Effectiveness of Nonoperative Management of Hip Microinstability

Short-term Outcomes After Hip Arthroscopic Surgery in Patients Participating in Formal Physical Therapy Versus a Home Exercise Program: A Prospectively Enrolled Cohort Analysis

BACKGROUND

Physical therapy is frequently utilized in the postoperative care of femoroacetabular impingement syndrome (FAIS). There has been limited research into the efficacy of a structured home exercise program (HEP) compared with formal physical therapy (FPT) in this patient population.

PURPOSE/HYPOTHESIS

The purpose was to evaluate the short-term outcomes of patients utilizing FPT versus an HEP after hip arthroscopic surgery for FAIS. It was hypothesized that both groups would show similar improvements regarding outcome scores, which would improve significantly compared with their preoperative scores.

STUDY DESIGN

Cohort study; Level of evidence, 2.

METHODS

Patients undergoing hip arthroscopic surgery for FAIS at a single center between October 2020 and October 2021 were prospectively enrolled. Patients were allowed to self-select FPT or an HEP and were administered a survey preoperatively and at 1 month, 3 months, 6 months, and 12 months postoperatively. The survey included the Single Assessment Numeric Evaluation, visual analog scale for pain, 12-item International Hip Outcome Tool, Patient-Reported Outcomes Measurement Information System Physical Function, and patient satisfaction with physical therapy and overall care. Statistical analysis was conducted between the 2 groups and within groups to compare preoperative and postoperative scores.

RESULTS

The patients' mean age was 32.6 ± 10.4 years, with 47.2% being female and 57.4% choosing the HEP. At 12 months postoperatively, no significant differences were reported between the FPT and HEP groups regarding the Single Assessment Numeric Evaluation score (P = .795), visual analog scale for pain score (P > .05), Patient-Reported Outcomes Measurement Information System Physical Function T-score (P = .699), 12-item International Hip Outcome Tool score (P = .582), and patient satisfaction (P > .05). Outcome scores at 12 months postoperatively were significantly improved from the preoperative scores across all measures in both groups (P < .001).

CONCLUSION

There were no significant differences regarding patient outcomes between FPT and the HEP at 1-year follow-up after hip arthroscopic surgery for FAIS when patients selected their own treatment, with both groups demonstrating significant improvements in their outcome scores from their preoperative values. These findings suggest that a structured HEP may be a viable alternative to FPT after hip arthroscopic surgery in patients who prefer a self-directed rehabilitation program.

A New Clinical Examination Algorithm to Prescribe Conservative Treatment in People with Hip-Related Pain

Hip-related pain is a common issue in active adults affecting their quality of life, mobility, and overall function, and it can lead to persistent disability. However, diagnosing hip-related pain is challenging due to the many potential sources and causes, including intra-articular and extra-articular pathology, and referred pain from other areas (lumbar or groin related pain). To address this, there is a need for a clinical algorithm based on the best available evidence and expert consensus. This algorithm could guide healthcare professionals in assessing and managing patients with hip-related pain, during the diagnosis, test selection, intervention, monitoring, and promoting collaboration among various healthcare providers. This clinical algorithm for hip-related pain is a comprehensive, flexible, adaptable to different settings, and regularly updated to incorporate new research findings. This literature review aims to establish a clinical algorithm specifically for prescribing exercise treatment to patients with hip-related pain, addressing their individual needs and enhancing their overall care.

Hip Pain and Movement Dysfunction Associated With Nonarthritic Hip Joint Pain: A Revision

The Academy of Orthopaedic Physical Therapy (AOPT), formerly the Orthopaedic Section of the American Physical Therapy Association (APTA), has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). This is an update to the 2014 Clinical Practice Guideline (CPG) for Hip Pain and Movement Dysfunction Associated with Nonarthritic Hip Joint Pain. The goals of the revision were to provide a concise summary of the contemporary evidence since publication of the original guideline and to develop new recommendations or revise previously published recommendations to support evidence-based practice. This current CPG covers pathoanatomical features, clinical course, prognosis, diagnosis, examination, and physical therapy interventions in the management of nonarthritic hip joint pain. J Orthop Sports Phys Ther 2023;53(7):CPG1-CPG70. doi:10.2519/jospt.2023.0302.

Effective Management Options for Treatment of Microinstability of the Hip: a Scoping Review

PURPOSE OF REVIEW

To review the recent literature identifying and summarizing the research involving management of microinstability of the hip and highlight new and evolving techniques in its treatment.

RECENT FINDINGS

Recent updates in the understanding of capsular management hip arthroscopy will likely lead to less revision surgery and a decreased incidence of persistent post-operative pain. Repair of residual capsular defects has shown good outcomes with high patient satisfaction. Capsular plication remains the gold standard for hips with increased pain that show signs of capsular laxity/deficiency on exam or imaging. Capsular reconstruction has shown equivalent results to other revision hip arthroscopy procedures with low rates of complications. Ligamentum teres pathology, although rare, should be considered a source of pain, particularly in patients with laxity on exam. In cases where CAM over-resection has occurred, remplissage using allograft is an effective option for restoring the capsular suction seal and stability. Microinstability is increasingly being recognized as a source of post-operative hip pain. Patients with collagen disorders remain a challenging clinical entity with increased rates of complications and post-operative pain. CAM resection should be performed carefully and not disrupt the suction seal but be sufficient to not cause further impingement. Improved evidence including well-designed prospective studies with large sample sizes will determine the future management of this complex problem.