It is important to set realistic expectations for players who are considering a hip arthroscopy. One year after surgery for femoroacetabular impingement (FAI) and/or a labral injury a player’s ability to participate in sport and physical activity may be improved, but they are unlikely to have returned to ‘normal’.
This FastFact reviews two papers from the Sports Orthopaedic Research Centre in Copenhagen. These have both been published in the current issue of the American Journal of Sports Medicine. This issue has a number of articles about hip arthroscopy, and is well worth reading.
The first study measured clinical outcomes at 3,6, and 12 months following hip arthroscopy in 97 consecutive patients (and in a group of healthy controls).1 Outcomes were measured using the modified Harris Hip Score (mHHS) and the Copenhagen Hip and Groin Outcome (HAGOS) score. Patients in this series showed significant statistical and clinical improvements in pain and symptoms on both scores at 3-month follow up. Additional improvements were seen in the HAGOS score (but not the mHHS) at 12-month follow up. At one-year post-hip arthroscopy there were however ongoing functional limitations with physical activity when compared with the healthy sample.
The second paper followed 189 athletes who had a hip arthroscopy to investigate their ability to return to play.2 The study found that only 57% of the cohort returned to play at the same level and that only 16.9% considered their post-surgical performance to be ‘optimal’. This is considerably lower than what has been previously reported. This may be because other publications have reported a successful return to play – but have not necessarily defined what this means. While patients may have been able to return to play, this may not have been at the same level of participation. This is clearly an important distinction.
The expectation of returning to sport and activity post-surgery, to the same level as before injury, may need to be adjusted. Football players who are contemplating hip surgery (when rehabilitation fails) should be made aware that they will generally experience an improvement but that their hip is not likely to be ‘normal’ afterwards. They should also clearly understand that there is no guarantee that they will be able to return to play at the same level. As with most studies that investigate outcomes following surgery there are some methodological issues that need to be considered – including a small sample size and the generalizability of the sample to all athletes, including professional athletes.
1. Thorborg K, Kraemer O, Madsen AD, et al. Patient-reported outcomes within the first year after hip arthroscopy and rehabilitation for femoroacetabular impingement and/or labral injury: The Difference Between Getting Better and Getting Back to Normal. Am J Sports med. 2018;46:2607-2614.
2. Ishoi L, Thorborg k, Kraemer O, et al. Return to Sport and Performance After Hip Arthroscopy for Femoroacetabular Impingement in 18- to 30-Year-Old Athletes: A Cross-sectional Cohort Study of 189 Athletes. Am J Sports med. 2018;46:2578-2587.