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

Abstract

Background: Although the initial treatment recommendations for femoroacetabular impingement syndrome (FAIS) may include nonsurgical therapies such as injections and rehabilitation, many patients undergo isolated injections or a rudimentary exercise regimen. Purpose: To investigate the benefit of an intra-articular hip injection and concomitant structured exercise rehabilitation program in patients with symptomatic FAIS ≥6 months. Study Design: Case series; Level of evidence, 4. Methods: For this study we recruited 49 patients with a mean age of 32.8 years (range, 16-56 years) and symptoms ≥6 months (range, 6-250 months) associated with FAIS, as confirmed via magnetic resonance imaging and radiography. After a guided intra-articular injection of corticosteroid and local anesthetic, patients underwent a structured 12-week rehabilitation program. Patients were assessed before and after injection (8 weeks and 4, 6, 12, and 24 months) with a range of patient-reported outcome measures (PROMs), including the 33-item International Hip Outcome Tool, Hip Outcome Score, modified Harris Hip Score, the Tegner Activity Score, a visual analog scale assessing the frequency and severity of hip pain, and a Global Rating of Change scale. Range of motion, peak isometric hip strength, and hop tests were assessed. Absolute scores and limb symmetry indices were calculated. The percentage of patients transitioning toward surgery over the period was evaluated. Results: Of the 44 patients who underwent the injection and completed the initial 8-week rehabilitation component, 14 (31.8%) progressed toward surgical intervention over the 24-month postinjection period owing to dissatisfaction and/or symptom recurrence. Patients who progressed toward surgery, as compared with those who did not, reported significantly worse ( P < .05) PROMs presurgery and more pain within the first 4 weeks after injection. In the nonoperative cohort, a significant improvement ( P < .05) in all PROMs was observed, with 93% of these patients satisfied overall. The Global Rating of Change did not improve, although this was measured only after the injection, reflecting no further significant perceived global change from 8 weeks to 24 months. A significant increase ( P < .05) in all hip range of motion and most isometric strength measures was observed at 8 weeks after injection, with these improvements largely sustained until 24 months. Bilateral improvements in hop capacity were observed, with hop test LSIs significantly improving for the single ( p = 0.009), triple ( p = 0.029) and triple crossover ( p = 0.005) hop tests for distance. Conclusion: Although 32% of patients progressed toward surgery, significant improvement in hip pain, symptoms, and physical function was observed in the majority of patients with symptomatic FAIS as a result of a targeted nonoperative management pathway consisting of an intra-articular injection and a structured exercise program.

Association of Chondrolabral Lesions with Ultrasound-Guided Detection of Pathological Head–Neck Contour

“…Besides the surgical treatment of femoroacetabular impingement (FAI), conservative therapeutic approaches are also discussed in the current literature. In a more recent publication in 2023, in which injections and physical therapy were combined, Ebert et al were able to achieve a significant improvement in the clinical findings for 32% of their patient cohort in a 2-year follow-up, although no long-term results were described [34]. Despite the therapeutic successes presented in the previously mentioned study using conservative therapy for FAI, a meta-analysis from the year 2020 was already able to demonstrate that surgical treatment is significantly superior to non-operative therapy [35].…”

Team Approach: Hip Preservation Surgery

“…Physical therapy is a key part of the team providing nonoperative care for individuals with hip joint-related pain 38 . Therapy begins with a compre-hensive examination, which allows the clinician to determine the extent to which a patient's pain problem and movement dysfunction are associated with the structural impairments identified by imaging.…”

Non-operative Management and Outcomes of Femoroacetabular Impingement Syndrome

“…More recently, a larger case series by Ebert et al examined 44 patients with FAIS and found significant improvement in pain and function after intra-articular corticosteroid injection followed by a structured 12-week rehabilitation program. While these improvements were largely sustained at 24 months, it should be noted that 32% of patients progressed to surgery [51]. It is important to note that these studies include a heterogeneous population which makes it difficult to draw firm conclusions regarding the benefit of corticosteroid injections in FAIS.…”