Low rates of physiotherapy prior to hip arthroscopy in Israeli soldiers and short-term results: A retrospective study

1. To investigate the use of physical therapy prior to hip arthroscopy. 2. To determine which proportion of soldiers, return to duty following hip arthroscopy. And 3. To evaluate surgical complication rates.

1. To investigate the use of physical therapy prior to hip arthroscopy. 2. To determine which proportion of soldiers, return to duty following hip arthroscopy. And 3. To evaluate surgical complication rates.

A retrospective chart review of all hip arthroscopies performed in the IDF between January 1^st, 2018, and December 31^th, 2020. Demographic, medical, and military service data were collected manually from the computerized patient record. All Statistical analyses were performed using SAS® software (SAS Institute Inc, Cary, NC, USA, 2016, version 9.4 T5 M6). Mean time to return to activity was calculated using PROC LIFETEST using the Kaplan-Meier method.

117 soldiers (24% females) had hip arthroscopy, mean age 22±3 years, range 18 to 42. Pre-operative factors: The mean duration of complaints before surgery was 23 months ± 18 (SD). 55% of the soldiers were not referred to physiotherapy before surgery. 20% were under psychosocial consultation during the 6 months pre-op. post-operative follow-up: following surgery, the mean time of return to duty (any work including part-time clerical work) was 8.0 months ± 0.6, proportional hazard regression, PROC LIFETEST, SAS). 15.4% had serious adverse events. 56% of the soldiers were discharged from the military (never returned to any service). During the 1-year follow-up, only 6% returned to their full pre-disease activity.

Most soldiers were not referred to physical therapy prior to surgery. Moreover,  return to duty rates of IDF soldiers who underwent hip arthroscopy were much inferior to those reported in the literature. Further research is needed to understand the reasons for poor utilization of physical therapy, and to evaluate the risk factors for poor outcomes following hip arthroscopy in the military population.

Physical therapy is recommended as the first line option for musculoskeletal conditions. Looking at the low RTD rates and high levels of complications, it is of utmost importance that orthopedics refer patients with FAIS to physical therapy, before recommending surgery.