Return to Play in Amateur Soccer Players Undergoing Hip Arthroscopy: Short- to Mid-Term Follow-Up.

PURPOSE: To describe patient-reported outcomes (PROs) and return to play at any level in amateur soccer players undergoing hip arthroscopy for femoroacetabular impingement syndrome at short- to mid-term follow-up. METHODS: Data were prospectively collected and retrospectively reviewed for patients who underwent hip arthroscopy between March 2009 and June 2014. Patients who participated in amateur soccer within 1 year prior to surgery and intended to return to their sport after hip arthroscopy for femoroacetabular impingement syndrome were considered for inclusion in our study. Patients were excluded if they had a preoperative Tönnis osteoarthritis grade of 2 or greater, previous ipsilateral hip conditions or hip surgical procedures, or Workers' Compensation status. The patients from the initial group who had preoperative and minimum 2-year postoperative measures for the modified Harris Hip Score, Non-Arthritic Hip Score, Hip Outcome Score-Sports Specific Subscale, and visual analog scale for pain were included in our final group. In addition to PROs, data regarding the patients' return to soccer, surgical complications, and secondary surgical procedures were collected. RESULTS: A total of 41 patients were eligible for inclusion in our study, of whom 34 (82.9%) had a mean follow-up period of 47.4 months. Five patients were not eligible because they did not intend to return to soccer. There were 15 male hips (44.1%) and 19 female hips (55.9%). The mean age at surgery was 20.8 ± 7.4 years. All PROs and the visual analog scale score improved significantly from preoperatively to latest follow-up. Of the 34 patients, 27 (79.4%) returned to soccer. Of the patients who returned to soccer, 19 (70.4%) were competing at the same level or a higher level compared with their highest level within 1 year of surgery. Regardless of competitive level, 21 patients (77.8%) reported that their athletic ability was the same as or higher than it was within 1 year of surgery. CONCLUSIONS: Hip arthroscopy was associated with significant improvements in PROs for amateur soccer players. There was a high level of return to soccer and a high proportion of patients whose competitive level was similar or improved. As such, hip arthroscopy is a good option for soccer players, in the absence of underlying osteoarthritis, presenting with hip pathology. LEVEL OF EVIDENCE: Level IV, case series.

Implications of Core and Hip Injuries on Major League Baseball Pitchers on the Disabled List.

PURPOSE: To investigate the frequency of core and hip injuries in Major League Baseball (MLB) pitchers and their impact on performance, workload, and pitch type. METHODS: Demographic, performance data, and injury data were acquired for 330 MLB pitchers with 454 injuries placed on the disabled list (DL) from 2014 to 2015 seasons. Core and hip/groin injuries were analyzed in which injury year data were compared with career data and against other injury groups. RESULTS: Core injuries represented 14% of all injuries and hip/groin injuries represented 7%. Average days on the DL for core injuries were 47.0 (standard deviation 5.6) days and 37.7 (standard deviation 8.1) days for hip/groin injuries. Return from the DL the same season for core injuries was 78% and 73% for hip/groin injuries. Core injuries returned to the DL 46% of the time (73% for noncore injuries) and hip/groin returned 56% of the time (60% for nonhip/groin injuries). No changes in workload were noted except starters with core injuries pitched less innings/game (5.3 vs 4.9 innings/game, P = .031) and more pitches/game (85.5 vs 78.4 pitches, P = .026). Fastball velocity decreased in the core injury group the year of injury (91.6 vs 92.2 mph, P = .001). Core injuries had slightly fewer home runs/9 innings and fewer strikeouts/9 innings; hip/groin injuries had slightly more strikeouts/9 innings, with all other performance statistics no different between the groups including earned run average and wins above replacement. CONCLUSIONS: Core and hip injuries in MLB pitchers result in similar time on the DL compared with other injuries. Pitching workload during the year of injury does not seem to have a significant impact on sustaining a core or hip injury. Although there is a high rate of return to play from the DL, there is a high rate of reinjury in these pitchers more often for other injuries. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Assessing long-term return to play after hip arthroscopy in football players evaluating risk factors for good prognosis.

PURPOSE: Groin pain is the third most common disease in football players and has often been associated with hip pathology such as femoroacetabular impingement and labral lesions. Hip arthroscopy offers possibilities of function restoration via minimally invasive procedures. The aim of this study is to evaluate professional football player's injuries and their return to play after hip arthroscopy for FAI and labral injuries. METHODS: Patients that underwent hip arthroscopy between 2009 and 2014 were selected retrospectively. From this population, only professional soccer players competing at national level were included (Tegner 10). Arthroscopic surgery was proposed in patients with persistent pain. All patients were assessed for VAS score preoperatively and at 3, 6, 12 and 24 months post-op. HOS (sport and DLA) and mHHS tests were performed at the same time periods. RESULTS: All patients were men with a mean age of 26.5 ± 7.1 years old. Preoperative VAS (7.4 ± 1.3), HOS ADL (67.7 ± 5.5), HOS sport (37.6 ± 18.7) and mHHS (72.5 ± 8.8) showed improved scores during long-term follow-up. Time to return to play was 10.8 months (SD ± 4.3), with range between 4 and 20 months. Mean follow-up was 45.4 ± 15.6 months (range from 26 to 72 months). No differences were observed between non-active and active patients at final follow-up with respect to chondral lesions, but significant differences were observed with reference to management of the labrum (p = 0.031), where a higher rate of labrectomies existed among inactive patients and a higher rate of suture among active patients. CONCLUSIONS: Hip arthroscopy is a safe procedure with very good return to play results, but for optimized return to football one should consider patient age at the time of surgery, the condition of the labrum and low scores on the Harris Hip Score (mHHS) and HOS (sport version) as predictive factors for poor prognosis. Level of evidence IV.

Advanced Concepts in Hip Morphology, Associated Pathologies, and Specific Rehabilitation for Athletic Hip Injuries.

Hip and groin injuries comprise up to 17% of athletic injuries and can pose rehabilitation challenges for many athletes. Injuries involving abnormal femoral acetabular morphology, reduced range of motion, and decreased lumbopelvic strength and endurance also may increase the risk of injury to lower extremities and delay return to play if proper rehabilitation does not take place. The rehabilitation of athletic hip injuries requires a multifaceted interdisciplinary approach that manages the interplay of multiple factors to restore preinjury function and facilitate return to play. Emphasis should be placed on activity modification, preservation of the arcs of range of motion, functional strengthening of the lumbopelvic core, and optimization of proprioceptive and neuromechanical strategies. Communication between providers and the injured athlete also is crucial to ensure that proper therapeutic approaches are being applied.

Nonsurgical Treatment of Acetabular Labral Tears.

Clinical Scenario: Surgical treatment of acetabular labral tears has been explored in multiple studies, while there is a lack of research on the effectiveness of conservative methods. Focused Clinical Question: To what extent can nonsurgical treatment produce symptomatic or functional improvements in athletes with an acetabular labral tear? Summary of Search, Best Evidence Appraised, and Key Findings: The literature was searched for studies of patients with confirmed acetabular labral tears who participated in any level of sport. Four studies were located, all of which were included. Clinical Bottom Line: The research discussed in this review agreed that conservative management of acetabular labral tears produced measurable improvements in pain and function among the athletes studied, including their ability to participate in sport activities. Based on these findings, it appears that conservative management is effective at rehabilitating athletes with acetabular labral tears. However, this method should not be applied to every athlete based on the low strength of current research. Treatment plans should be decided upon on a case-by-case basis. Strength of Recommendation: The studies located were of low quality. The highest Oxford Center for Evidence-Based Medicine Level of Evidence achieved was 4. Higher level studies must be conducted before the conclusions of this research can be applied clinically with assertion. Strength of recommendation is level 3.

Recognizing and Managing Snapping Hip Syndrome in Dancers.

BACKGROUND: Snapping hip syndrome (SHS) is a common hip pathology in dancers. SHS can be either internal or external, resulting from muscle tendon tightness from repetitive hip flexion and extension, accompanied with hip abduction and/or external rotation. Muscular tightness may cause the tendon to become taut and snap over a bony prominence during hip movement, leading to muscular weakness and reduced range of motion from pain. Because SHS is poorly identified and can present similarly to other hip pathologies, many SHS incidences are underreported or misdiagnosed. Though SHS can begin as a harmless popping sensation, pain can become severe enough to limit dancers' activities and potentially result in the development of concomitant issues. EVALUATION: Physical examination for snapping hip includes moving the hip from flexion, abduction, and external rotation (FABER) into extension, adduction, and rotated to a neutral position. Dynamic ultrasound can also be used to study SHS, as using this method allows clinicians to observe the snapping tendon in real-time. Radiographs and magnetic resonance imaging may serve to rule out other differential diagnoses. MANAGEMENT: Conservative management through rehabilitative therapy is the standard for initial management. In severe cases, arthroscopic intervention may be useful in releasing tension in the pathological tendon. Active rest with training modifications should be attempted to mitigate further injury. CONCLUSION: Early and comprehensive examination and management can help to reduce SHS risk and potentially decrease the ability of this debilitating condition to derail a dancer's career.

Hip Arthroscopy in High-Level Baseball Players.

PURPOSE: To report the results of hip arthroscopy among high-level baseball players as recorded by outcome scores and return to baseball. METHODS: All patients undergoing hip arthroscopy were prospectively assessed with the modified Harris Hip Score. On review of all procedures performed over a 12-year period, 44 hips were identified among 41 intercollegiate or professional baseball players who had achieved 2-year follow-up. RESULTS: Among the 41 players, follow-up averaged 45 months (range, 24 to 120 months), with a mean age of 23 years (range, 18 to 34 years). There were 23 collegiate (1 bilateral) and 18 professional (2 bilateral) baseball players, including 10 Major League Baseball players. Of the 8 Major League Baseball pitchers, 6 (75%) also underwent ulnar collateral ligament elbow surgery. Improvement in the modified Harris Hip Score averaged 13 points (from 81 points preoperatively to 94 points postoperatively); a paired-samples t test determined that this mean improvement of 13 points was statistically significant (P < .001). Players returned to baseball after 42 of 44 procedures (95%) at a mean of 4.3 months (range, 3 to 8 months), with 90% regaining the ability to participate at their previous level of competition. There were no complications. Three players (1 bilateral) underwent repeat arthroscopy. CONCLUSIONS: This study supports the idea that arthroscopic treatment for a variety of hip pathologies in high-level baseball players provides a successful return to sport and improvement in functional outcome scores. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Evaluation of hip pain in young adults.

Hip pain is a common complaint in the young, athletic patient population. Primary, intra-articular sources of hip pain are becoming increasingly recognized by primary care providers and sports medicine specialists. Prior to deciding among the various treatment options for the many sources of hip pain in the athletic patient population, the clinician must be able to recognize and accurately diagnose the underlying pathology. Advances in imaging modalities and our understanding of the pathophysiology have improved our ability to accurately understand and diagnose the source of hip pain in this patient population. This review presents a comprehensive strategy for the workup and diagnosis of young, athletic patients presenting with hip pain, and provides the sports medicine specialist with the tools to correlate the patient's history, physical examination, and imaging findings and to treat these challenging patients.

What are athletes' perceptions of rehabilitation outcome 1 year after hip arthroscopy?

BACKGROUND: Hip arthroscopy is a minimally invasive surgical procedure. Femoroacetabular impingement (FAI) is being increasingly recognized as a cause of hip pain in athletes and is a growing indication for arthroscopic surgery. Few studies have attempted to address patient views on outcome after arthroscopy, and no qualitative studies have been carried out to date. OBJECTIVES: To explore athletes' perceptions of rehabilitation outcome, the rehabilitative process, and return to sport and to gain insight into factors that affected this process. METHODOLOGY: A retrospective qualitative approach was adopted using semistructured interviews. Eight eligible participants were interviewed. Each had been treated with hip arthroscopy for FAI from September to November 2010. Data were audiotaped, transcribed verbatim, and analyzed using thematic analysis. RESULTS: Three main themes emerged. (1) The ability to participate in sport; athletes were relatively satisfied with outcome despite some limitations in sporting ability. (2) Perceptions of hip problems; there was a lack of understanding and an association of hip problems with older people among the general public. (3) Athletes' perception of rehabilitation; athletes were dissatisfied with the rehabilitation and sought greater physiotherapy input. CONCLUSIONS: Overall, athletes were relatively satisfied with their outcome 1 y after hip arthroscopy, despite some having to adapt their sporting activities. Key areas that need to be addressed in future research include factors affecting outcomes of hip arthroscopy, longer-term outcomes, perception of FAI among the public and health practitioners, and the development of a standardized evidence-based rehabilitation protocol.

Return to play after hip arthroscopy with microfracture in elite athletes.

PURPOSE: The purpose of this study was to compare elite athletes who underwent hip arthroscopy with and without microfracture with respect to their ability to return to sport at the professional level. METHODS: All elite male athletes who underwent hip arthroscopy between 1999 and 2010 were identified. Inclusion criteria were hip arthroscopy with treatment of labrum, femoroacetabular impingement, cartilage, ligamentum teres, capsule, and/or loose body removal. Exclusion criteria were diffuse degenerative joint disease, previous surgery, plans to retire, labral reconstruction, soft tissue release, and concomitant lower extremity injury. Thirty-nine athletes underwent hip arthroscopy with microfracture and were assigned to the microfracture treatment group. Eighty-one elite athletes (94 hips) underwent hip arthroscopy without microfracture and were assigned to the control group. Sports played included hockey, soccer, football, baseball, tennis, and golf. RESULTS: Seventy-seven percent (30 of 39) of athletes in the microfracture treatment group and 84% (79 of 94) in the control group returned to play. There was no statistical difference in rate of return to play between groups (odds ratio = 1.6; 95% confidence interval, 0.633 to 4.049). Those players who did return were followed for an average of 3 years (range, 2 to 12). Athletes in the microfracture treatment group who returned have averaged 3 seasons thus far, and 73% are still playing. We found no significant difference in the microfracture group in age, time from injury to surgery, number of seasons played preoperatively, or size of lesion for return versus no return. We also found no increased risk of not returning because of contact sport, multiple lesions, or lesion on weightbearing surface. CONCLUSIONS: There was no detectable statistically significant difference in return to play rate after hip arthroscopy with microfracture and hip arthroscopy without microfracture. Professional athletes who underwent hip arthroscopy with microfracture procedure were able to return to the same high level of competition after surgery at a high rate. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Soothing suffering swimmers: a systematic review of the epidemiology, diagnosis, treatment and rehabilitation of musculoskeletal injuries in competitive swimmers.

BACKGROUND: This review details the examination, diagnosis, treatment and management of injuries encountered by competitive swimmers. Primarily, these involve the shoulder, however, the spine, knee and hip can be involved. Using the Coleman methodology score, we show that the methods used in obtaining and reporting clinical findings and intervention results could be improved. Where possible, we suggest improvements. SOURCES OF DATA: A literature review was conducted in English, Italian, French and German using PubMed, Google Scholar and Ovid search engines with strict inclusion/exclusion criteria. AREAS OF AGREEMENT: Poor technique, and high training intensity and distance are the most common cause of missed swim practice and competition through injury. AREAS OF CONTROVERSY: Few articles agree on a single method of each of clinical examination, diagnosis, treatment and rehabilitation. GROWING POINTS: Articles are consistently retrospective with few investigating spine, hip and knee injuries. AREAS TIMELY FOR DEVELOPING RESEARCH: Clinical findings and rehabilitation methods should be reported using a more structured method possibly based on the Coleman methodological scoring system.

Rehabilitation of Soft Tissue Injuries of the Hip and Pelvis.

The athlete's hip is complex when it comes to the surrounding musculature-approximately 21 different muscles can cross the hip and pelvis region, all synchronously working to maintain pelvic stability and functional hip activities. Commonly injured muscle groups for high-level athletes include flexors, adductors, abductors, and/or proximal hamstring musculotendinous complex. These muscle groups work in harmony; however, each has an independent function and propensity for injury. Rehabilitation phases for each injury group can be broken down into 3 phases: acute management, strengthening, and return-to-sport or return-to-competition phase. Specific rehabilitation principles and modalities are described for each injury group.

Hip and Knee Injuries.

Hip and knee injuries are a common presenting concern for patients to a primary care office. This pathology represents a large differential and it can often be a diagnostic challenge for providers to determine the etiology of a patient's symptoms. This article discusses several of the most common causes for hip and knee pain while providing an evidence based review of physical examination maneuvers, imaging studies and treatment modalities to assist a primary care provider when encountering active patients with underlying hip or knee pain.

Combined arthroscopic and modified open approach for cam femoroacetabular impingement: a preliminary experience.

PURPOSE: We report our case series of patients undergoing surgical treatment (femoral osteoplasty) for symptomatic cam femoroacetabular impingement (FAI). Clinical results using a modified Heuter anterior approach combined with adjunctive hip arthroscopy are presented. METHODS: A chart review of 16 hips (14 consecutive patients) was conducted. Radiographic parameters (alpha angle, head-neck offset, and Tönnis grade) were compared preoperatively and postoperatively. Clinical features (range of motion, provocative testing, and Harris hip score) were assessed. RESULTS: At 2.0 years, mean hip flexion improved from 94.1 degrees to 110.0 degrees (P < .01) and internal rotation from 7.1 degrees to 12.3 degrees (P = .02). The mean alpha angle improved from 64.5 degrees to 43.3 degrees (P < .01), whereas the mean femoral head-neck offset improved from 1.9 to 9.6 mm (P < .01). The mean Harris hip score improved from 63.8 to 76.1 (P = .01). No deterioration in overall radiographic Tönnis grades was present at last follow-up. CONCLUSIONS: The combination of hip arthroscopy with a limited anterior approach (Heuter) is a useful technique for patients with cam or cam-dominant FAI lesions. We believe the limited anterior approach with open osteoplasty presents a reasonable alternative to arthroscopic methods of osteoplasty with minimal drawbacks in the event that total hip arthroplasty is indicated in the future. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

[Rehabilitation of patients with post-traumatic coxarthrosis].

This paper reports the results of rehabilitative treatment of 102 patients with post-traumatic coxarthrosis. The data obtained during clinical and instrumental examination provided a basis for the development of a diagnostic algorithm that allows for objective verification of ethiopathogenesis of structural and functional disturbances in the supporting organ. An original approach is proposed based on distinguishing the principal clinical syndromes associated with post-traumatic coxarthrosis. Ways and means for medical rehabilitation of patients with post-traumatic coxarthrosis are reviewed with special reference to the mechanism of action of various therapeutic agents. Their combined application permitted to achieve a synergistic effect and thereby improve the functional outcome of remedial measures.

Evaluation of the Surgical Treatment of Patients over 90 Years Old with Hip Fractures and Their Morbidity and Mortality / Avaliação do tratamento cirúrgico de pacientes acima de 90 anos com fraturas de quadril e sua morbimortalidade

Abstract Objective: Hip fractures in older adults have the highest impact on the patient's health. These injuries result in many complications, reducing functional capability, quality of life, and life expectancy. This study aimed to provide more epidemiological data on the outcomes of these fractures in nonagenarians from a large city treated at a tertiary hospital. Methods: This study consisted of medical record reviews and interviews. Results: In this study, 76 patients underwent 82 surgeries. The mean age of the patients was 92.5 years. Ninety percent of the subjects were female. The patients spent 10.4 days in hospital. Surgery occurred on average 2.3 days after hospitalization. Regarding fractures, 46 were trochanteric (56%), and 34 affected the femoral neck (41.5%). Forty-one surgeries used the short proximal femoral nail (50%), and 18 were partial hip replacements (22%). During hospitalization, 46 patients (55%) had no complications, excluding episodes of delirium, and seven patients (9%) died. Forty-two subjects completed the one-year postoperative follow-up period, with 56% alive and 44% dead. Conclusions: Treating hip fractures in older patients is challenging. Our goal must focus on helping these subjects receive the quickest and least aggressive treatment possible and start mobilization early. We hope the data presented in this study can lead to a better understanding of the characteristics of our nonagenarian population with hip fractures and seek the best possible treatment for them.

Resumo Objetivo: As fraturas de quadril em idosos são as que mais impactam na saúde do paciente e estão associadas a muitas complicações, levando a redução da capacidade funcional, da qualidade de vida e da expectativa de vida. O nosso trabalho visa trazer mais dados epidemiológicos sobre os desfechos dessas fraturas em nonagenários em uma grande cidade atendidos em um hospital terciário. Métodos: O trabalho foi realizado através de revisão de prontuários e entrevistas. Resultados: Foram realizadas 82 cirurgias em 76 pacientes nesse período. A média de idade foi de 92,5 anos, 90% eram mulheres e ficaram 10,4 dias internados. A cirurgia foi realizada em média 2,3 dias após a internação. Do total, 46 fraturas foram trocantéricas (56%) e 34 do colo do fêmur (41,5%). Foram realizadas 41 cirurgias com a técnica da haste cefalomedular curta (50%) e 18 artroplastias parcial de quadril (22%). Durante a internação, 46 pacientes (55%) não apresentaram complicações, excluindo episódios de delirium, e 7 pacientes (9% dos casos) evoluíram para óbito. 42 pacientes já fecharam 1 ano após cirurgia: 56% estão vivos e 44% evoluíram para óbito. Conclusões: O tratamento de fraturas de quadril em pacientes idosos é desafiador. O nosso objetivo deve estar focado em ajudar esses idosos a receber um tratamento rápido e menos agressivo possível e a mobilizar precocemente. Esperamos que, com os dados apresentados nesse trabalho, possamos entender melhor acerca das características da nossa população nonagenária vítimas de fratura de quadril e buscar o melhor tratamento possível para esses pacientes.

Lower-extremity burn reconstruction in the child.

Lower-extremity burns in a pediatric patient require special consideration. The management of burn reconstruction in pediatric patients is often complex, requiring multiple reconstructive operations, and the primary intention of the surgeon is to prevent burn scar deformities. Timely management of the burn wound and postburn scars has decreased the incidence of burn scar deformities and contractures of the lower extremity in recent years. We present an overview of the principles of reconstruction techniques using skin grafting and biologic skin substitutes to restore the important barrier lost secondary to burns. In addition, we address methods of repairing scar contracture, a common occurrence in burn patients, at specific locations on the lower extremity. Finally, special scenarios such as burns associated with fractures, burn injury in insensate children, and Marjolin ulcer are discussed.

Return to Play After Hip Arthroscopy: A Systematic Review and Meta-analysis.

BACKGROUND: The use of arthroscopic treatment for intra-articular hip pathology has demonstrated improved patient-reported outcomes (PROs) with a lower rate of complications, reoperation, and patient morbidity as compared with traditional methods. Although the use of this minimally invasive approach has increased in prevalence, no evidence-based return-to-play (RTP) criteria have been developed to ensure an athlete's preparedness for sporting activities. PURPOSE: To determine if there exists sufficient evidence in the literature to support an RTP protocol and functional assessment after hip arthroscopy, as well as to assess the mean rate and duration of RTP. STUDY DESIGN: Systematic review and meta-analysis. METHODS: The search terms "hip arthroscopy," "return to play," and 10 related terms were searched in PubMed, Cochrane Library, Scopus, and Web of Science, yielding 263 articles. After screening, 22 articles were included. RTP timeline, rehabilitation protocols, and conditional criteria measures were assessed with previously established criteria. Pooled estimates were calculated for RTP rate and duration, and weighted mean scores were determined for PROs. RESULTS: A total of 1296 patients with 1442 total hips were identified. Although 54.5% (12 of 22) of studies did not provide a guideline for RTP duration after hip arthroscopy, 36.4% (8 of 22) recommended a duration of 4 months, while 9.1% (2 of 22) recommended 3 months. The most frequently described postoperative rehabilitation protocols were weightbearing guidelines (15 studies) and passive motion exercises (9 studies). Only 2 studies satisfied the criteria for a sufficient RTP protocol, and 3 provided a specific replicable test for RTP. The mean RTP duration was 7.4 months (95% CI, 6.1-8.8 months), and the return rate was 84.6% (95% CI, 80.4%-88.8%; P = .008) at a mean ± SD follow-up of 25.8 ± 2.4 months. Mean modified Harris Hip Score (mHHS) improved from 63.1 to 84.1 postoperatively (+33.3%), while Non-arthritic Hip Score improved from 61.7 to 86.8 (+40.7%). A lower preoperative mHHS was significantly associated with a higher postoperative improvement ( r = -0.95, P = .0003). CONCLUSION: Significant variability exists in RTP protocols among institutions owing to a lack of standardization. Despite a high overall rate of RTP and improvement in PROs after hip arthroscopy, the majority of rehabilitation protocols are not evidence based and rely on expert opinion. No validated functional test currently exists to assess RTP.

Arthroscopic Surgical Procedures Versus Sham Surgery for Patients With Femoroacetabular Impingement and/or Labral Tears: Study Protocol for a Randomized Controlled Trial (HIPARTI) and a Prospective Cohort Study (HARP).

Study Design Study protocol for a randomized controlled trial and a prospective cohort. Background The number of arthroscopic surgical procedures for patients with femoroacetabular impingement syndrome (FAIS) has significantly increased worldwide, but high-quality evidence of the effect of such interventions is lacking. Objectives The primary objective will be to determine the efficacy of hip arthroscopic procedures compared to sham surgery on patient-reported outcomes for patients with FAIS (HIP ARThroscopy International [HIPARTI] Study). The secondary objective will be to evaluate prognostic factors for long-term outcome after arthroscopic surgical interventions in patients with FAIS (Hip ARthroscopy Prospective [HARP] Study). Methods The HIPARTI Study will include 140 patients and the HARP Study will include 100 patients. The international Hip Outcome Tool-33 will be the primary outcome measure at 1 year. Secondary outcome measures will be the Hip disability and Osteoarthritis Outcome Score, Arthritis Self-Efficacy Scale, fear of movement (Tampa Scale of Kinesiophobia), Patient-Specific Functional Scale, global rating of change score, and expectations. Other outcomes will include active hip range of motion, hip muscle strength tests, functional performance tests, as well as radiological assessments using radiographs and magnetic resonance imaging. Conclusion To determine the true effect of surgery, beyond that of placebo, double-blinded placebo-controlled trials including sham surgery are needed. The HIPARTI Study will direct future evidence-based treatment of FAIS. Predictors for long-term development and progression of degenerative changes in the hip are also needed for this young patient group with FAIS; hence, responders and nonresponders to treatment could be determined. J Orthop Sports Phys Ther 2018;48(4):325-335. doi:10.2519/jospt.2018.7931.

The hip joint: arthroscopic procedures and postoperative rehabilitation.

Recent technological improvements have resulted in a greater number of surgical options available for individuals with hip joint pathology. These options are particularly pertinent to the relatively younger and more active population. The diagnosis and treatment of acetabular labral tears have become topics of particular interest. Improvements in diagnostic capability and surgical technology have resulted in an increased number of arthroscopic procedures being performed to address acetabular labral tears and associated pathology. Associated conditions include capsular laxity, femoral-acetabular impingement, and chondral lesions. Arthroscopic techniques include labral tear resection, labral repair, capsular modification, osteoplasty, and microfracture procedures. Postoperative rehabilitation following arthroscopic procedures of the hip joint carries particular concerns regarding range of motion, weight-bearing precautions, and initiation of strength activities. Postoperative rehabilitation protocols that have been typically used for surgeries such as total hip arthroplasty are often not sufficient for the population of patients undergoing arthroscopic procedures of the hip joint. Postoperative rehabilitation should be based upon the principles of tissue healing as well as individual patient characteristics. As arthroscopic procedures to address acetabular labral tears and associated pathology evolve, physical therapists have the opportunity to play a significant role through the development of corresponding rehabilitation protocols.