Trajectory and rate of recovery of function,pain and activity level after hip arthroscopy

Abstract

Purpose:

Understanding the trajectory of recovery after hip arthroscopy is valuable to help manage expectations and recognise patients at risk for delayed recovery. The purpose of this study was to determine the recovery profile of function, pain, and activity level up to 2 years after hip arthroscopy.

Methods:

Patients from a single centre’s orthopaedic registry who underwent hip arthroscopy were identified. Function, pain, and activity level were measured using Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF), PROMIS Pain Interference (PI), a numeric pain scale (NPS), and Tegner Activity Scale (TAS) up to 2 years postoperatively. Nonlinear growth models were used to estimate the effect of recovery time on each outcome.

Results:

Of 92 patients identified, 64 (70%) were followed up to 2 years. There was significant improvement in all outcome measures at 2 years. The time to 50% recovery for PROMIS PF, PROMIS PI, and TAS was 11.0, 6.7, and 18.5 weeks, respectively. The time, in weeks, to full recovery of PROMIS PF, PROMIS PI, and TAS was estimated at 17.0, 37.4, and 28.8 respectively. NPS declined at a rate of -0.22 points per week, plateauing by 12 weeks.

Conclusions:

Physical function and activity levels plateau at 4 and 7 months respectively, while pain recovery is more variable. These results can help guide discussions with patients regarding recovery after hip arthroscopy and provide benchmarks for identifying patients who could benefit from changes in postoperative protocol.

Keywords

Activity level hip arthroscopy pain physical function recovery profile recovery rate

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References

Bozic

Chan

Valone

, et al Trends in hip arthroscopy utilization in the United States. J Arthroplasty 2013; 28(Suppl.): 140–143.

Bonazza

Homcha

Liu

, et al Surgical trends in arthroscopic hip surgery using a large national database. Arthroscopy 2018; 34: 1825–1830.

Beck

Kalhor

Leunig

, et al Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip. J Bone Joint Surg Br 2005; 87: 1012–1018.

Annin

Lall

Yelton

, et al Patient-reported outcomes in athletes following hip arthroscopy for femoroacetabular impingement with subanalysis on return to sport and performance level: a systematic review. Arthroscopy 2021; 37: 2657–2676.

Arciero

Kakazu

Garvin

, et al Favorable patient-reported outcomes and high return to sport rates following hip arthroscopy in adolescent athletes: a systematic review. Arthroscopy 2022; 38: 2730–2740.

Casartelli

Leunig

Maffiuletti

, et al Return to sport after hip surgery for femoroacetabular impingement: a systematic review. Br J Sports Med 2015; 49: 819–824.

Chen

Maldonado

, et al Outcomes of hip arthroscopic surgery in adolescents with a subanalysis on return to sport: a systematic review. Am J Sports Med 2020; 48: 1526–1534.

Lovett-Carter

Jawanda

Hannigan

Meta-analysis of the surgical and rehabilitative outcomes of hip arthroscopy in athletes with femoroacetabular impingement. Clin J Sport Med 2020; 30: 404–411.

Elwood

El-Hakeem

Singh

, et al Outcomes and rate of return to play in elite athletes following arthroscopic surgery of the hip. Int Orthop 2021; 45: 2507–2517.

10.

Alter

Knapik

Chapman

, et al Return to sport in athletes with borderline hip dysplasia after hip arthroscopy for femoroacetabular impingement syndrome. Am J Sports Med 2022; 50: 30–39.

11.

Ishøi

Thorborg

Kraemer

, et al Return to sport and performance after hip arthroscopy for femoroacetabular impingement in 18- to 30-year-old athletes: a cross-sectional cohort study of 189 athletes. Am J Sports Med 2018; 46: 2578–2587.

12.

Sjövall Anari

Olsson

Öhlin

, et al High-level soccer players have a low rate of return to performance after hip arthroscopy for femoroacetabular impingement syndrome. Knee Surg Sports Traumatol Arthrosc 2023; 31: 2071–2078.

13.

Snaebjörnsson

Anari

Lindman

, et al Most elite athletes who underwent hip arthroscopy for femoroacetabular impingement syndrome did not return to the same level of sport, but the majority were satisfied with the outcome of surgery. Arthrosc Sports Med Rehabil 2022; 4: e899–e906.

14.

Bodendorfer

Clapp

DeFroda

, et al The natural course of recovery after hip arthroscopy for femoroacetabular impingement according to the International Hip Outcome Tool-12 and Hip Outcome Score Sports Subscale. Am J Sports Med 2021; 49: 3250–3260.

15.

Christensen

Marland

Miller

, et al Trajectory of clinical outcomes following hip arthroscopy in female subgroup populations. J Hip Preserv Surg 2019; 6: 25–32.

16.

Lee

Nam-Woo Kim

Moran

, et al Patients undergoing primary hip arthroscopy report favorable outcomes at minimum 10 year follow-up: a systematic review. Arthroscopy 2023; 39: 459–475.

17.

Lee

Owens

Fong

, et al Athletes report favorable outcomes at 5-year minimum follow-up after primary hip arthroscopy: a systematic review. Arthroscopy 2023; 39: 510–528.

18.

Nwachukwu

Beck

Kunze

, et al Defining the clinically meaningful outcomes for arthroscopic treatment of femoroacetabular impingement syndrome at minimum 5-year follow-up. Am J Sports Med 2020; 48: 901–907.

19.

Röling

Hesseling

Mathijssen

NMC

, et al Hip arthroscopy for femoroacetabular impingement syndrome results in 2 recovery patterns based on preoperative pain and on arthritis: improvers and non-improvers. Arthrosc Sports Med Rehabil 2021; 3: e1481–e1490.

20.

Joseph

Pan

Cenkus

, et al Sex differences in self-reported hip function up to 2 years after arthroscopic surgery for femoroacetabular impingement. Am J Sports Med 2016; 44: 54–59.

21.

Robinson

Williamson

, et al

Do the outcomes of hip arthroscopy for femoroacetabular impingement change over time?

Orthop Traumatol Surg Res 2022; 108: 103157.

22.

Henn

Dubina

Jauregui

, et al The Maryland Orthopaedic Registry (MOR): design and baseline characteristics of a prospective registry. J Clin Orthop Trauma 2017; 8: 301–307.

23.

Harris

Taylor

Thielke

, et al Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inf 2009; 42: 377–381.

24.

Amtmann

Cook

Jensen

, et al Development of a PROMIS item bank to measure pain interference. Pain 2010; 150: 173–182.

25.

Johnson

Measuring pain. Visual analog scale versus Numeric Pain Scale: what is the difference?

J Chiropr Med 2005; 4: 43–44.

26.

Rose

Bjorner

Becker

, et al Evaluation of a preliminary physical function item bank supported the expected advantages of the Patient-Reported Outcomes Measurement Information System (PROMIS). J Clin Epidemiol 2008; 61: 17–33.

27.

Tegner

Lysholm

Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 1985; 198: 43–49.

28.

Nguyen

Friedman

Flores

, et al Fast starters and slow starters after hip arthroscopy for femoroacetabular impingement: correlation of early postoperative pain and 2-year outcomes. Am J Sports Med 2020; 48: 2903–2909.

29.

Martin

Harris

Ellis

, et al Comparison of the PROMIS and iHOT-12 in determining satisfaction levels after hip arthroscopy for FAIS. Orthop J Sports Med 2023; 11: 23259671231168887.

30.

Bodendorfer

DeFroda

Clapp

, et al Defining clinically significant improvement on the Patient-Reported Outcomes Measurement Information System test at 1-year follow-up for patients undergoing hip arthroscopy for the treatment of femoroacetabular impingement syndrome. Am J Sports Med 2021; 49: 2457–2465.

31.

Haws

Condidorio

Adler

, et al Diagnostic intra-articular injection with provocative functional testing predicts patient-reported outcomes following hip arthroscopy: a prospective investigation. J Hip Preserv Surg 2022; 9: 158–164.

32.

Kuhns

Reuter

Lawton

, et al Threshold values for success after hip arthroscopy using the Patient-Reported Outcomes Measurement Information System assessment: determining the minimum clinically important difference and Patient Acceptable Symptomatic State. Am J Sports Med 2020; 48: 3280–3287.

33.

Mohan

Johnson

Hevesi

, et al Return to sport and clinical outcomes after hip arthroscopic labral repair in young amateur athletes: minimum 2-year follow-up. Arthroscopy 2017; 33: 1679–1684.

34.

Wang

Lamba

Okoroha

, et al Long-term outcomes of primary hip arthroscopy with labral repair for femoroacetabular impingement: results at minimum 9-year follow-up. Orthop J Sports Med 2023; 11: 23259671231204337.

35.

Weber

Nakata

Mayer

, et al Return to sport after hip arthroscopy for femoroacetabular impingement syndrome in NCAA Division I athletes: experience at a single institution. Orthop J Sports Med 2020; 8: 2325967120918383.

36.

Schallmo

Fitzpatrick

Yancey

, et al Return-to-play and performance outcomes of professional athletes in North America after hip arthroscopy from 1999 to 2016. Am J Sports Med 2018; 46: 1959–1969.

37.

Vogel

Wright-Chisem

Alvero

, et al The promising 2-year performance of the Patient-Reported Outcomes Measurement Information System in primary hip arthroscopy for femoroacetabular impingement syndrome. Am J Sports Med 2024; 52: 998–1004.