Pain, activities of daily living and sport function at different time points after hip arthroscopy in patients with femoroacetabular impingement: a systematic review with meta-analysis

Kierkegaard, Signe; Langeskov‐Christensen, Martin; Lund, Bent; Naal, Florian D.; Mechlenburg, Inger; Dalgas, Ulrik; Casartelli, Nicola C.

doi:10.1136/bjsports-2016-096618

Cited by 78 publications

(93 citation statements)

References 56 publications

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“…A systematic review about pain, daily living activities, and returning after FAI surgery, found that the first clinically relevant improvement in hip pain was observed at 3 to 6 months after hip arthroscopy. Improvements in pain continued to postoperative 1 year [51]. Generally, we consider 1 year of follow-up, a sufficient time interval to predict if the patient could be a candidate for early revision surgery, including early conversion to THA.…”

Section: Discussionmentioning

confidence: 99%

Labral calcification plays a key role in hip pain and symptoms in femoroacetabular impingement

et al. 2020

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Background: Hip osteoarthritis (HOA) is the most common hip disorder and a major cause of disability in the adult population, with an estimated prevalence of end-stage disease and total hip replacement. Thus, the diagnosis, prevention, and treatment of the early stages of the disease in young adults are crucial to reduce the incidence of end-stage HOA. The purpose of this study was to determine whether (1) a relationship among the inflammatory status of labrum and synovium collected from patients with femoroacetabular impingement (FAI) would exist; and (2) to investigate the associations among the histopathological features of joint tissues, the pre-operative symptoms and the postoperative outcomes after arthroscopic surgery. Methods: Joint tissues from 21 patients undergoing hip arthroscopy for FAI were collected and their histological and immunohistochemical features were correlated with clinical parameters. Results: Synovial mononuclear cell infiltration was observed in 25% of FAI patients, inversely correlated with the hip disability and osteoarthritis outcome score (HOOS) pain and function subscales and with the absolute and relative change in total HOOS. All the labral samples showed some pattern of degeneration and 67% of the samples showed calcium deposits. The total labral score was associated with increased CD68 positive cells in the synovium. The presence of labral calcifications, along with the chondral damage worsened the HOOS post-op symptoms (adjusted R-square = 0.76 p = 0.0001). Conclusions: Our study reveals a relationship between the histologic labral features, the synovial inflammation, and the cartilage condition at the time of FAI. The presence of labral calcifications, along with the cartilage damage and the synovitis negatively affects the postoperative outcomes in patients with FAI.

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Section: Discussionmentioning

confidence: 99%

Labral calcification plays a key role in hip pain and symptoms in femoroacetabular impingement

et al. 2020

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“…Trials are currently underway to compare surgical with conservative management and to investigate efficacy of postsurgical physiotherapy interventions for FAI syndrome and chondropathology (Bennell et al, ; Palmer et al, ; Kemp et al, ; Tijssen et al, ; Griffin et al, ). Surgery to correct the bony alignment and repair or resect the damaged acetabular labrum has been advocated, with good outcomes reported postoperatively (Kemp et al, ; Kierkegaard et al, ) although recent research has indicated that function and participation in sport and physical activity is still reduced 1 year after surgery (Thorborg et al, ). More recently, conservative nonsurgical management approaches focusing on improving neuromuscular function around the hip have been proposed as an alternative (Casartelli et al, ; Casartelli et al, ; Casartelli et al, ; Pennock et al, ).…”

Section: Introductionmentioning

confidence: 99%

Hip muscle atrophy in patients with acetabular labral joint pathology

et al. 2019

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Intra‐articular hip joint pathology is a source of hip and groin pain in active individuals and is thought to be a precursor to hip osteoarthritis. Limited evidence exists to guide appropriate physiotherapy management for these patients. Identification of which hip muscles are affected may help clinicians to develop effective exercise programs. A cross‐sectional observational study in a hospital setting was conducted to investigate the size of individual hip abductor, hip extensor, and hip external rotator muscles in patients with acetabular labral joint pathology compared with age and sex matched healthy subjects. Twelve participants (eight females, four males), aged 20–53 years, with a medical diagnosis of unilateral acetabular labral tear and 12 healthy participants were recruited. Magnetic resonance imaging was used to assess cross‐sectional areas of the gluteus minimus, gluteus medius, upper gluteus maximus, lower gluteus maximus, piriformis, and quadratus femoris muscles bilaterally. Gluteus medius muscle cross‐sectional area was significantly different between groups (P < 0.01, effect size = 0.92) with muscle size found to be smaller in the pathology group. No differences were found for the other hip muscles (P > 0.05). These findings suggest that hip muscles are not all affected equally by the presence of intra‐articular hip joint pathology. Atrophy of specific hip muscles, which are important in hip joint and pelvic stability, may alter hip joint function during gait and functional tasks. Clinicians treating patients with intra‐articular hip joint pathology may need to prescribe exercises targeting the specific muscles with demonstrated dysfunction. Clin. Anat. 33:538–544, 2020. © 2019 Wiley Periodicals, Inc.

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“…Where sufficient data were available, sports activities were categorised using previously established criteria in which activities are grouped based on the mechanical load placed on the hip joint ( To accommodate heterogeneity in the reporting of duration of follow-up, data collection points were collated under the following time frames: ≤ 6 months, 7-12 months, 13-18 months, 19-24 months, ≥ 25 months. Improvements in activity-specific subscales are known to be limited beyond 2 years post-arthroscopy [11,35].…”

Section: Data Extraction Synthesis and Analysesmentioning

confidence: 99%

“…Despite this expectation, physical activity-related outcomes are only reported in approximately a quarter of studies investigating surgical intervention for FAIS [8], returning to sport or play being the predominant outcome assessed. A high level of return to sport/ return to play following hip arthroscopy (88-91%) has been reported in a number of systematic reviews [9][10][11][12][13][14][15][16] ; however, recent study findings suggest the need for a more expansive analysis, beyond these simplified nominal criteria, to assess the wider impact of hip arthroscopy on physical activity. When adding the further consideration of level to sports status, Ishøi et al [17] identified a relatively low return to pre-injury sport at pre-injury level of 57%, and Thorborg et al [18] identified that at 1 year post-arthroscopy, only 25% of patients that met physical activity reference scores commensurate with those expected in a healthy population.…”

Section: Introductionmentioning

confidence: 99%

Physical Activity Following Hip Arthroscopy in Young and Middle-Aged Adults: A Systematic Review

et al. 2020

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Background: Hip arthroscopy is a common surgical intervention for young and middle-aged adults with hiprelated pain and dysfunction, who have high expectations for returning to physical activity following surgery. The purpose of this review was to evaluate the impact of hip arthroscopy on physical activity post-arthroscopy. Methods: A systematic search of electronic databases was undertaken in identifying studies from January 1st 1990 to December 5th 2019. The search included English language articles reporting physical activity as an outcome following hip arthroscopy in adults aged 18-50 years. Quality assessment, data extraction and synthesis of included studies were undertaken. Results: Full text articles (n = 234) were assessed for eligibility following screening of titles and abstracts (n = 2086), yielding 120 studies for inclusion. The majority (86%) of the studies were level 4 evidence. One study reported objective activity data. The most frequently occurring patient-reported outcome measure was the Hip Outcome Score-sport-specific subscale (HOS-SS, 84% of studies). Post--arthroscopy improvement was indicated by large effect sizes for patient-reported outcome measures (standard paired difference [95% confidence interval] −1.35[−1.61 to −1.09] at more than 2 years post-arthroscopy); however, the majority of outcome scores for the HOS-SS did not meet the defined level for a patient-acceptable symptom state. Conclusion: The current level of available information regarding physical activity for post arthroscopy patients is limited in scope. Outcomes have focused on patients' perceived difficulties with sport-related activities with a paucity of information on the type, quality and quantity of activity undertaken. Level of Evidence: Level IV, systematic review of Level 2 through to Level 4 studies

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Pain, activities of daily living and sport function at different time points after hip arthroscopy in patients with femoroacetabular impingement: a systematic review with meta-analysis

Cited by 78 publications

References 56 publications

Labral calcification plays a key role in hip pain and symptoms in femoroacetabular impingement

Labral calcification plays a key role in hip pain and symptoms in femoroacetabular impingement

Hip muscle atrophy in patients with acetabular labral joint pathology

Physical Activity Following Hip Arthroscopy in Young and Middle-Aged Adults: A Systematic Review

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