Patients With Unilateral Femoroacetabular Impingement Syndrome Have Asymmetrical Hip Muscle Cross-Sectional Area and Compensatory Muscle Changes Associated With Preoperative Pain Level

Abstract

To compare the symptomatic hip muscle cross-sectional area (CSA) in patients with unilateral femoroacetabular impingement syndrome (FAIS) with the asymptomatic-side hip muscle CSA and to determine whether correlations exist between the hip muscle CSA and preoperative pain level, preoperative symptom duration, and postoperative function. We performed a retrospective review of magnetic resonance imaging data of patients who underwent hip arthroscopy from January 2012 through June 2015 for the treatment of unilateral FAIS and who had a minimum of 2years' follow-up after hip arthroscopy for FAIS. A picture archiving and communication system workstation with an embedded region-of-interest tool was used to measure the muscle CSA of both the symptomatic and asymptomatic sides in FAIS patients. One-way repeated-measures analyses of variance were used to determine differences between symptomatic and asymptomatic hip muscle CSAs. Spearman rank correlations were used to determine relations between the symptomatic-side hip muscle CSA and preoperative pain level, preoperative symptom duration, and multiple validated patient-reported outcomes to quantify the level of function. A total of 50 patients met the inclusion criteria and were analyzed. The mean age of the patients was 34.22 ± 14.12years, and 64% were women. Specific muscles of the symptomatic hip displaying significantly decreased CSAs compared with the asymptomatic hip included the gluteus maximus (P= .007), gluteus minimus (P= .022), and rectus femoris (P= .028). The tensor fascia lata (ρ= 0.358; P= .011), pectineus (ρ= 0.369, P= .008), adductor longus (ρ=0.286, P= .044), and obturator externus (ρ= 0.339, P= .016) showed a moderate positive correlation with preoperative pain level on a visual analog scale in unilateral FAIS patients. No associations were found between the symptomatic-side hip muscle CSA in patients with unilateral FAIS and symptom duration or patient-reported function. Patients with unilateral FAIS have a significantly decreased muscle CSA in the symptomatic hip compared with the asymptomatic hip. The symptomatic-side hip muscle CSA was correlated with the preoperative pain level on a visual analog scale. The association between the muscle CSA and preoperative pain level may represent a compensatory change in muscle function around the hip joint in patients with unilateral FAIS. Level IV, therapeutic case series.