Nonoperative Management of Femoroacetabular Impingement in Adolescents: Clinical Outcomes at a Mean of 5 Years: A Prospective Study

Abstract

Background: There is a lack of midterm or long-term outcome data on nonoperative management of femoroacetabular impingement (FAI) syndrome in adolescents despite expanding research mostly focused on arthroscopic management. Purpose: To present 5-year outcome data utilizing a nonoperative protocol on a consecutive series of patients presenting to our clinic with FAI syndrome. Study Design: Cohort study, Level of evidence, 2. Methods: A total of 100 patients (62% female; mean age 15 years) who presented to the clinic for evaluation of hip pain and had at least 1 hip with a positive impingement sign were prospectively recruited. The management protocol consisted of an initial trial of rest, physical therapy, and activity modification. Patients who remained symptomatic were offered an intra-articular steroid injection. Patients with recurrent symptoms were then offered arthroscopic treatment. Patient-reported outcomes (PROs), including the modified Harris Hip Score (mHHS) and the Nonarthritic Hip Score (NAHS) were then collected at a mean 1, 2, and 5 years after the initial evaluation. Results: At enrollment, the mean mHHS and NAHS were 69.6 ± 12.9 and 75.5 ± 15.2, respectively. A total of 51 patients (n = 69 hips) were available at a mean 5-year follow-up, with the mean mHHS and NAHS of 89.5 ± 10.8 and 88.1 ± 12, respectively. There was no significant difference in the mHHS or the NAHS between activity modification and physical therapy, injection, or arthroscopic surgery groups at 5-year follow-up ( P > .6) and no difference in the proportion of hips meeting the minimal clinically important difference (MCID) for the mHHS based on treatment course ( P = .99). There was no significant difference in the mHHS or the NAHS between FAI types at any time point, or in the proportion of hips that met the MCID among FAI types ( P = .64). Also, 11 out of 12 hips that required surgery had surgery in less than 2 years. One hip underwent surgery at 5 years after the initial visit. There was no significant drop-off in the mHHS or the NAHS between the 2-year and 5-year time periods ( P > .3). Conclusion: Nonoperative management of FAI syndrome is effective in a majority of adolescent patients, with significant improvements in PROs persisting at a mean 5-year follow-up.

The Effect of a Formal Nonoperative Management Program Combining a Hip Injection With Structured Adjunctive Exercise Rehabilitation in Patients With Symptomatic Femoroacetabular Impingement Syndrome

“…The improvement seen in PROMs was reiterated at the 5-year follow-up. 42 A pilot RCT in 15 patients undertaken by Wright et al 40 revealed no early differences between a 6-week program consisting of supervised exercise and manual therapy (with additional home exercise and advice) versus a program of home exercise and advice only in patients with FAIS. Mansell et al 24,25 undertook an RCT of surgery versus a 6-week physical therapy program for FAIS, reporting improvement in both groups over 2 years, though no between-group differences.…”

“…Other studies investigating outcomes after nonoperative protocols have demonstrated improvement in PROMs, including the iHOT-33, HOS, and mHHS. 1,14,30,32,40,42 Although change in PROMs has been documented in studies, less so has the incorporation of detailed assessment of hip ROM, strength, and functional performance. In the current study, even though the absolute increase in hip ROM, strength, and hop measures was generally greater on the affected limb, resulting in a more symmetrical profile, it was encouraging to see significant gains on the affected and nonaffected limbs as a result of the program.…”

Femoroazetabuläres Impingement-Syndrom bei Adoleszenten – Wie beraten? Wie behandeln?

“…71 % kehrten zu ihrer sportlichen Aktivität zurück. Trotz methodischer Limitationen zeigte diese Arbeit, dass die nichtoperative Therapie in der adoleszenten FAIS-Population einen wichtigen Stellenwert hat und zu einer stabilen Verbesserung der klinischen Symptomatik über 5 Jahre bei der Mehrheit der untersuchten Patienten führte [ 31 ].…”

“Nonoperative Management of Femoroacetabular Impingement in Adolescents: Clinical Outcomes at a Mean of 5 Years: A Prospective Study”: Letter to the Editor

“…For several years, I have been following the work from Rady Children’s Hospital on nonoperative management of femoroacetabular impingement (FAI). 2,4 These studies, written by some of my mentors and friends, have had as much impact on my daily practice as any other study. I frequently print out the appendix of their original article, which contains a physical therapy (PT) protocol, and give it to patients with hip pain along with their PT referral.…”

“…Based on the methodology described in the 2 papers on nonoperative management of FAI, patients were included based on a positive “impingement sign” on examination (ie, pain with passive hip flexion, adduction, and internal rotation) and radiographic findings of impingement, such as a cam or pincer lesion. 2,4 Despite its name, the impingement sign is typically positive in both symptomatic FAI and dysplasia. Similarly, it is not uncommon to have some excess bone on the anterior femoral neck at the epiphyseal-metaphyseal junction in the setting of dysplasia.…”