ContextRehabilitation following hip arthroscopy is an integral component of the clinical outcome of the procedure. Given the increase in quantity, complexity, and diversity of procedures performed, a need exists to define the role of rehabilitation following hip arthroscopy.Objectives(1) To determine the current rehabilitation protocols utilized following hip arthroscopy in the current literature, (2) to determine if clinical outcomes are significantly different based on different post-operative rehabilitation protocols, and (3) to propose the best-available evidence-based rehabilitation program following hip arthroscopy.Data sourcesPer PRISMA guidelines and checklist, Medline, SciVerse Scopus, SportDiscus, and Cochrane Central Register of Controlled Trials were searched.Study selectionLevel I–IV evidence clinical studies with minimum 2-year follow-up reporting outcomes of hip arthroscopy with post-operative rehabilitation protocols described were included.Data extractionAll study, subject, and surgery parameters were collected. All elements of rehabilitation were extracted and analyzed. Descriptive statistics were calculated. Study methodological quality was analyzed using the modified Coleman methodology score.ResultsEighteen studies were included (2,092 subjects; 52% male, mean age 35.1 ± 10.6 years, mean follow-up 3.2 ± 1.0 years). Labral tear and femoroacetabular impingement were the most common diagnoses treated and labral debridement and femoral/acetabular osteochondroplasty the most common surgical techniques performed. Rehabilitation protocol parameters (weight-bearing, motion, strengthening, and return to sport) were poorly reported. Differences in clinical outcomes were unable to be assessed given heterogeneity in study reporting. Time-, phase-, goal-, and precaution-based guidelines were extracted and reported.ConclusionThe current literature of hip arthroscopy rehabilitation lacks high-quality evidence to support a specific protocol. Heterogeneity in study, subject, and surgical demographics precluded assimilation of protocols and/or outcomes to generate evidence-based guidelines. Strengths and limitations in the literature were identified. Future studies should recognize and report the essentials of rehabilitation following hip arthroscopy.

Background: Hip arthroscopy for femoroacetabular impingement syndrome (FAIS) is a rapidly expanding field, and preoperative factors predictive of persistent postoperative pain are currently unknown. Purpose: To identify predictors for persistent postoperative pain at the site of surgery after hip arthroscopy for FAIS. Study Design: Case-control study; Level of evidence, 3. Methods: Patients who underwent hip arthroscopy for FAIS and had a minimum 2-year follow-up with patient-reported outcomes (PROs) were included in this study. Patients with previous open hip surgery and diagnoses other than FAIS were excluded. Patients were grouped by visual analog scale scores for pain as limited (<30) and persistent (≥30). Patient factors and outcomes were analyzed with univariate and correlation analyses to build a logistic regression model to identify predictors of persistent postoperative pain. Results: The limited pain (n = 514) and persistent pain (n = 174) groups totaled 688 patients (449 females). There was a statistically significant difference in age between groups, with the persistent pain group being older than the low pain group (35.9 ± 12.2 vs 32.4 ± 12.6, respectively; P = .002). Patients with persistent postoperative pain demonstrated significantly lower preoperative PRO scores in the Hip Outcome Score–Activities of Daily Living (57.6 ± 21.2 vs 67.7 ± 16.8), Hip Outcome Score–Sport Specific (35.9 ± 23.9 vs 44.1 ± 22.7), modified Harris Hip Score (51.6 ± 16.2 vs 59.6 ± 12.9), and International Hip Outcome Tool (32.0 ± 16.8 vs 40.0 ± 17.82) but no significant differences in preoperative visual analog scale scores for pain (7.3 ± 1.8 vs 7.2 ± 1.7). Mean postoperative PRO differences between pain groups were all statistically significant. Bivariate logistic regression analysis demonstrated that history of anxiety or depression (odds ratio, 1.8; 95% CI, 1.02-3.32; P = .042), revision hip arthroscopy (odds ratio, 8.6; 95% CI, 1.79-40.88; P = .007), and a low preoperative modified Harris Hip Score (odds ratio, 0.97; 95% CI, 0.95-0.99; P = .30) were predictors of persistent postoperative pain. Conclusion: Independent predictors for persistent postoperative pain include revision hip arthroscopy and mental health history positive for anxiety and depression. Our analysis demonstrated significant improvements in pain and functional PROs in the limited pain and persistent pain groups; however, those with persistent pain demonstrated significantly lower PRO scores.

The objective of this study was to validate three‐dimensional (3D) proximal femoral surface models generated from a 1.5 T magnetic resonance imaging (MRI) by comparing these 3D models to those derived from the clinical “gold standard” of computed tomography (CT) scan and to ground‐truth surface models obtained by laser scans (LSs) of the excised femurs. Four intact bilateral cadaveric pelvis specimens underwent CT and MRI scans and 3D surface models were generated. Six femurs were extracted from these specimens, and the overlying soft tissues were removed. The extracted femurs were then laser scanned to produce a ground‐truth surface model. A 3D‐3D registration method was used to compare the signed and absolute surface‐to‐surface distances between the 3D models. Absolute agreement was evaluated using a 95% confidence interval (CI) derived from the precision of the LS ground‐truth. Paired samples t tests and Kolmogrov–Smirnov tests were performed to compare the differences between the signed and absolute surface‐to‐surface distances between the models. The average signed surface‐to‐surface distances for the MRI vs LS and MRI vs CT models were 0.07 and 0.16 mm, respectively. These differences fell within the 95% CI of ±0.20 mm indicating absolute agreement between the surface models generated from these modalities. The signed surface‐to‐surface distance was significantly smaller for MRI vs LS ground truth model as compared with the CT vs LS model. Femoral models derived from a 1.5 T MRI scan demonstrated absolute agreement with the clinical gold standard of CT‐derived models and were most like LS ground truth models of the excised femurs.

Kipp, K, Malloy, PJ, Smith, J, Giordanelli, MD, Kiely, MT, Geiser, CF, and Suchomel, TJ. Mechanical demands of the hang power clean and jump shrug: a joint-level perspective. J Strength Cond Res 32(2): 466-474, 2018-The purpose of this study was to investigate the joint- and load-dependent changes in the mechanical demands of the lower extremity joints during the hang power clean (HPC) and the jump shrug (JS). Fifteen male lacrosse players were recruited from a National Collegiate Athletic Association DI team, and completed 3 sets of the HPC and JS at 30, 50, and 70% of their HPC 1 repetition maximum (1RM HPC) in a counterbalanced and randomized order. Motion analysis and force plate technology were used to calculate the positive work, propulsive phase duration, and peak concentric power at the hip, knee, and ankle joints. Separate 3-way analysis of variances were used to determine the interaction and main effects of joint, load, and lift type on the 3 dependent variables. The results indicated that the mechanics during the HPC and JS exhibit joint-, load-, and lift-dependent behavior. When averaged across joints, the positive work during both lifts increased progressively with external load, but was greater during the JS at 30 and 50% of 1RM HPC than during the HPC. The JS was also characterized by greater hip and knee work when averaged across loads. The joint-averaged propulsive phase duration was lower at 30% than at 50 and 70% of 1RM HPC for both lifts. Furthermore, the load-averaged propulsive phase duration was greater for the hip than the knee and ankle joint. The joint-averaged peak concentric power was the greatest at 70% of 1RM for the HPC and at 30%-50% of 1RM for the JS. In addition, the joint-averaged peak concentric power of the JS was greater than that of the HPC. Furthermore, the load-averaged peak knee and ankle concentric joint powers were greater during the execution of the JS than the HPC. However, the load-averaged power of all joints differed only during the HPC, but was similar between the hip and knee joints for the JS. Collectively, these results indicate that compared with the HPC the JS is characterized by greater hip and knee positive joint work, and greater knee and ankle peak concentric joint power, especially if performed at 30 and 50% of 1RM HPC. This study provides important novel information about the mechanical demands of 2 commonly used exercises and should be considered in the design of resistance training programs that aim to improve the explosiveness of the lower extremity joints.