Does Hip Arthroscopy as part of a Structured Evidence-based Multidisciplinary Care Pathway produce Significant & Continued Symptomatic, Functional & Vocational Improvements?

Research Paper Title

Prospective 12-month functional and vocational outcomes of hip arthroscopy for femoroacetabular impingement as part of an evidence-based hip pain rehabilitation pathway in an active military population.

Background

Femoroacetabular impingement (FAI) is common with an estimated prevalence of 10-15% among young active individuals. The natural history of the disorder is progression to early osteoarthritis.

Hip arthroscopy is recommended if conservative treatments fail; however, outcomes are unclear, particularly in highly active populations.

Therefore, the aim of this study was to evaluate the functional and vocational outcome of hip arthroscopy, as part of an evidence-based rehabilitation hip pain pathway, for the treatment of FAI in an active military population.

Methods

All patients in the defence rehabilitation hip pain pathway, with a confirmed diagnosis of FAI who failed conservative treatment, were assessed prior to surgery and at 2, 6 and 12 months postsurgery. Outcome measures included the Visual Analogue Scale (VAS) for hip pain, Non-Arthritic Hip Score (NAHS) for function, and vocational assessments including functional activity assessment (FAA) and Joint Medical Employment Standard for military employability and deployability.

Results

101 patients completed the study (mean age=33 years) (male:female:75:26) (Royal Navy/British Army/Royal Air Force: 13%/48%/39%). Outcomes demonstrated significant improvements with large effect size. Preoperative NAHS mean=62.9 (SD 16.4), 12-month postoperative NAHS mean=78.8 (18.3), mean improvement in NAHS=15.9 (95% CI 12.3 to 19.5, p<0.001). Preoperative VAS pain mean=51.3 (20.9), 12-month postoperative VAS pain=25.6 (24.5). Mean improvement 25.7 (95% CI 19.4 to 31.99, p<0.001). 73% of patients had a deployable medical category at 12 months postoperative.

Conclusions

These data confirm that hip arthroscopy as part of a structured evidence-based multidisciplinary care pathway produces significant and continued symptomatic, functional and vocational improvements over a 12-month period in a military population exposed to high intensity, weight-bearing exercise in uncontrolled and unforgiving environments.

Reference

Bennett, A.N., Nixon, J., Roberts, A., Barker-Davies, R., Villar, R. & Houghton, J.M. (2016) Prospective 12-month functional and vocational outcomes of hip arthroscopy for femoroacetabular impingement as part of an evidence-based hip pain rehabilitation pathway in an active military population. BMJ Open Sport and Exercise Medicine. 9;2(1):e000144. eCollection 2016.

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