Strength and range of movement deficits are associated with symptom severity in people scheduled for hip arthroscopy

Freke, Matthew; Kemp, Joanne L; Crossley, Kay M; Sims, Kevin; Russell, Trevor; Semciw, Adam

doi:10.1002/ejp.1371

Cited by 12 publications

(6 citation statements)

References 45 publications

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“…Also, an association between thickness of the hip capsule and lower ROM has been reported [ 33 ]. In one study, patients with FAIS with more severe symptoms had significantly lower flexion ROM [ 9 ]. In another study, elite football players who had a previous time-loss injury to the hip or groin were found to have significantly lower ROM, regardless of cam morphology [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

Less hip range of motion is associated with a greater alpha angle in people with longstanding hip and groin pain

Estberger

Pålsson

Kostogiannis

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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Purpose A higher alpha angle has been proposed to correlate with lower hip range of motion, but the association in people with longstanding hip and groin pain is currently unclear. The aims were to: (1) assess the association between range of motion and alpha angle in patients with longstanding hip and groin pain; (2) examine if a cut-off value in range of motion variables could identify patients with an alpha angle above or below 60°. Methods Seventy-two participants were consecutively recruited from an orthopaedic department after referral for hip- and groin-related pain. Passive hip range of motion was measured in flexion, internal rotation with 90° hip flexion, internal rotation in neutral hip position, external rotation with 90° hip flexion, and abduction. The alpha angle was calculated from a frog-leg lateral radiograph. Linear regression examined the association between range of motion and alpha angle, and an ROC-curve analysis was performed to identify the sensitivity and specificity of range of motion cut-offs. Results Lower range of motion in internal rotation in flexion, external rotation, and abduction were associated with higher alpha angle. Internal rotation of 27° or less displayed good sensitivity (81%) and specificity (85%) to detect an alpha angle above 60°, while a cut-off of 41° in external rotation and 27° in abduction showed a sensitivity of 72% and specificity of 50% and 60%, respectively. Conclusion Less internal rotation in flexion, external rotation, and abduction are associated with a greater alpha angle in a cohort of people with longstanding hip and groin pain. A cut-off of 27° in internal rotation has good sensitivity and specificity to identify people with an alpha angle above or below 60° and have the potential to be used in the clinical setting to identify patients that require further imaging, or that are unlikely to have cam morphology. Level of evidence II.

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Section: Discussionmentioning

confidence: 99%

Less hip range of motion is associated with a greater alpha angle in people with longstanding hip and groin pain

Estberger

Pålsson

Kostogiannis

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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“…Retrospective cohort NR 14 200 NR 65 NR 24 Ellenrieder (2017) 21 Case series NR 12 c 30 44.2 38 45.4 3 Flores (2020) 22 Cohort 2 18 59 35.8 72 34.2 24 Frank (2016) 23 Prognostic cohort 2 21 75 37.38 75 38.41 24 Freke (2019) 24 Cross-sectional 3 16 66 NR 48 NR NR Fukushima (2021) 25 Retrospective cohort NR 11 c 5 46.2 0 NR 12 (mean: 40.2) Glein (2021) 28 Cohort 3 21 73 26.4 73 25.6 3, 12, annually Gupta (2016) 30 Case series 4 16 228 NR 367 NR 24 Haynes (2018) 33 Prospective cohort NR 15 254 NR 1321 NR 36 Hetsroni (2013) 34 Retrospective comparative, cross-sectional 45 Case series 4 12 c 810 NR 805 NR 18.7 (mean) Laurito (2021) 46 Retrospective cohort 2 16 131 39 63 43 17 (mean) Lee (2010) 47 Therapeutic case series (retrospective)…”

Section: Hos-ssmentioning

confidence: 99%

Sex-Based Differences in Prevalence, Outcomes, and Complications of Hip Arthroscopy for Femoroacetabular Impingement: A Systematic Review and Meta-analysis

Owen

Gohal

Angileri

et al. 2023

Orthopaedic Journal of Sports Medicine

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Background: Trends between the sexes have been reported regarding prevalence, patient-reported outcomes (PROs), and complications of hip arthroscopy (HA) for femoroacetabular impingement syndrome (FAIS), yet current results lack consensus. Purpose: To evaluate sex-based differences after HA for FAIS in (1) prevalence of cam and pincer morphology in FAIS and (2) PROs, pain scores, and postoperative complication rates. Study Design: Systematic review; Level of evidence, 4. Methods: The EMBASE, PubMed, and Ovid (MEDLINE) databases were searched from establishment to February 28, 2022, according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Included studies had sex-based data on prevalence, outcomes, and complications of HA for FAIS. Reviews and commentaries were excluded. Data were combined, and between-sex differences were analyzed. Meta-analyses using random-effects models were performed when possible. Pooled risk ratios (RRs) and standardized mean differences were calculated. Results: A total of 74 studies were included (213,059 patients; 132,973 female hips [62.4%] and 80,086 male hips [37.6%]). The mean age was 30.7 ± 7.7 years among male patients and 31.1 ± 7.8 years among female patients. Male patients experienced mixed-type impingement significantly more often (39.4% vs 27.2% for female patients; RR = 0.69 [95% confidence interval [CI], 0.58-0.81]; P < .001), whereas female patients experienced pincer-type impingement more often (50.6% vs 30.8% for male patients; RR = 2.35 [95% CI, 1.14-4.86]; P = .02). Male patients had higher likelihoods of undergoing femoroplasty (89.8% vs 77.4% for female patients; RR = 0.90 [95% CI, 0.83-0.97]; P = .006), acetabuloplasty (67.1% vs 59.3% for female patients; RR = 0.87 [95% CI, 0.79-0.97]; P = .01), or combined femoroplasty/acetabuloplasty (29.2% vs 14.5% for female patients; RR = 0.63 [95% CI, 0.44-0.90]; P = .01). Although female patients showed greater improvements in Hip Outcome Score–Sport-Specific subscale ( P = .005), modified Harris Hip Score ( P = .006), and visual analog scale pain ( P < .001), both sexes surpassed the minimal clinically important difference at 1, 2, and 5 years postoperatively. Female patients had higher complication rates ( P = .003), although no sex-based differences were found in total hip arthroplasty conversion rates ( P = .21). Conclusion: Male patients undergoing HA for FAIS had a higher prevalence of mixed-type FAIS while female patients had more pincer-type FAIS. Female patients gained greater improvements in PROs, although both sexes exceeded the minimal clinically important difference, suggesting that both male and female patients can benefit from HA.

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“…A limited ability to exert hip flexor force is likely due to a varying combination of pain inhibition [158], decreased neural drive and/or muscle weakness. The association between increased symptoms and decreased strength has been reported in previous studies that found individuals with hip pain who reported very low scores in the iHOT33 subscale of symptoms and functional limitations presented with significantly less flexion strength when compared to individuals with moderate or mild scores [62]. Hip strength deficits are consistently described in people with hip pain when compared to asymptomatic controls [64,67,119].…”

Section: Discussionmentioning

confidence: 71%

“…One hundred and forty-six patients aged 19-50 years (90 men) were recruited, seventy-eight were included in the final analysis (Figure 1). Data and methodology of collection from subsets of this cohort have been published in other papers [62,[64][65][66].…”

Section: Participantsmentioning

confidence: 99%

Clinical predictors of outcome following hip arthroscopy

Freke¹

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Intra-articular hip pathology, including femoro-acetabular impingement syndrome (FAIS), is a cause of hip and groin pain in otherwise healthy young adults. While arthroscopic surgery in the hip joint has historically lagged behind its counterparts in the shoulder and knee, there has recently been a rapid evolution of the management of hip injuries in the young, active population utilizing hip arthroscopic techniques which has improved understanding of mechanical hip pathology. The aims of this thesis were to; investigate the clinical presentation of individuals scheduled to undergo hip arthroscopy; assess and report pre-operative deficits in hip strength, range of movement (ROM) and dynamic balance; determine the changes that occur post surgery, and; identify potentially modifiable predictors of outcome post arthroscopy.A review of literature revealed that there is limited evidence that those with FAI syndrome have reduced hip abduction and flexion ROM compared to healthy matched controls. There were no differences in hip adduction or extension ROM, and conflicting results for external rotation and internal rotation ROM. However, people with symptomatic FAIS demonstrated deficits in hip muscle strength and reduced dynamic balance on one leg when compared to controls. For hip joint ROM, there were no significant within-group differences between pre and post intervention time points while hip muscle strength improved significantly from pre to post-hip arthroscopy in a single case series.In people undergoing hip arthroscopy, severe femoral head chondropathy, large labral tears, along with a high prevalence of labral pathology and acetabular chondropathy, were relatively common findings. Severe femoral head chondropathy and large labral tears were most associated with patient related outcomes (PROs), however, at best only explained 22% of the variability. Individuals with hip pain and severe scores in the International Hip Outcome Tool (iHOT33) subscale of symptoms and functional limitations presented with significantly lesser hip muscle strength and hip flexion ROM when compared to individuals with moderate or mild scores. Individuals scheduled for arthroscopic hip surgery were also significantly weaker, had less hip mobility and reduced dynamic balance compared to healthy matched controls. In the hip pain population, dynamic balance performance was associated with various hip strength and ROM measurements in a direction specific manner. The clinical significance of these findings may assist therapists in providing targeted rehabilitation programs for people with FAIS and chondrolabral hip pain to improve hip strength and ROM, help reduce symptoms and to improve function. 3 By three months post arthroscopy to address bony morphology and/or chondrolabral pathology, all directions of hip strength (with the exception of adduction squeeze in crook lying and flexion) and hip flexion ROM were significantly improved. While by six months post arthroscopy, strength in all directions, and flexion and rotation ROM were signifi...

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Strength and range of movement deficits are associated with symptom severity in people scheduled for hip arthroscopy

Cited by 12 publications

References 45 publications

Less hip range of motion is associated with a greater alpha angle in people with longstanding hip and groin pain

Less hip range of motion is associated with a greater alpha angle in people with longstanding hip and groin pain

Sex-Based Differences in Prevalence, Outcomes, and Complications of Hip Arthroscopy for Femoroacetabular Impingement: A Systematic Review and Meta-analysis

Clinical predictors of outcome following hip arthroscopy

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