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia.,Department of Physical Therapy, The University of Western Ontario, London, Ontario, Canada
| | - Karen L Dundules
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Michael J O'Brien
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Benjamin F Mentiplay
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Joshua J Heerey
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Joanne L Kemp
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
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Everhart JS, Poland S, Vajapey SP, Kirven JC, France TJ, Vasileff WK. CrossFit-related hip and groin injuries: a case series. J Hip Preserv Surg 2020; 7:109-115. [PMID: 32382437 PMCID: PMC7195938 DOI: 10.1093/jhps/hnz072] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 11/07/2019] [Accepted: 12/27/2019] [Indexed: 12/12/2022] Open
Abstract
To provide descriptive data on injury presentation and treatment and to identify risk factors for requiring surgical treatment for athletes presenting with CrossFit-related hip and groin injuries. CrossFit-related injuries (n = 982) were identified within a single hospital system from 2010 to 2017, with 83 (8.5% of total) identified hip or groin injuries. Patient demographics, injury diagnosis, surgical procedure and rehabilitation were assessed. Independent predictors of requiring surgery were analyzed via multivariate logistic regression analysis. Patients with hip or groin injuries were more often female (hip injuries: 63%; all injuries: 50%; P < 0.001) with mean age 34.3 years (standard deviation 10.9). Median symptom duration was 4 months with 70% reporting insidious onset. Most common diagnoses were femoral-acetabular impingement syndrome (34%), hamstring strain (11%), non-specific hip/groin pain (imaging non-diagnostic) (11%), hernia (7%) and iliotibial band syndrome (6%). Most (90%) required physical therapy (median 2 months). Surgery occurred in 24% (n = 12 hip arthroscopy, n = 5 inguinal hernia repair, n = 3 total hip arthroplasty), with 100% return to sport after arthroscopy or hernia repair. The only predictor of surgery was complaint of primarily anterior hip/groin pain (82% surgical patients, 46% non-surgical) (odds ratio 5.78, 95% confidence interval 1.44-23.1; P = 0.005); age, sex, body mass index, symptom duration and symptom onset (insidious versus acute) were non-significant (P > 0.25). CrossFit athletes with hip and groin injuries often present with prolonged symptoms with insidious onset. Most patients require several months of physical therapy and approximately one quarter require surgery. Patients presenting with primarily anterior hip/groin pain are at increased risk for requiring surgery. LEVEL OF EVIDENCE IV, case series.
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Affiliation(s)
- Joshua S Everhart
- Department of Orthopaedics, The Ohio State University, Sports Medicine Research Institute, 2835 Fred Taylor Drive, Columbus, OH 43202, USA
| | - Sarah Poland
- College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Sravya P Vajapey
- Department of Orthopaedics, The Ohio State University, Sports Medicine Research Institute, 2835 Fred Taylor Drive, Columbus, OH 43202, USA
| | - James C Kirven
- College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Thomas J France
- College of Medicine, The Ohio State University, Columbus, OH, USA
| | - W Kelton Vasileff
- Department of Orthopaedics, The Ohio State University, Sports Medicine Research Institute, 2835 Fred Taylor Drive, Columbus, OH 43202, USA
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20
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Ramos N, Youssefzadeh K, Gerhardt M, Banffy M. Results of hip arthroscopy in elite level water polo players with femoroacetabular impingement: return to play and patient satisfaction. J Hip Preserv Surg 2020; 7:116-121. [PMID: 32382438 PMCID: PMC7195926 DOI: 10.1093/jhps/hnz069] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 12/17/2019] [Accepted: 12/24/2019] [Indexed: 11/30/2022] Open
Abstract
Water polo places significant stress on the hip joint requiring repetitive hip flexion and rotation to elevate the body out of water for passing, shooting and blocking. Femoroacetabular impingement (FAI) is common in water polo athletes; however, no study to date has investigated the results of hip arthroscopy in this patient population. The purpose of this study was to determine return to play rates and satisfaction following hip arthroscopy for FAI in a cohort of elite level water polo players. A retrospective review of our surgical database was performed. Collegiate water polo players with clinical and radiographic FAI who underwent hip arthroscopy were identified. Pre- and post-operative modified Harris hip scores (mHHSs) were obtained. Patient surveys were administered to determine return to play rates, level of return to play, timing of return and patient satisfaction. A Wilcoxon ranked sum test was performed to compare pre- and post-operative outcome scores. Ten patients met inclusion criteria. Average age was 19.5 years old (SD ±1.08). All patients were male Division 1 collegiate water polo players. Median mHHS improved from 66.0 (SD ±7.9) pre-operatively to 89.5 (SD ±3.2) at average 1.6 years (range: 0.4-3.6 years) post-operatively. Patient survey responses demonstrated a 100% return to water polo and 100% return to the same level of play (NCAA Division 1) at mean 5.75 months (SD ±1.8). All patients (10/10) reported being satisfied with their surgical result. Our study results, suggest that return to sport rates and patient satisfaction are high in water polo players who undergo hip arthroscopy for FAI.
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Affiliation(s)
- Nicholas Ramos
- Kerlan Jobe Institute, 6801 Park Terrace, Los Angeles, CA 90045, USA
| | - Keon Youssefzadeh
- Kerlan Jobe Institute, 6801 Park Terrace, Los Angeles, CA 90045, USA
| | - Michael Gerhardt
- Kerlan Jobe Institute, 6801 Park Terrace, Los Angeles, CA 90045, USA
| | - Michael Banffy
- Kerlan Jobe Institute, 6801 Park Terrace, Los Angeles, CA 90045, USA
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Frank RM, Kunze KN, Beck EC, Neal WH, Bush-Joseph CA, Nho SJ. Do Female Athletes Return to Sports After Hip Preservation Surgery for Femoroacetabular Impingement Syndrome?: A Comparative Analysis. Orthop J Sports Med 2019; 7:2325967119831758. [PMID: 30915378 PMCID: PMC6429664 DOI: 10.1177/2325967119831758] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background Female patients undergoing surgery for femoroacetabular impingement syndrome (FAIS) often experience inferior clinical outcomes and higher failure rates when compared with male patients. The influence of athletic status on hip arthroscopic outcomes in female patients, however, is unclear. Purpose To compare patient-reported outcomes (PROs) of athletic and nonathletic female patients undergoing hip arthroscopic surgery for FAIS, and to determine the return-to-sports rate in the athlete group. Study Design Cohort study; Level of evidence, 3. Methods Two-year PROs were assessed in female patients who had undergone hip arthroscopic surgery for FAIS by a single surgeon. Patients who self-identified as athletes were compared with nonathletes. Preoperative and postoperative PRO scores including the Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sport-Specific (HOS-SS), modified Harris Hip Score (mHHS), and visual analog scale (VAS) for pain and satisfaction were analyzed and compared between athletes and nonathletes. Subanalysis was performed based on patient age and body mass index (BMI). Results A total of 330 female patients undergoing hip arthroscopic surgery for FAIS were identified. Of these, 221 patients identified as athletes (mean age, 29.1 ± 11.1 years; mean BMI, 23.0 ± 3.5 kg/m2) and 109 as nonathletes (mean age, 39.3 ± 11.4 years; mean BMI, 27.8 ± 5.8 kg/m2). Both groups demonstrated improvements in HOS-ADL, HOS-SS, mHHS, VAS for pain, and VAS for satisfaction scores (P < .001 for all). Athletes had significantly higher postoperative PRO scores compared with nonathletes (P < .001 for all). A 1:1 matched-pair subanalysis of 97 athletes and 97 nonathletes controlling for age and BMI indicated that these relationships held independently of potential demographic confounders (P < .001 for all). The number of patients meeting the minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) for the HOS-ADL, HOS-SS, and mHHS was significantly higher in athletes aged ≤25 years versus those aged >25 years and for athletes versus nonathletes (P < .05 for all). Further, 189 of 194 athletes returned to sports at a mean of 6.0 ± 3.9 months postoperatively, with 93.7% reporting returning to the same or higher level of competition. Conclusion Among female patients undergoing hip arthroscopic surgery for FAIS, patients considered athletes achieved superior clinical outcomes compared with patients considered nonathletes. In addition, younger female athletes had higher rates of achieving the MCID and PASS for all PRO measures.
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Affiliation(s)
- Rachel M Frank
- Division of Sports Medicine and Shoulder Surgery, Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Kyle N Kunze
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Edward C Beck
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - William H Neal
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Charles A Bush-Joseph
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Shane J Nho
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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Reider B. High Hopes for Hips. Am J Sports Med 2018; 46:2575-2577. [PMID: 30169138 DOI: 10.1177/0363546518794917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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