Hip arthroscopy is now the surgical treatment of choice in cases of femoroacetabular impingement. It is not uncommon for a long period of rehabilitation to follow, in which improvement may not come very quickly. The need for rapid rehabilitation is particularly common in athletes or people with generally increased sporting activity. In clinical practice it has been observed that the overwhelming majority of patients improve very quickly, in the first weeks after hip arthroscopy; there is, however, a small proportion in whom the improvement in symptoms may be considerably delayed.
Not many studies have been carried out that demonstrate the exact timing of the improvement in symptoms, particularly over the whole two-year period after surgery.
A new study published in the journal “American Journal of Sports Medicine” set out to answer this question; its aim was the prospective assessment of the changes in patient-reported outcomes during the first two years after hip arthroscopy performed for femoroacetabular impingement, and it analysed the time point at which the minimal clinically important difference (MCID) was achieved in the patient. The initial hypothesis of the study was that the clinically significant changes would be achieved one year after surgery.
The study population consisted of patients who underwent hip arthroscopy for femoroacetabular impingement and who were enrolled prospectively. The patients were assessed with patient-reported scores such as the 12-Item Short Form Health survey (SF-12), modified Harris Hip Score, and Hip disability and Osteoarthritis Outcome Score (HOOS). These scores were recorded preoperatively and at three months, six months, one year and two years postoperatively. The mean scores and the proportions of patients who reached the MCID at each time point were analysed. In total, 129 hips in 122 patients were assessed, all of which showed significant improvement after hip arthroscopy for femoroacetabular impingement. They reached the MCID in 95.8%, 93.6% and 84.8% for the HOOS-Sports, HOOS–Quality of Life (QoL) and HOOS-Pain scores respectively at the two-year follow-up. It was observed that the greatest improvement occurred at three months postoperatively, with smaller improvements at six months, one year and two years. The SF-12 physical component score, HOOS-Sports and HOOS-QoL continued to show statistically significant improvements within the two years, while the other scores plateaued after three months.
The authors observed that after hip arthroscopy there is a continuing improvement in patients' clinical outcome that carries on for up to two years after surgery. The majority of the clinical improvement occurs within three months of surgery, but the results of certain outcome scores can continue to improve for up to two years postoperatively.
Source: “The American Journal of Sports Medicine”, September 2018
