Midterm Outcomes and Satisfaction After Hip Arthroscopy Are Associated With Postoperative Rehabilitation Factors

Abstract

Background: Arthroscopic hip-preservation surgery is commonly performed to address nonarthritic sources of hip pain in young, active individuals. However, there is little evidence to support postoperative rehabilitation protocols, including the most appropriate frequency and length of individual formal physical therapy sessions. There is also a lack of information to look at patients’ perceived value of their home program/self-practice in relation to outcomes. Purpose: To investigate postoperative rehabilitation factors after hip arthroscopy related to formal physical therapy and home program/self-practice and their correlation with patient outcomes and satisfaction. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 125 patients who underwent hip arthroscopy for femoroacetabular impingement syndrome and a labral tear (75 men) were included. The mean age was 34.6 ± 14.4 years, and the mean follow-up time was 4.9 ± 1.6 years. Hip Outcome Score–Activities of Daily Living subscale (HOS-ADL) scores, overall satisfaction scores, and factors related to supervised physical therapy and home program/self-practice were collected. Correlations between continuous variables and differences in the length of individual formal physical therapy and patients’ rating of the importance of their home program/self-practice between those who would and those who would not undergo surgery again were assessed. Results: The frequency and length of individual formal physical therapy sessions were significantly correlated with postoperative HOS-ADL scores ( r = 0.22, P = .014; and r = 0.24, P = .007, respectively) and level of satisfaction ( r = 0.24, P = .007; and r = 0.21, P = .02, respectively). The length of individual formal physical therapy sessions was significantly greater in those who noted they would undergo surgery again (35.3 vs 26.3; P = .033). A significant correlation was identified between the rating of the importance of their home program/self-practice and postoperative HOS-ADL scores ( r = 0.29; P = .001) and their level of satisfaction ( r = 0.23; P = .009). There was a significant difference in the rating of the importance of their home program/self-practice between those who would undergo surgery again and those who would not (8.9 vs 7.8; P = .007). Conclusion: Surgeons and physical therapists should emphasize the value of home program/self-practice when it comes to outcomes and may want to encourage their patients to participate in more frequent, longer, formal physical therapy sessions.

Rehabilitation and Return to Sport After Arthroscopic Treatment of Femoroacetabular Impingement: A Review of the Recent Literature and Discussion of Advanced Rehabilitation Techniques for Athletes

“…Amar et al demonstrated improved outcomes with increased frequency and duration of physical therapy, as well as the importance of a home program when considering patients that would choose surgical treatment again. 6 In a unique study, Cvetanovich et al queried the International Society for Hip Arthroscopy (ISHA) surgeon database and reviewed their websites for rehabilitation protocols; even in this select group, considerable variability was identified. 7 Together with two physical therapists, Domb described two-year outcomes and associated clinical guidelines for physical therapy following hip arthroscopy.…”

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

“…Of the 23 studies, three were randomized controlled trials (RCTs), 23,27,30 four pilot RCTs, 19,25,29,34 four RCT study protocols, 21,36,37,41 five prospective case series, 20,22,24,26,32 one feasibility study, 28 and six retrospective case series. 31,33,35,[38][39][40] Sample size ranged from 15 to 348. The studies used exercise therapy alone, [19][20][21][22][23][24][25][26][27][28][29]40,41 or in combination with hip surgery.…”

“…The studies used exercise therapy alone, [19][20][21][22][23][24][25][26][27][28][29]40,41 or in combination with hip surgery. [30][31][32][33][34][35][36][37][38][39]…”

“…The studies reported mean ages ranging from 23-43 years and included participants with a diagnosis of FAIS, [19][20][21][22][23][24][25]27,29,30,[34][35][36][37][38] dysplasia, 26,28,41 FAIS and borderline dysplasia, 33,39 hip-related pain, 31,40 and chondrolabral pathology. 32…”

“…Six (26%) studies 21,25,29,30,34,36 sufficiently described the title and qualifications of the prescriber. Of the studies that did not report this item, eleven studies 20, 23,24,[26][27][28]32,37,38,40,41 described the professional title (primarily physical therapists) but not qualifications or experience, while six studies 19,22,31,33,35,39 provided no details about the prescribers.…”