ePoster #718 - ISHA Annual Scientific Meeting 2016

Clinical Presentation of Patients Undergoing Hip Arthroscopy for Symptomatic Femoroacetabular Impingement

Alexis Wright, PT, PhD, High Point, NC UNITED STATES
Elizabeth A. Howse, MD, Walnut Creek, CA UNITED STATES
Thomas J. Kelsey, MA, Winston Salem, NC UNITED STATES
Ryan H. Barnes, BS, Richmond, VA UNITED STATES
Andre Antunes, HSDG, Winston Salem, NC UNITED STATES
Halis Atil Atilla, MD, Ankara TURKEY
Allston J. Stubbs, MD, MBA, Winston Salem, NC UNITED STATES

Wake Forest School of Medicine, Winston-Salem, NC, UNITED STATES

FDA Status Not Applicable

Summary: Our study of a large database of 1000 patients supports that at diagnosis for femoroacetabular impingement, patients characteristically have asymmetric hip pain with activity, loss of hip motion, and hip pain with provocative testing.

Abstract:
Introduction: Femoroacetabular impingement is a morphological hip condition that can cause hip pain in younger, active adults. The purpose of this study is to capture the nature of physical impairments associated with symptomatic FAI in a large surgical database of 1000 subjects. Our hypothesis is that patients who present with femoroacetabular impingement demonstrate significantly asymmetric findings of hip pain, loss of hip motion, and pain with provocative testing.

Methods: This study is a retrospective analysis of a prospectively collected hip data within a large healthcare system. We reviewed 1000 consecutive patients with symptomatic femoroacetabular impingement attending their pre-operative visit for hip arthroscopy. Evaluation of clinical history, physical exam, and previous treatments was performed. Statistical analysis comprised paired sample t-tests to calculate differences between the involved and non-involved sides of all continuous variables. A related sample McNemar Test was performed to compare differences of the involved and non-involved sides for the Flexion Adduction Internal Rotation (FADIR) test. To compare clinical findings between gender, a multivariate general linear modeling was performed only on the symptomatic hip. Significance was determined at p<0.05.

Results: The average patient age was 32.9 (+/-12.2) years and 67% were female; BMI was 25.7 (+/-5.5); average pain duration was 28.1 (+/-3.7) months. The right hip was the symptomatic hip in 54% of the sample population. Asymmetric symptoms included 77% reported hip pain while sitting; 64% reported pain while walking; 73% reported pain while crossing their legs; 43% reported night pain; 97% reported pain with activity. Of those offered an NSAID previously, only 35% reported any relief. On exam, 89% of the involved hips were painful with the anterior impingement test whereas only 15% were positive on the noninvolved side (p<0.001); average hip flexion was 95.0 (13.4) degrees on the involved hip compared to 106 (13.2) on the noninvolved side for a mean difference of 11.4 (13.1) degrees (p<0.001); average involved hip internal rotation was 10.1 (11.0) degrees compared to 19.2 (13.0) on the noninvolved side for a mean difference of 9.1 (11.3) degrees (p<0.001); average involved FABER distance was 25.1 (9.1) cm compared to 15.9 (7.5) cm on the noninvolved side for a mean difference of 9.1 (8.2)cm (p<0.001). Mean flexion values for males and females for were 95.5 (12.4) compared to 96.5 (13.1) for a non significant mean difference of 1.0 degrees in favor of the females (p=0.28); mean internal rotation values were 7.6 (8.7) compared to 11.4 (11.6) for a significant mean difference of 3.8 degrees in favor of the females (p<0.001); mean FABER distance measures for males and females were 26.6 (9.6) compared to 24.0 (8.6) for a mean difference of 2.6cm in favor of the females (p<0.001). 27% of these patients were classified radiographically as CAM only; 14% were classified as Pincer only; and 71% were classified as Mixed FAI.


Conclusions: Our study of a large database of 1000 patients supports our hypothesis that at original diagnosis for femoroacetabular impingement, patients characteristically have asymmetric hip pain with activity, loss of hip motion, and hip pain with provocative testing. Additionally, this study highlights two other findings consistent with smaller case series: females appear to present more often than males with prearthritic hip pain and mixed impingement is the predominate pathomorphology.