11 of 12 Top Hip Papers of 2024 | Postoperative effusion-synovitis and outcomes of hip arthroscopy
Second last day! Can you believe we are almost at the end of our 12 Hip Days of Christmas! Make sure you don't miss out on our special holiday offer. Today is Day 11 of my 12 Top Hip Papers series of miniblogs for 2024! If you missed Day 10, you'll find a link at the bottom of this page to take you back. For day 11 we'll be looking at a paper that reviewed the association between effusion-synovitis and outcomes after hip arthroscopic surgery for Femoroacetabular Impingement Syndrome (FAIS).
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11 of 12 Top Hip Papers of 2024: Postoperative effusion-synovitis is associated with poor clinical outcomes after arthroscopy for Femoroacetabular Impingement Syndrome (FAIS)1
Background:
- Femoroacetabular Impingement Syndrome (FAIS) is a painful hip condition linked to the development of extra bone around the femoral head-neck junction during adolescence.
- For some people with FAIS, surgery may be undertaken to trim the excess bone with the aim of reducing pain, improving function and theoretically reducing the risks of developing hip osteoarthritis (although there is no strong evidence for the latter at this point).
- In those with FAIS, effusion synovitis is commonly present and may be linked both with symptoms and joint health.
- Consistent presence of inflammatory cytokines and matrix proteases in the joint may contribute to persistent hip pain, development of joint adhesions, and progression of hip osteoarthritis (OA), which may negatively affect clinical outcomes.
- Arthroscopic surgery for FAIS is assumed to reduce effusion-synovitis by removing the impinging excess bone, however further information is required on joint recovery after surgery and the relationship with outcomes.
Study Aim:
This study aimed:
i) to investigate changes in effusion-synovitis after primary arthroscopic treatment for FAIS, and
ii) to determine the effect of postoperative effusion-synovitis on clinical outcomes.
What was done:
- A cohort study following patients after primary arthroscopy for femoracetabular impingement syndrome (FAIS).
Cohort:
n = 61 (41 females); mean age: 36.3 ± 9.6 years
Mean alpha angle: 64.1+/- 9.9°, mean LCEA: 33.7+/- 6.5°
Treatment:
- Arthroscopic surgery as indicated: femoroplasty, acetabuloplasty, labral repair, synovial debridement, capsular repair +/- plication.
- Rehabilitation:
- Early isometrics and passive range of motion.
- Partial weightbearing from Day 3 - Week 3.
- Full weightbearing at week 4.
- Full weightbearing strength and dynamic balance exercises from 6 weeks.
Outcome Assessment:
- MRI pre-operatively and at 3,6 and 12 months post-operatively.
- Effusion measures - thickness and cross sectional area.
- Outcome Measures: VAS Pain Score, modified HHS, and iHOT-12.
Effusion-synovitis on Magnetic Resonance Imaging (MRI) and Patient Rated Outcome Measures were tracked for 12 months post arthroscopy for FAIS. Changes in effusion and the relationship with 12-month outcomes was reported.
Key Findings:
- Effusion - synovitis increases after hip arthroscopy for FAIS, peaking at around 3 months post-operatively.
- At 12 months post-operatively, more than 60% of patients still had effusion - synovitis.
- Patients with effusion had inferior outcomes on the mHHS, iHOT-12 outcomes measures and lower achievement of PASS of mHHS and iHOT-12.
Clinical Implications:
- Persistent effusion-synovitis is a risk factor for poorer surgical outcomes. Inflammatory cytokines and matrix proteases can contribute to pain, joint adhesions, and the progression of OA.
- Monitoring and controlling hip joint effusion may be important in optimising medium and long term outcomes after hip arthroscopy.
It's important for physiotherapists and other rehabilitation professionals to be aware what is happening in the joints of their patients after hip arthroscopy. This study showed that effusion-synovitis continued to increase after hip arthroscopy for FAIS for 3 months, before starting to decline. More than 60% still had effusion at 12 months post-operatively, and this was linked with inferior outcomes.
Monitoring and controlling effusion may be important for longer term outcomes. Early joint management that aims to reduce effusion and adhesions is key. We also need to be careful to control activity levels and monitor response to exercise and overall loading. Returning to running and jumping too early may add to the degree and persistence of effusion, with potentially adverse effects on chondral health.
Like to learn more about managing FAIS?
In this course, you can find detailed information on pathoaetiology, assessment and management FAIS and other joint, soft tissue and nerve related conditions. To learn more, take the anterior hip and groin pain online course, or join me in an online or practical anterior hip and groin pain workshop.
This online course is included in Hip Academy and Hip Academy members receive discounts for online workshops. In Hip Academy, you will also have access to additional lectures on post operative protocols for hip arthroscopy and total hip arthroplasty.
I hope you enjoyed the infographics and key learnings from Day 11 of my 12 Top Hip Papers of 2024. There is only 1 more paper to come in this series. Don't miss the last day!! Join me for our last day tomorrow.
Missed paper 10? Click above to read it!
Paper 12 comes out tomorrow!
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