File
Husain M.A.1,2, Schilders E.1,3,4,5, Griffiths C.1, Matu J.1, Cooke C.6
1Leeds Beckett University, Institute for Sport Physical Activity & Leisure, Leeds, United Kingdom, 2University of Bahrain, College of Health Sciences, Sakheer, Bahrain, 3Fortius Clinic, London, United Kingdom, 4Wellington Hospital, London, United Kingdom, 5Yorkshire Clinic, Bradford, United Kingdom, 6Leeds Trinity University, School of Social and Health Sciences, Leeds, United Kingdom
Background: Muscle strength (MS) and range of motion (ROM) improvements after hip arthroscopy (HA), have not been studied extensively. Multiple factors at time of surgical intervention may play a role in prognosis. Therefore, physiotherapy (PT) programs should be tailored based on these factors and expected outcomes to ensure optimum recovery.
Purpose: This study was performed to explore postoperative changes in hip abduction (HAbd) and adduction (HAdd) MS, external (ER) and internal (IR) rotation ROM, and the flexion-abduction-external rotation distance (FABER-D). Factors that may influence these measurements were also explored.
Methods: The data of 309 patients (167 male: age 39.9±13.2 years; 142 female: age 43.3±14.4 years) who underwent arthroscopy procedures for their right (n=169) and left hips (n=140) were analysed retrospectively (mean duration of pre-operative symptoms 21.1±23.2 months). A single surgeon performed all HA procedures while two physiotherapists performed MS, ROM and FABER-D measurements. Repeated measures ANOVA with Bonferroni adjustment (p=0.025) and mean of difference (MD) were used to examine differences between 2, 8, and 24 weeks postoperatively to preoperative scores. Magnitude of difference was estimated with partial eta square (Ƞp2). Multilevel modelling (MLM) was used to examine effects of age, sex, level of athletic activity, duration of symptoms and side of dominance on postoperative measurements.
Results: HAbd and HAdd strength reduced at 2 weeks (p=0.002 and p=0.037, respectively) and moderately improved at 8 weeks (p=0.001 and p 0.001, respectively). At 24 weeks, highest improvement in HAbd strength (MD=16.57, 95% CI [7.59, 25.55]) was seen (F [1, 53] =25.59, p 0.001) with modest effect size (Ƞp2=0.326). Similar improvement in HAdd strength (MD=18.29, 95% CI [10.17, 26.40]) was observed
(F [1, 52] =38.19, p 0.001) with moderate effect size (Ƞp2=0.423). FABER-D slightly increased at 2 weeks (p=0.07) and mildly decreased at 8 weeks (p=0.009). Biggest reduction in FABER-D (MD= -3.53, 95% CI [-5.34, -1.71]) was also observed at 24 weeks (F [1, 59] =28.20, p 0.001) with modest effect size (Ƞp2=0.323). However, ER and IR ROM did not show statistically significant changes postoperatively (p=0.569). MLM showed that females had lower HAbd and HAdd strength, lower ER ROM and higher IR ROM compared to males in all weeks. Athletes had higher HAbd and HAdd strength compared to amateur players and sedentary patients. Patients aged >60 years had lower ER and IR ROM combined with higher FABER-D. No effects of symptoms duration and dominance were found on the measurements.
Conclusion(s): After hip arthroscopy procedures, hip muscle strength and flexibility require ≥8 weeks to improve with marked changes seen at 24 weeks postoperatively. No change in ROM was seen.
Implications: Patients should expect noticeable recovery from hip arthroscopy to take ≥8 weeks with regular PT. Rehabilitation programs should accommodate variation in strength levels based on sex and activity levels. Moreover, advanced age was found to negatively impact hip ROM improvement.
Funding acknowledgements: No funding was received for this research.
Topic: Musculoskeletal: lower limb
Ethics approval: Ethical approval was obtained from the Local Research Ethics Co-ordinator of Carnegie School of Sport, Leeds Beckett University.
All authors, affiliations and abstracts have been published as submitted.
