Femoroacetabular impingement syndrome is a well-known cause of chronic hip pain in people with a high level of sporting activity. Femoroacetabular impingement is caused by morphological abnormalities of the hip joint that result in abnormal contact between the bone of the femur and the region of the acetabulum, chiefly during repeated movements with an increased range of motion. In many cases this condition is not amenable to conservative treatment and may be treated by hip arthroscopy. In the arthroscopic technique the anatomy of both regions is reshaped so that it approaches its normal form. Besides chronic pain and a restricted range of motion, femoroacetabular impingement syndrome has also been implicated in causing osteoarthritis in the long term, since this abnormal movement causes microtrauma which in turn extends the wear of the joint over a greater area.
Hip arthroscopy is now an internationally recognised and established technique for the surgical correction of femoroacetabular impingement syndrome. The great advantage of the arthroscopic technique lies in how little invasive it is, since the whole procedure is carried out through small portals in the skin. It is therefore greatly superior to the open surgical technique that was performed in the past, in which a large incision in the skin and dislocation of the hip were required.
The effectiveness of hip arthroscopy in this syndrome has been recorded extensively and in detail over the last 15 years in numerous publications in the international literature. All patients are required to follow a physiotherapy protocol postoperatively for a few weeks up to a few months, depending on the case. It is widely accepted that a sound programme of physiotherapy rehabilitation is a necessary factor in the final outcome of a successful hip arthroscopy. Physiotherapy rehabilitation protocols vary from surgeon to surgeon, from hospital to hospital and in some cases from country to country. It is very rare for a patient not to be placed under the supervision of a physiotherapist after hip arthroscopy. No clinical study has been carried out, however, comparing the outcome of patients who followed a physiotherapy programme postoperatively with those who followed no physiotherapy programme at all.
A recent study carried out at treatment centres in Australia set out to assess the effectiveness of a physiotherapy rehabilitation programme in patients who underwent hip arthroscopy for femoroacetabular impingement syndrome. The main hypothesis was that those who followed a physiotherapy rehabilitation programme would have significantly better results as regards the outcome scores for quality of life, and also function in sporting activities, at 14 weeks postoperatively than those who followed no physiotherapy programme.
For the study, patients over 16 years of age with femoroacetabular impingement syndrome who were scheduled for hip arthroscopy were identified and were selected at random. The patients were divided into two groups, those who followed physiotherapy postoperatively and those who followed no postoperative rehabilitation programme at all. The physiotherapy group followed seven physiotherapy sessions which included manual therapy, a rehabilitation programme at home, exercises in the gym and in a pool, while the control group followed no rehabilitation programme. The measurements were made at two weeks preoperatively and at 14 and 24 weeks postoperatively. The main outcome scores used were the International Hip Outcome Tool and the sport subscale of the Hip Outcome Score at week 14.
In all, 30 participants were used (14 in the physiotherapy group and 16 as the control group), who were randomised. For the 14-week results the physiotherapy group showed significantly greater improvement on the International Hip Outcome Tool outcome score and on the sport subscale of the Hip Outcome Score. There were no differences between the groups at week 24.
The authors concluded that a physiotherapy rehabilitation protocol, as part of the overall arthroscopic management of femoroacetabular impingement syndrome, can improve patient-reported outcomes at 14 weeks postoperatively, but not at 24 weeks. This is strong evidence that physiotherapy rehabilitation can accelerate a good result from hip arthroscopy. According to the authors, however, the sample of patients in this study was relatively small and they judge that larger similar studies are needed in order to confirm the results of this work.
Source: Bennell KL, Spiers L, Takla A, O''Donnell J, Kasza J, Hunter DJ, Hinman RS. Efficacy of adding a physiotherapy rehabilitation programme to arthroscopic management of femoroacetabular impingement syndrome: a randomised controlled trial (FAIR). BMJ Open. 2017.