Abstract
Objectives:
Anecdotally, weight-bearing status following hip arthroscopy is gradual and requires 2-6 weeks of protected weight bearing. In a recent cadaveric study, it was demonstrated that a repaired acetabular labrum can handle physiological loads of weight bearing. Therefore, it is hypothesized that allowing patients to be immediately weight-bearing as tolerated (WBAT) may allow them to have reduced kinesiophobia and expedited return to activities of daily living compared to the current standard of care of 2 weeks of flat-foot weight bearing (FFWB). This quicker return to normal activities would allow them to benefit from advanced therapeutic interventions leading to improved short and longer term post-operative results. The objective of this study is to assess the effectiveness of advancing weight bearing immediately following hip arthroscopic labral repair and femoroplasty as it relates to short term pain, function, and long-term return to activities. This abstract is a presentation of our initial pilot data.
Methods:
This study received IRB approval at the University of Pittsburgh. Study design was a prospective randomized controlled trial (Level 1). Inclusion criteria included all patients over 12 years of age who presented for hip arthroscopy, including labral repair and femoroplasty at UPMC St. Margaret Hospital Hip Preservation Program. Surgical management was performed by a single surgeon at a single center. The single surgeon was blinded to randomization. No exclusions based on patient sex, race, or other demographics. Revision hip arthroscopy, labral reconstruction, and microfracture of cartilage defects were excluded. Two separate protocols were created to indicate weight bearing status, either WBAT immediately post-operatively or FFWB immediately post-operatively, to distribute to rehabilitation staff to ensure compliance. A randomized pamphlet with post-operative instructions with weight bearing education were given to PACU nursing staff to educate patients and fit crutches. Both groups received standard of care, including physical therapy starting either day one or two post-operative to implement passive range of motion and peri-hip musculature activation. All patients had precautions protecting from hip extension past 0 degrees and external rotation of the hip to protect healing of the joint capsule. Patients completed patient reported outcomes (PROs) pre-operatively, followed by 1 week, 3 months, 6 months, 9 months, 1 year and 2 years post-operatively. Objective data will include quadriceps girth measurements, dynamometric hip abduction and external rotation strength measures at 6 months and 1-year post-operative. Diagnostic ultrasound evaluation of the joint capsule was performed by a PM&R physician at 6 weeks post-operatively to ensure that capsular repair was healing appropriately in both groups. PM&R staff were blinded to the weight bearing group. PROs included: Tampa Kinesiophobia Scale, Hip Outcome Score (HOS), Hip and Groin Outcome Score (HAGOS), iHOT-12, Modified Harris Hip Score, Subjective hip satisfaction score/global rating of improvement. Overall recruitment goal of 40 patients in each group. The collected data will allow us to review overall function, objective measures, and return to desired activity/athletics, as well as determine the effectiveness of progressive weight bearing following hip arthroscopy, labral repair, and femoroplasty.
Results:
A total of 14 patients were randomized to WBAT and 10 patients randomized to FFWB. No patients were excluded. The 6-week capsule assessment by ultrasound showed a well approximated capsule repair site in 23 of 24 patients. The one patient with a potential capsular defect was in the WBAT group. Ultrasound demonstrated a 6mm x 6mm anechoic finding in the anterior capsule concerning for focal capsular defect. Tampa Kinesiophobia Scale and Modified Harris Hip Score were compared between groups at 2 weeks and 3 months post-operatively in our initial sample using a two-sample t-test with equal variances. No statistically significant difference was observed between groups at 2 weeks and 3 months.
Conclusions:
In summarizing our initial data, no statistically significant differences were observed in the immediate weight bearing and delayed weight bearing groups in terms of Tampa Kinesiophobia Scale and Modified Harris Hip Score at 2 weeks and 3 months post-operatively. One patient showed a potential capsular defect on ultrasound at 6 weeks in the WBAT group. No complications have been observed thus far in our pilot sample.