Hip Arthroscopy, Rehabilitation and Return to Function

Transcription

1 Hip Arthroscopy, Rehabilitation and Return to Function The rate of surgical intervention for activity related intra-articular hip pain has increased 2600% from 2004 to 2016, and is expected to continue to rise. A greater number of surgeons are utilizing hip arthroscopy as a treatment strategy for their hip pain patients. One-third of this 2600% growth is new surgeons. Therefore, the number of physical therapists that will be treating these surgical patients is increasing, and will continue to increase. Large increases in surgical utilization have historically been followed by a lapse in postsurgical rehabilitation planning and implementation. Surgical outcome studies related to the hip have been currently limited to level IV evidence. Published reports on postsurgical hip arthroscopy protocols are limited and heterogeneous. The overall goal of this educational session is to provide course attendees with in-depth understanding of hip joint pathology, how these various pathologies are treated surgically and provide the learner with the best evidence synthesis of post-surgical rehabilitation. Post-surgical guidelines will include current evidence support, as well as proposed guidance based on principles of biomechanics, biological healing and neuromuscular training. Course Objectives: At the conclusion of the course, each attendee will: a) Understand the various intra-articular hip joint pathomechanics. b) Differentiate the structural variations/pathologies that contribute to intra-articular hip pain. c) Describe the key considerations regarding surgical intervention with respect to the principally discussed pathologies. d) Identify and describe key components of post-surgical rehabilitation with respect to the principally discussed pathologies e) Identify key patient variables associated with poor surgical outcomes and success. 1) Hip joint pathomechanics (35 minutes) - Cara Lewis a) Femoroacetabular impingement syndrome (FAIS) i) Measures of acetabular anatomy (1) Center edge angle (2) Anteversion angle ii) Measures of femoral anatomy (1) Alpha angle (2) Neck-shaft angle (3) Version iii) Implications for femoroacetabular impingement (FAIS) b) Acetabular labrum 1

2 i) Structure ii) Function iii) Implications of labral lesions c) Hip capsule i) Structure ii) Function iii) Implications of dysfunction d) Chondral injury i) Structure ii) Function iii) Chondral pathology 2) Surgical procedures (35 minutes) Stephanie Di Stasi a) Osteoplasty: Femoroplasty/Acetabuloplasty (Clohisy et al. 2013, Enseki et al. 2006, Griffin et al. 2016, Jackson et al. 2013, Larson & Giveans, 2008) ii) Evidence for use in the presence of borderline dysplasia iii) Risks and factors associated with revision procedures b) Labral procedures: resection/repair/reconstruction (Domb et al. 2013, Enseki et al. 2006, Krych et al. 2013, Matsuda et al. 2013, Redmond et al. 2015) ii) Isolated labral treatment vs combination with osteoplasty iii) Comparison of outcomes between techniques (1) Repair vs resection (2) Reconstruction vs refixation c) Capsular repair (Domb et al. 2013, Enseki et al. 2006,Hartigan et al. 2018, Kalisvaart et al. 2017, Perets et al. 2017, Telleria et al. 2011, Trindade et al, 2015, Astur et al. 2018, de Girolamo et al. 2018) ii) Capsular reconstruction procedures iii) Combined procedures with osteoplasty, iliofractional lengthening d) Chondral: Microfracture, Subchondroplasty (Astur et al. 2018, de Girolamo et al. 2018, Domb et al. 2018) (1) acetabular vs femoral side pathology ii) Contemporary cartilage procedures (1) early outcomes and limitations 2

3 3) Rehabilitation guidelines (35 minutes) - Mike Reiman a) Current literature (Grzbowski et al. Front Surg. 2015; Smith et al. J Hip Preserv Surg. 2016) b) General guidelines c) Specific surgical procedure rehabilitation concerns i) Osteoplasty: femoro vs acetabuloplasty ii) Labral: resection, repair, reconstruction iii) Capsular iv) Chondral: microfracture d) Outcomes, including Return to work/duty/sport i) Overall outcomes: (1) 2600% increase in surgical outcome reporting between 2004 and 2016 (Reiman MP, et al. Arthroscopy 2018) (a) Primarily still level 3b and 4 studies (b) Inconsistency in reporting (2) Return to sport rates (Reiman et al. BJSM 2018; Ishoi et al. AJSM. 2018) 4) Questions and answers / panel discussion (15 min) All Bibliographic References 1. Reiman MP, Peters S, Sylvain J, Hagymasi S, Ayeni O. Prevalence and Consistency in Surgical Outcome Reporting for Femoroacetabular Impingement Syndrome: A Scoping Review. Arthroscopy. In Print. 2. Reiman MP, Peters S, Sylvain J, Hagymasi S, Mather RC, Goode A. Femoroacetabular impingement surgery allows 74% of athletes to return to the same competitive level of sports participation but their level of performance remains unreported: a systematic review with meta-analysis. British Journal of Sports Medicine. In Print. 3. Reiman MP, Peters S, Rhon D. Most military service members return to activity duty with limitations after surgery for femoroacetabular impingement syndrome: a systematic review. Arthroscopy. In Review. 4. Kemp J, Moore K, Fransen M, Russell T, Freke M, Crossley KM. A pilot randomised clinical trial of physiotherapy (manual therapy, exercise, and education) for early-onset hip osteoarthritis post-hip arthroscopy. Pilot Feasibility Stud Jul 7;4: Rath E, Sharfman ZT, Paret M, Amar E, Drexler M, Bonin N. Hip arthroscopy protocol: expert opinions on post-operative weight bearing and return to sports guidelines. J Hip Preserv Surg Feb 23;4(1):

4 6. Grzybowski JS, Malloy P, Stegemann C, Bush-Joseph C, Harris JD, Nho SJ. Rehabilitation Following Hip Arthroscopy - A Systematic Review. Front Surg May 26;2:21. Int J Sports Phys Ther Aug;12(4): Kuhns BD, Weber AE, Batko B, Nho SJ, Stegemann C. A FOUR-PHASE PHYSICAL THERAPY REGIMEN FOR RETURNING ATHLETES TO SPORT FOLLOWING HIP ARTHROSCOPY FOR FEMOROACETABULAR IMPINGEMENT WITH ROUTINE CAPSULAR CLOSURE. 8. Cheatham SW, Enseki KR, Kolber MJ. Post-Operative Rehabilitation after Hip Arthroscopy: A Search for the Evidence. J Sport Rehabil Nov 12. [Epub ahead of print] PubMed PMID: Hunt D, Prather H, Harris Hayes M, Clohisy JC. Clinical outcomes analysis of conservative and surgical treatment of patients with clinical indications of prearthritic, intra-articular hip disorders. PM R Jul;4(7): doi: /j.pmrj Epub 2012 May 16. PubMed PMID: ; PubMed Central PMCID: PMC Enseki KR, Martin RL, Draovitch P, Kelly BT, Philippon MJ, Schenker ML. The hip joint: arthroscopic procedures and postoperative rehabilitation. J Orthop Sports Phys Ther Jul;36(7): Review. PubMed PMID: Wahoff M, Ryan M. Rehabilitation after hip femoroacetabular impingement arthroscopy. Clin Sports Med Apr;30(2): doi: /j.csm PubMed PMID: Enseki KR, Kohlrieser D. Rehabilitation following hip arthroscopy: an evolving process. Int J Sports Phys Ther Nov;9(6): PubMed PMID: ; PubMed Central PMCID: PMC Lewis CL, Loverro KL, Khuu A. Kinematic differences during single leg stepdown between individuals with femoroacetabular impingement syndrome and individuals without hip pain. Journal of Orthopaedic & Sports Physical Therapy, in press. 14. Lewis CL, Khuu A, Loverro KL. Gait alterations in femoroacetabular impingement syndrome differ by sex. Journal of Orthopaedic & Sports Physical Therapy, in press. 15. Kester BS, Capogna B, Mahure SA, Ryan MK, Mollon B, Youm T. Independent Risk Factors for Revision Surgery or Conversion to Total Hip Arthroplasty After Hip Arthroscopy: A Review of a Large Statewide Database From 2011 to Arthroscopy Feb;34(2): doi: /j.arthro Epub Jan 4. PubMed PMID: Mehta N, Chamberlin P, Marx RG, Hidaka C, Ge Y, Nawabi DH, Lyman S. Defining the Learning Curve for Hip Arthroscopy: A Threshold Analysis of the Volume-Outcomes Relationship. Am J Sports Med Jan 1: doi: / [Epub ahead of print] PubMed PMID: Clohisy JC, Carlisle JC, Beaule PE, et al, "A systematic approach to the plain radiographic evaluation of the young adult hip", J.Bone Joint Surg.Am.,,

5 18. Desteli EE, Gulman AB, Imren Y, et al, "Comparison of mechanoreceptor quantities in hip joints of developmental dysplasia of the hip patients with normal hips", Hip Int., 1, Harris MD, Anderson AE, Henak CR, et al, "Finite element prediction of cartilage contact stresses in normal human hips", J.Orthop.Res., 7, Haversath M, Hanke J, Landgraeber S, et al, "The distribution of nociceptive innervation in the painful hip: a histological investigation", Bone Joint J., 6, Kim Y, Giori NJ, Lee D, et al, "Role of the acetabular labrum on articular cartilage consolidation patterns", Biomech.Model.Mechanobiol,. 22. Le Bouthillier A, Rakhra KS, Belzile EL, et al, "Soft Tissue Structures Differ in Patients With Prearthritic Hip Disease", J.Orthop.Trauma,, S Lewis CL, Khuu A and Loverro KL, "Gait Alterations in Femoroacetabular Impingement Syndrome Differ by Sex", J.Orthop.Sports Phys.Ther.,, Lewis CL, Loverro KL and Khuu A, "Kinematic Differences During Single- Leg Step-Down Between Individuals With Femoroacetabular Impingement Syndrome and Individuals Without Hip Pain", J.Orthop.Sports Phys.Ther., 4, Lewis CL and Sahrmann SA, "Acetabular labral tears", Phys.Ther., 1, Mosler AB, Agricola R, Thorborg K, et al, "Is Bony Hip Morphology Associated With Range of Motion and Strength in Asymptomatic Male Soccer Players?", J.Orthop.Sports Phys.Ther., 4, Rakhra KS, Bonura AA, Nairn R, et al, "Is the hip capsule thicker in diseased hips?", Bone Joint Res., 11, Tak I, Glasgow P, Langhout R, et al, "Hip Range of Motion Is Lower in Professional Soccer Players With Hip and Groin Symptoms or Previous Injuries, Independent of Cam Deformities", Am.J.Sports Med., 3, Tresch F, Dietrich TJ, Pfirrmann CW, et al, "Hip MRI: prevalence of articular cartilage defects and labral tears in asymptomatic volunteers. A comparison with a matched population of patients with femoroacetabular impingement", 2, Astur DC, de Freitas EV, Cabral PB, Morais CC, Pavei BS, Kaleka CC, Debieux P, Cohen M. Evaluation and Management of Subchondral Calcium Phosphate Injection Technique to Treat Bone Marrow Lesion. Cartilage Apr 1: doi: / [Epub ahead of print] PubMed PMID: Clohisy JC, Baca G, Beaulé PE, Kim YJ, Larson CM, Millis MB, Podeszwa DA, Schoenecker PL, Sierra RJ, Sink EL, Sucato DJ, Trousdale RT, Zaltz I; ANCHOR Study Group. Descriptive epidemiology of femoroacetabular impingement: a North American cohort of patients undergoing surgery. Am J Sports Med. 2013Jun;41(6): doi: / Epub 2013 May 13. PubMed PMID: de Girolamo L, Jannelli E, Fioruzzi A, Fontana A. Acetabular Chondral Lesions Associated With Femoroacetabular Impingement Treated by Autologous Matrix- Induced Chondrogenesis or Microfracture: A Comparative Study at 8-Year 5

6 Follow-Up. Arthroscopy Nov;34(11): doi: /j.arthro Epub 2018 Sep 25. PubMed PMID: Domb BG, El Bitar YF, Stake CE, Trenga AP, Jackson TJ, Lindner D. Arthroscopic labral reconstruction is superior to segmental resection for irreparable labral tears in the hip: a matched-pair controlled study with minimum 2-year follow-up. Am J Sports Med Jan;42(1): doi: / Epub 2013 Nov 1. PubMed PMID: Domb BG, Philippon MJ, Giordano BD. Arthroscopic capsulotomy, capsular repair, and capsular plication of the hip: relation to atraumatic instability. Arthroscopy Jan;29(1): doi: /j.arthro Epub 2012 Aug 15. Review. PubMed PMID: Domb BG, Rybalko D, Mu B, Litrenta J, Chen AW, Perets I. Acetabular microfracture in hip arthroscopy: clinical outcomes with minimum 5-year followup. Hip Int Nov;28(6): doi: / Epub 2018 Jun 5. PubMed PMID: Domb BG, Stake CE, Lindner D, El-Bitar Y, Jackson TJ. Arthroscopic capsular plication and labral preservation in borderline hip dysplasia: two-year clinical outcomes of a surgical approach to a challenging problem. Am J Sports Med Nov;41(11): doi: / Epub 2013 Aug 16. PubMed PMID: Enseki KR, Martin RL, Draovitch P, Kelly BT, Philippon MJ, Schenker ML. The hip joint: arthroscopic procedures and postoperative rehabilitation. J Orthop Sports Phys Ther Jul;36(7): Review. PubMed PMID: Griffin DR, Dickenson EJ, O'Donnell J, Agricola R, Awan T, Beck M, Clohisy JC, Dijkstra HP, Falvey E, Gimpel M, Hinman RS, Hölmich P, Kassarjian A, Martin HD, Martin R, Mather RC, Philippon MJ, Reiman MP, Takla A, Thorborg K, Walker S, Weir A, Bennell KL. The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. Br J Sports Med Oct;50(19): doi: /bjsports PubMed PMID: Hartigan DE, Perets I, Close MR, Walsh JP, Chaharbakhshi EO, Mohr MR, Domb BG. Arthroscopic Treatment of Iliopsoas Snapping in Patients With Radiographic Acetabular Dysplasia Using Iliopsoas Fractional Lengthening and Capsular Plication. Arthroscopy Jun;34(6): doi: /j.arthro Epub 2018 Apr 10. PubMed PMID: Jackson TJ, Stake CE, Trenga AP, Morgan J, Domb BG. Arthroscopic technique for treatment of femoroacetabular impingement. Arthrosc Tech Feb 16;2(1):e55-9. doi: /j.eats Print 2013 Feb. PubMed PMID: ; PubMed Central PMCID: PMC Kalisvaart MM, Safran MR. Hip instability treated with arthroscopic capsular plication. Knee Surg Sports Traumatol Arthrosc Jan;25(1): doi: /s Epub 2016 Nov 24. PubMed PMID: Krych AJ, Thompson M, Knutson Z, Scoon J, Coleman SH. Arthroscopic labral repair versus selective labral debridement in female patients with femoroacetabular impingement: a prospective randomized study. Arthroscopy. 6

7 2013 Jan;29(1): doi: /j.arthro PubMed PMID: Larson CM, Giveans MR. Arthroscopic management of femoroacetabular impingement: early outcomes measures. Arthroscopy May;24(5): doi: /j.arthro Epub 2008 Jan 7. PubMed PMID: Matsuda DK, Burchette RJ. Arthroscopic hip labral reconstruction with a gracilis autograft versus labral refixation: 2-year minimum outcomes. Am J Sports Med May;41(5): doi: / Epub 2013 Apr 2. PubMed PMID: Perets I, Hartigan DE, Chaharbakhshi EO, Ashberg L, Mu B, Domb BG. Clinical Outcomes and Return to Sport in Competitive Athletes Undergoing Arthroscopic Iliopsoas Fractional Lengthening Compared With a Matched Control Group Without Iliopsoas Fractional Lengthening. Arthroscopy Feb;34(2): doi: /j.arthro Epub 2017 Nov 3. PubMed PMID: Redmond JM, Cregar WM, Martin TJ, Vemula SP, Gupta A, Domb BG. Arthroscopic Labral Reconstruction of the Hip Using Semitendinosus Allograft. Arthrosc Tech Jul 27;4(4):e doi: /j.eats ecollection 2015 Aug. PubMed PMID: ; PubMed Central PMCID: PMC Telleria JJ, Lindsey DP, Giori NJ, Safran MR. An anatomic arthroscopic description of the hip capsular ligaments for the hip arthroscopist. Arthroscopy May;27(5): doi: /j.arthro PubMed PMID: Trindade CA, Sawyer GA, Fukui K, Briggs KK, Philippon MJ. Arthroscopic capsule reconstruction in the hip using iliotibial band allograft. Arthrosc Tech Feb 16;4(1):e71-4. doi: /j.eats ecollection 2015 Feb. PubMed PMID: ; PubMed Central PMCID: PMC