Increased pelvic mobility and altered hip muscles contraction patterns: two-year follow-up cam-FAIS corrective surgery

Abstract

Femoroacetabular impingement syndrome (FAIS) surgery can produce improvements in function and patient satisfaction; however, data on muscle assessment and kinematics of high mobility tasks of post-operative patients is limited. The purpose of this study was to evaluate kinematics and muscle activity during a deep squat task, as well as muscle strength in a 2-year follow-up FAIS corrective surgery. Eleven cam morphology patients underwent motion and electromyography capture while performing a squat task prior and 2-years after osteochondroplasty and were BMI-, age- and sex-matched to 11 healthy control (CTRL) participants. Isometric muscle strength, flexibility and patient-reported outcome measures (PROMs) were also evaluated. Post-operative FAIS was significantly weaker during hip flexion (23%) and hip flexion-with-abduction (25%) movements when compared with CTRL, no improvements in squat depth were observed. However, post-operative FAIS increased the pelvic range of motion during the squat descent (P = 0.016) and ascent (P = 0.047). They had greater peak activity for the semitendinosus and total muscle activity for the gluteus medius, but decreased peak activity for the glutei and rectus femoris during squat descent; greater total muscle activity for the tensor fascia latae was observed during squat ascent (P = 0.005). Although not improving squat depth, post-operative patients increased pelvic ROM and showed positive PROMs. The muscle weakness associated with hip flexion and flexion-with-abduction observed at the follow-up can be associated with the alterations in the muscle activity and neuromuscular patterns. Rehabilitation programs should focus on increasing pelvis and hip muscles flexibility and strength.

The 2019 International Society of Hip Preservation (ISHA) physiotherapy agreement on assessment and treatment of femoroacetabular impingement syndrome (FAIS): an international consensus statement

“…A plan can also be developed to help the patient prepare both mentally and physically for surgery [ 21 ]. A pre-operative assessment of ROM, strength, general function, pain level and quality of life can be compared to post-operative assessments as well as the benefits of surgical invention and ultimately improve patient care [ 22 ]. Grant et al .…”

Hip Muscle Forces and Contact Loading During Squatting After Cam-Type FAI Surgery

“…The bi-articular semimembranosus acts to overcome the bodyweight load and extend the hip. Increased activation of the other synergist medial hamstring, the semitendinosus, was already explored postoperatively during squat descent 36 . However, the postoperative increase of the semimembranosus force only reached significance in the ascending phase of the squat, as perhaps during the descending phase, the static optimization approach may not have perfectly expressed the eccentric mechanisms that were altered by the joint pathology.…”

“…This study used a subset of participants enrolled in other studies 36,38 , and the main surgical findings are reported in Beaulé et al (2017) 6 . The study was approved by the hospital's and university's research ethics boards and all participants provided written informed consent for participation.…”

“…Besides, neuromuscular adaptations have been reported to influence symptoms and contribute to changes in biomechanical outcomes 19,[29][30][31][32] . Although several studies reported on hip biomechanics in patients from pre-arthritic hip disease 20,27,[33][34][35][36][37] , the effect on musculoskeletal loading in terms of the dynamic muscle forces and hip contact force (HCF) is still limited to gait 32,37,38 with little information during functional ROM. As osteochondroplasty of the cam morphology can decrease joint contact loading by 21-27% 39,40 , a further understanding of changes in muscle forces and their consequent effect on joint loading may provide benefits to design better pre-and/or postoperative FAI rehabilitation programs after corrective FAI surgery 41,42 .…”

Muscle and Hip Contact Forces in Asymptomatic Men With Cam Morphology During Deep Squat

“…The cam-type hip morphology is defined by an aspherical femoral head-neck that produces elevated alpha angles and decreased anterior head-neck offsets (Nötzli et al, 2002), and can result in anterior hip or groin pain, labral tears, and damage to the acetabular articular cartilage (Ito et al, 2001;Gosvig et al, 2008;Bowman et al, 2010;Speirs et al, 2013). Previous studies on FAI pathomechanism have speculated the existence of the cam-type morphology as causative to limit the functional range of motion (ROM), which has been shown in patients with cam-type FAI who demonstrated less hip and pelvic ROM during gait (Kennedy et al, 2009;Rylander et al, 2011;Brisson et al, 2013;Diamond et al, 2016;Ng et al, 2018b;Catelli et al, 2019b;Savage et al, 2021), deep squat (Lamontagne et al, 2009(Lamontagne et al, , 2011Ng et al, 2015;Bagwell et al, 2016;Catelli et al, 2019aCatelli et al, , 2020, stairs (Rylander et al, 2013;Diamond et al, 2018;Catelli et al, 2019aCatelli et al, , 2021, and clinical assessments (Kapron et al, 2012;Ng et al, 2016). Recent in silico analyses have demonstrated reduced hip contact forces (HCFs) compared to matched healthy individuals while performing different tasks (Catelli et al, 2019b(Catelli et al, , 2020(Catelli et al, , 2021.…”