Acute and Subacute Changes in Hip Strength and Range of Movement After Arthroscopy to Address Chondrolabral Pathology

Are Exercise Therapy Protocols For The Treatment of Hip-Related Pain Adequately Described? A Systematic Review of Intervention Descriptions

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.

Hip Strength Before and After Arthroscopic Femoroacetabular Impingement Surgery

Femoroacetabular impingement (FAI) and labral pathology are associated with pain, decreased function, and hip strength deficits. Existing data are in conflict regarding when hip strength normalizes following arthroscopic treatment of FAI. The objective of this study was to identify preoperative hip strength relative to the contralateral hip not undergoing surgery as well as when postoperative strength in 4 functional muscle groups normalizes following arthroscopic treatment of FAI. Ninety-eight individuals with radiographic evidence of FAI and labral pathology underwent arthroscopic labral repair. Pre-surgical hip strength testing was performed in the symptomatic "surgical hip" and the contralateral "non-surgical hip." Hip strength measurements were repeated at 8 and 16 weeks postoperatively. Significant preoperative hip strength deficits were noted in the surgical hip compared with the non-surgical hip in flexion, extension, and adduction. At 8 weeks postoperatively, hip strength in the surgical hip improved to being equivalent to that in the non-surgical hip in adduction and extension, remained equivalent to that of the non-surgical hip in abduction, and decreased in flexion relative to the non-surgical hip. At 16 weeks, hip strength remained equivalent in the surgical hip and the non-surgical hip in abduction and adduction, but the surgical hip exceeded the non-surgical hip in extension. While flexion strength improved between 8 and 16 weeks postoperatively for the surgical hip, it had not fully recovered to that of the non-surgical hip. Using a structured postoperative rehabilitation protocol, abduction strength was maintained at 8 weeks postoperatively, while adduction and extension strength had improved to those of the non-surgical hip. At 16 weeks postoperatively, hip abduction and adduction had strength equivalent to those of the non-surgical hip. Despite preoperative improvement, flexion of the surgical hip lagged behind that of the non-surgical hip 16 weeks postoperatively. [Orthopedics. 2021;44(3):148-153.].

Acute and sub-acute changes in dynamic postural control following hip arthroscopy and post-operative rehabilitation."

CONTEXT

Hip pain is associated with impairments in postural control and balance. The Star Excursion Balance Test (SEBT) is a reliable and valid method to measure dynamic postural control.

OBJECTIVE

Examine changes to dynamic postural control following hip arthroscopy and subsequent rehabilitation from pre-surgery to three and six months post arthroscopy.

SETTING

Sixty-seven individuals (47 men) scheduled for hip arthroscopy to address chondrolabral pathology were matched with sixty-seven healthy controls. The hip pain group underwent post-operative rehabilitation including SEBT training.

MAIN OUTCOME MEASURES

SEBT reach normalized to limb length was collected pre-surgery and at three and six months post surgery, and compared with healthy matched controls. Repeated measure analysis of variance (ANOVA) evaluated whether SEBT reach differed between the three time points and t-tests were used to evaluate between-limb and between-group differences.

RESULTS

Pre-surgical SEBT reach was significantly less than the control group in all directions (p<0.001). At three months post surgery, SEBT reach significantly increased in the posterior-lateral (PL) (p<0.001), anterior-lateral (AL) (p<0.001) and posterior-medial (PM) (p=0.006) directions from pre-surgery. At six months post surgery, all directions of reach had significantly increased (p<0.001) from baseline. Compared to the control group, AL (-2.5 %, p=0.038), anterior medial (AM) (-2.9%, p=0.019) and posterior-medial (PM) (-5.2%, p= 0.002) reach remained significantly less at six months post surgery. No significant difference existed between the control and surgical groups for reach in the PL (-3.6%, p=0.061) direction.

CONCLUSIONS

Pre-surgical dynamic balance control within a hip pain group was significantly poorer than matched controls as measured by the SEBT. At three months post hip arthroscopy, there were significant improvements in dynamic balance in the PM, PL and AL SEBT directions. By six months post surgery, all directions of SEBT reach had significantly improved but only PL reach improved to the level of healthy controls.

Treatment of the Wave Sign With Femoral Osteoplasty With and Without Chondrolabral Stabilization Using Suture Anchors

PURPOSE

To discuss the surgical outcomes of patients identified to have the wave sign without an accompanying labral tear treated with and without stabilization of the chondrolabral junction in conjunction with femoral osteoplasty.

METHODS

A retrospective study was performed in patients with cartilage delamination (wave sign) treated with femoral osteoplasty alone (FO group) or femoral osteoplasty with chondrolabral stabilization (CLS group). Patient-reported outcomes including the modified Harris Hip Score, Hip Outcome Score (HOS)-Activities of Daily Living, and HOS-Sports-Specific Subscale were obtained at a minimum of 2 years postoperatively. Other outcomes included rates of revision hip arthroscopy and conversion to hip arthroplasty.

RESULTS

The study consisted of 47 patients in the FO group and 38 in the CLS group. Both groups showed significant increases in all patient-reported outcomes over the study period compared with preoperative values. The final modified Harris Hip Score was 72.8 ± 9.2 in the FO group and 79.9 ± 9.3 in the CLS group (P < .001). The HOS-Activities of Daily Living in the FO and CLS groups was 81.4 ± 10.3 and 87.2 ± 7.5, respectively (P < .001). There was no difference in the HOS-Sports-Specific Subscale between the FO group (74.4 ± 10.3) and the CLS group (78.0 ± 14.6) at final follow-up (P = .198). Revision hip arthroscopy was required in 5 patients in the FO group (13%) and 3 in the CLS group (6.3%). No patient in either group required conversion to hip arthroplasty throughout the study period.

CONCLUSIONS

Chondrolabral stabilization in conjunction with femoral osteoplasty is an effective treatment in patients with the wave sign without labral tears.

LEVEL OF EVIDENCE

Level III, retrospective cohort study.

Functional Condition of Patients after Unilateral Hip Arthroscopy in the Process of FAI-Femoroacetabular Impingement: A Case-Control Study and Preliminary Report

Introduction: Femoroacetabular impingement is a commonly recognized condition among people with hip pain. Aim: The aim of this study was to assess how arthroscopy and physiotherapy treatment influenced the quality of life and functional condition of patients after arthroscopic femoroacetabular impingement (FAI) surgery. Materials and methods: We examined 19 people for the study and included 12 (6 men and 6 women). Their mean age was 40.1 ± 9.7 years. Manual and digital goniometers were used for the range of motion (ROM) measurements, and a dynamometer for muscle strength was used. Results from the operated limb were compared to the nonoperated healthy limb. We examined the patient’s health and well-being using the Harris Hip Score (HHS) and Short-Form Health Survey (SF-36) scales. The mean follow-up period was 21.2 months. Results: The postsurgery mean range of motion for all movements was lower in the operated limb. Statistically significant differences between limbs in ROM were observed for flexion, abduction, extension, and external rotation. Muscle strength was comparable between hip joints, except extension and adduction, which were statistically significantly weaker. The mean strength of the hip flexors and internal rotators was higher in the operated limb. After surgery, 67% of patients returned to exercise at the same or higher level. The mean HHS results were good, with values of 88.00 ± 11.48. The SF-36 scores were >50. Conclusion: After surgery and physiotherapy of FAI, ROM remained lower in the operated limb. Flexion and rotations remained to cause pain. The strength of flexors and internal rotators improved, and there was a high rate of return to sport.