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

Takla, Amir; O’Donnell, John; Voight, Michael; Byrd, J. W. Thomas; Dienst, Michael; Martin, Rob Roy; Philippon, Marc J.; Enseki, Keelan R.; Andrade, Tony; Safran, Marc R.; Christoforetti, John J.; Martin, Hal David; Grant, Louise; Campbell, Ashley; Ryan, Mark; Tyler, Tim; McGovern, Ryan P.; Bizzini, Mario; Kohlrieser, David

doi:10.1093/jhps/hnaa043

Cited by 18 publications

(10 citation statements)

References 43 publications

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“…HA was found to be successful in 81.1% of the FAIS patients at a minimum of 2-years follow-up [ 38 ]. Whilst targeted postoperative physiotherapy is a valuable part of a surgical strategy [ 39 , 40 ], delayed surgery has been reported to be associated with significantly inferior outcomes [ 41 ] and worse intra-articular pathology [ 42 ]. This is important because FAIS is a risk factor for osteoarthritis [ 43–46 ], and so delayed surgical treatment may not only lead to prolonged symptoms but also result in earlier onset or worse degenerative change.…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic hip surgery offers better early patient-reported outcome measures than targeted physiotherapy programs for the treatment of femoroacetabular impingement syndrome: a systematic review and meta-analysis of randomized controlled trials

Mahmoud

Takla

Meyer

et al. 2022

Journal of Hip Preservation Surgery

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Targeted physiotherapy programs (TPP), and surgery, using either open surgical hip dislocation or hip arthroscopy (HA), are the treatment modalities available for femoroacetabular impingement syndrome (FAIS). Randomized controlled trials have recently been performed to compare these treatment options. This review was performed to provide a focused synthesis of the available evidence regarding the relative value of treatment options. A systematic search was performed of Medline, Embase, Cochrane Library and ClinicalTrials.gov databases. Inclusion criteria were randomized controlled trials comparing treatment methods. The Cochrane Risk of Bias assessment tool (RoB2) was used to assess the selected studies. A meta-analysis was performed between homogenous studies. Four trials were identified including 749 patients (392 males). The mean ages of the cohorts ranged between 30.1 and 36.2 years old. Three hundred thirty-five patients underwent HA by 46 surgeons among all trials. Fifty-two patients crossed over from the TPP to the HA group. One of the trials was found to have a high risk of bias, while the other three were between low risk and some concerns. The iHOT-33 was the most commonly used patient-reported outcome measure followed by the HOS ADL and EQ-5D-5L. Others scores were also identified. Scores from two trials could be pooled together for meta-analysis. Apart from SF-12 and GRC, all other scores have shown significantly better outcomes with HA in comparison to TPP at 8- and 12-months follow-up points. HA offers better patient-reported outcomes than TPP for management of FAIS at 8- and 12-months follow-up.

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Section: Discussionmentioning

confidence: 99%

Arthroscopic hip surgery offers better early patient-reported outcome measures than targeted physiotherapy programs for the treatment of femoroacetabular impingement syndrome: a systematic review and meta-analysis of randomized controlled trials

Mahmoud

Takla

Meyer

et al. 2022

Journal of Hip Preservation Surgery

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“…A progressive load is then applied during the fourth and last stage to increase hip muscle strength, endurance, function, dynamic balance and gait pattern. Progressive and adapted physical activities are recommended and manual therapy techniques are used to improve hip range of motion and reduce pain [ 25 , 26 , 27 , 28 , 29 ]. Rehabilitation is finally completed with a phase of increased muscle strength based on heavy load exercises and return to full function of the hip.…”

Section: Methodsmentioning

confidence: 99%

Evolution of Hip Muscles Strength in Femoroacetabular Impingement Patients Treated by Arthroscopy or Surgical Hip Dislocation: A Retrospective Exploratory Study

Servant

Fourchet

Pernoud

et al. 2022

Biology

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Hip arthroscopy and surgical hip dislocation (SHD) can be adequate surgical options for patients suffering from femoroacetabular impingement (FAI) syndrome, but there is to date no published data on their impact on hip muscles strength. The purpose of this retrospective study was, therefore, to evaluate it on a consecutive series of 50 FAI patients treated either by arthroscopy (n = 29, aged 27.4 ± 7.5 years, 76% of women) or SHD (n = 21, aged 25.9 ± 6.5 years, 38% of women) at La Tour Hospital between 2020 and 2021. The bilateral isometric strengths of eight hip-related muscles were evaluated before and three months after surgery (halfway through the rehabilitation program). For arthroscopy, a statistically significant (p < 0.05) reduction in hip muscles strength could be noted on the operated hamstrings (1.49 ± 0.43 vs. 1.39 ± 0.38 Nm/kg), flexors (1.88 ± 0.46 vs. 1.73 ± 0.41 Nm/kg), abductors (1.97 ± 0.42 vs. 1.72 ± 0.40 Nm/kg) and external rotators (1.17 ± 0.40 vs. 1.04 ± 0.37 Nm/kg). The abductors were the most affected muscles, with 45% of the patients suffering from a strength reduction ≥15%. The non-operated external rotators were also affected but to a lesser extent (1.21 ± 0.38 vs. 1.10 ± 0.36 Nm/kg). For SHD, a statistically significant strength reduction could be noted on the operated extensors (2.28 ± 0.84 vs. 2.05 ± 0.70 Nm/kg), abductors (1.87 ± 0.49 vs. 1.65 ± 0.41 Nm/kg), quadriceps (2.96 ± 0.92 vs. 2.44 ± 0.89 Nm/kg), external rotators (1.16 ± 0.42 vs. 0.93 ± 0.36 Nm/kg) and internal rotators (1.26 ± 0.38 vs. 0.96 ± 0.30 Nm/kg). The internal rotators were the most affected muscles, with 75% of the patients suffering from a strength reduction ≥15%. To conclude, particular attention should be paid to operated abductors for patients treated by arthroscopy as well as operated internal/external rotators, abductors and quadriceps for those treated by surgical hip dislocation. It reinforces that a rehabilitation method based on isolated muscle reinforcement and functional exercises that goes beyond three postoperative months is needed.

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“…In particular, microfracture procedures usually necessitate an extended period of non-weightbearing after surgery. 16 Therefore, this protocol does not replace the surgeon-specific rehabilitation regimen; rather, it may serve as a supplement to guide management.…”

Section: Overview Of Protocolmentioning

confidence: 99%

Return to Ballet Progression for Dancers After Hip Arthroscopy for Instability or Femoroacetabular Impingement Syndrome

Curley

Stack

Ruh

et al. 2023

Clinical Journal of Sport Medicine

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Ballet dancers may be predisposed to hip injuries because of the unique demands placed on the hips during dance training and performance. Hip arthroscopy can be used to address several of these symptomatic disorders, including hip instability and femoroacetabular impingement syndrome (FAIS). After hip arthroscopy, ballet dancers undergo a rehabilitation program to allow for healing, range of motion restoration, and progressive strengthening. Once patients complete the standard postoperative therapy program, a paucity of information is available to guide dancers back to the advanced hip movements involved in ballet. Therefore, the purpose of this clinical commentary is to present a stepwise rehabilitation protocol with return to ballet progression for dancers undergoing hip arthroscopy for instability or FAIS. Particular emphasis is placed on movement-specific exercises for ballet performers, and objective clinical metrics, to guide return to dance progression.

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

Cited by 18 publications

References 43 publications

Arthroscopic hip surgery offers better early patient-reported outcome measures than targeted physiotherapy programs for the treatment of femoroacetabular impingement syndrome: a systematic review and meta-analysis of randomized controlled trials

Arthroscopic hip surgery offers better early patient-reported outcome measures than targeted physiotherapy programs for the treatment of femoroacetabular impingement syndrome: a systematic review and meta-analysis of randomized controlled trials

Evolution of Hip Muscles Strength in Femoroacetabular Impingement Patients Treated by Arthroscopy or Surgical Hip Dislocation: A Retrospective Exploratory Study

Return to Ballet Progression for Dancers After Hip Arthroscopy for Instability or Femoroacetabular Impingement Syndrome

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