Outcomes from hip arthroscopy may not be as good as previously reported (or as good as players expect)

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.

To learn more about hip injuries and outcomes complete the ‘Hip’ module of the FIFA Diploma in Football Medicine.

References
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.

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L arthroscopie est une technique qui permet de visualiser et d intervenir sais une articulation à l aide d un optique relié par un mini camera. Le traitement médical en première intention n est pas très efficace avec la triade(ANTALGIQUE. AINS. REPOS)les infiltrations intra articulaires peuvent être efficaces temporairement. Sans résultat escompté on fait recours à la chirurgie. Le traitement chirurgical quelque soit la technique repose sur la symptomatologie sur les performances sportives du patient et de son retour aux activités sportives. Lorsqu un sportif soufre d’une arthrose avancée avec pincement des inerlignes articulaires les résultats sont souvent décevants et… Read more »