Functional Condition of Patients after Unilateral Hip Arthroscopy in the Process of FAI—Femoroacetabular Impingement: A Case–Control Study and Preliminary Report

Abstract

Introduction: Femoroacetabular impingement is a commonly recognized condition among people with hip pain. Aim: The aim of this study was to assess how arthroscopy and physiotherapy treatment influenced the quality of life and functional condition of patients after arthroscopic femoroacetabular impingement (FAI) surgery. Materials and methods: We examined 19 people for the study and included 12 (6 men and 6 women). Their mean age was 40.1 ± 9.7 years. Manual and digital goniometers were used for the range of motion (ROM) measurements, and a dynamometer for muscle strength was used. Results from the operated limb were compared to the nonoperated healthy limb. We examined the patient’s health and well-being using the Harris Hip Score (HHS) and Short-Form Health Survey (SF-36) scales. The mean follow-up period was 21.2 months. Results: The postsurgery mean range of motion for all movements was lower in the operated limb. Statistically significant differences between limbs in ROM were observed for flexion, abduction, extension, and external rotation. Muscle strength was comparable between hip joints, except extension and adduction, which were statistically significantly weaker. The mean strength of the hip flexors and internal rotators was higher in the operated limb. After surgery, 67% of patients returned to exercise at the same or higher level. The mean HHS results were good, with values of 88.00 ± 11.48. The SF-36 scores were >50. Conclusion: After surgery and physiotherapy of FAI, ROM remained lower in the operated limb. Flexion and rotations remained to cause pain. The strength of flexors and internal rotators improved, and there was a high rate of return to sport.

Clinical Commentary: A Criteria-Based Testing Protocol for Return to Sport Post Hip Arthroscopy for Impingement

“…It has been shown that the pathology of FAI causes a significant difference in hip range of motion in the planes of flexion, abduction, extension, external rotation (ER) and internal rotation (IR). 22,23 Clinicians should consider contralateral hip FAI morphology or range of motion limitations when clearing an athlete in this category. 22 The recommended passing criteria is pain-free active and passive range of motion within five degrees of the contralateral hip in all planes with consideration to any contralateral hip morphology.…”

“…22,23 Clinicians should consider contralateral hip FAI morphology or range of motion limitations when clearing an athlete in this category. 22 The recommended passing criteria is pain-free active and passive range of motion within five degrees of the contralateral hip in all planes with consideration to any contralateral hip morphology. In this situation, clinicians can reference previously established normative ranges of motion for the hip joint bearing in mind the influences of factors such as age, gender, and race.…”

“…23 When possible, the device should be fixated against a stable base to avoid any error in measurement from clinician pressure or losing joint position during isometric testing. 22,23 Not only should the clinician look at the amount of force produced but also the quality of muscle contraction as well as any compensatory movements or patterns noted during the test. Proper setup for HHD strength testing of the hip has been previously described using a belt with an emphasis on a fixed and stable base.…”

“…Proper setup for HHD strength testing of the hip has been previously described using a belt with an emphasis on a fixed and stable base. 22,23 The authors encourage using HHD to test all six motions across three planes.…”

Hip Range of Motion Is Increased After Hip Arthroscopy for Femoroacetabular Impingement: A Systematic Review

“…Clinical examination typically reproduces pain upon specific patterns of hip movement: flexion, adduction and internal rotation (FADIR, impingement test), and/or flexion, abduction, and external rotation (FABER test). 1 , 2 , 3 Additional diagnostic workup includes a loss or marked reduction in hip ROM between the affected and unaffected contralateral joint, 2 , 4 , 5 , 6 or in the case in which symptoms are experienced bilaterally, significant restriction in the available ROM from the acceptable normative ranges. 7 Owing to the typical location of these deformities, movements such as flexion, adduction, and internal rotation 10 , 11 , 12 , 13 , 8 , 9 often are reduced with abduction and external rotation being spared.…”