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

Abstract

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

How Many Patients Achieve an Acceptable Symptom State After Hip Arthroscopy for Femoroacetabular Impingement Syndrome? A Cross-sectional Study Including PASS Cutoff Values for the HAGOS and iHOT-33

“…The fact that 60% did not achieve PASS in relation to sport is in line with a recent systematic review reporting that 64% of studies failed to achieve the PASS cutoff score for the HOS Sport subscale. 21 Thus, in a general population, achieving PASS in relation to sports function seems less likely than achieving PASS in relation to ADL. Such information should be included as part of the shared decision-making process before surgery.…”

“… 12 , 22 , 32 Additionally, many cohort studies suggest that hip arthroscopy for FAIS is associated with large and clinically relevant improvements in pain and function pre- to post-operatively. 17 , 23 , 24 , 30 , 39 Many patients, however, still present with persistent hip and groin pain and functional limitations after surgery, 17 , 18 , 21 , 39 indicating that discrepancies may exist between “getting better” and “feeling good.” 25 To better understand if patients consider their current state of health (eg, pain and function) to be at an acceptable level after hip arthroscopy for FAIS, the Patient Acceptable Symptom State (PASS) can be used. 5 , 25 A 2015 study determined the cutoff scores of the modified Harris Hip Score (mHHS) and the Hip Outcome Score (HOS) for patients to be considered to have achieved PASS.…”

“… 5 In addition, a recent systematic review showed that the majority of studies on hip arthroscopy did not achieve the PASS cutoff score for the HOS Sport subscale; however, this was measured across studies and not on an individual patient level. 21 Furthermore, recent consensus statements and systematic reviews do not recommend the use of mHHS and HOS to evaluate patients with FAIS due to lack of content validity. 11 , 15 , 40 The Copenhagen Hip and Groin Outcome Score (HAGOS) 38 and the International Hip Outcome Tool-33 (iHOT-33) 29 are recommended as the 2 preferred self-reported outcome measures to assess hip-related pain and function in young and middle-aged patients.…”

Low Self-Efficacy and High Kinesiophobia Are Associated With Worse Function in Patients With Femoroacetabular Impingement Syndrome

“…[4][5][6] Though many patients report improved pain and function following intervention; currently, both surgical and conservative treatments for FAIS are falling short of providing sustained benefit. [7][8][9] Conservative treatment including therapy and intraarticular hip injections can improve pain and function in the short term. 10 However, the vast majority of patients have relapsing pain and functional impairments and thus progress to surgical intervention.…”

Relationship of Average Outcomes Scores and Change in Status Requires Further Interpretation Between 1 and 2 Years Following Hip Arthroscopy

“…Analysis of outcomes after hip arthroscopy is an area of substantial interest, and systematic reviews demonstrate significant improvements in pain and function, high patient satisfaction, and low complication rates in short-, mid-, and long-term follow-up assessments. 2,8,12,22,29,30 Patients are most likely to achieve desired outcomes 3 to 6 months postoperatively, with improvements continuing for at least 2 years after hip arthroscopy for femoroacetabular impingement syndrome (FAIS). 6,13,26,37,40 When these studies are closely examined, it appears that the magnitude of change in the average score on patient-reported outcome measures (PROMs) between 1 and 2 years postoperatively is relatively small.…”