A Randomized Controlled Trial of Postoperative Hip Bracing After Arthroscopic Osteoplasty and Labral Repair for Femoroacetabular Impingement Syndrome

Abstract

Background:

There is disagreement regarding use of hip orthoses after arthroscopic surgery for femoroacetabular impingement syndrome (FAIS). Few data exist on the postoperative effect of bracing in this context.

Hypothesis/Purpose:

It was hypothesized that at 6 weeks after arthroscopic surgery for FAIS, patients wearing a brace would have significantly lower mean Numerical Pain Ranking Scale (NPRS) score compared with those who did not wear a brace. Secondary goals included comparison of additional patient-reported outcome measures, physical examination findings, complications, and use of medications or injections at 6 weeks and 6 months postoperatively.

Study Design:

Randomized controlled trial; Level of evidence 1,

Methods:

An intention-to-treat randomized controlled trial for treatment superiority was performed. Inclusion criteria were patients aged 14 to 60 years undergoing arthroscopic osteoplasty and labral repair for FAIS. Patients who would not be able to undergo follow-up in clinic or who did not speak English were excluded. Patients were randomized to brace and no-brace groups at their preoperative appointment. Braces were worn full-time for 3 weeks postoperatively and then weaned. Surgeries were performed by a single surgeon who was not aware of brace assignment. Patients completed NPRS, Hip disability Osteoarthritis Outcome Score (HOOS), and Veterans Rand 12 (VR-12) assessment at regular intervals with a primary endpoint of 6 weeks after surgery. The study was designed to have 80% power to detect a clinically meaningful difference in NPRS of 1.2 points (32 patients per group).

Results:

A total of 82 patients were enrolled in the study (41 per group). Four patients in the brace group and 3 in the no-brace group were found to be ineligible after randomization. In total, 37 brace and 36 no-brace patients reached the primary 6-week endpoint. Follow-up at 6 months included 30 patients in the brace group and 27 in the no-brace group. Baseline demographic characteristics, outcome scores, and radiographic and intraoperative findings were similar between groups. Mean NPRS score at 6 weeks did not differ significantly between the brace (1.8 ± 1.6) and no-brace (2.3 ± 1.7) groups; the adjusted mean difference was −0.5 (95% CI, –1.2 to 0.2; P = .17). No differences (all P > .05) were found in NPRS score at the 3-week and 6-month postoperative timepoints, and no differences in HOOS scores, VR-12 components, physical examination, narcotic use, or injections were found at either timepoint. No serious adverse events were recorded during the trial period. Self-reported brace compliance was excellent (mean 87%, median 95%).

Conclusion:

In this randomized controlled trial, patients who wore a hip brace after FAIS surgery did not experience less pain (mean NPRS) at 6 weeks postoperatively compared with patients who did not wear a brace.

Registration:

Clinicaltrials.gov NCT04599296