Femoroacetabular impingement (FAI) is a common cause of hip pain, often treated with arthroscopy. The optimal approach among unilateral, staged bilateral, and simultaneous bilateral procedures remains unclear due to limited comparative data. To compare clinical outcomes and complication rates among simultaneous bilateral, staged bilateral, and unilateral hip arthroscopy in patients with FAI syndrome. Systematic review and Meta-analysis; Level of evidence, 3. A systematic review and meta-analysis were conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed, Scopus, and Ovid MEDLINE databases were searched through April 2025. Eligible comparative studies included patients with FAI undergoing hip arthroscopy via unilateral, simultaneous bilateral, or staged bilateral approaches and reported outcomes such as patient-reported scores, complications, and revision or conversion to total hip arthroplasty (THA). Nine studies with a total of 4040 hips were included. All surgical approaches showed significant improvements in pain and functional outcome scores. There were no statistically significant differences in postoperative visual analog scale score, Modified Harris Hip Score, Non-Arthritic Hip Score, International Hip Outcome Tool-12 score, rates of revision surgery, or conversion to THA among the 3 groups. Meta-analyses confirmed similar outcomes between staged and unilateral groups. Although 1 study reported a lower THA conversion rate in the simultaneous group, findings were inconsistent across the literature. Simultaneous bilateral, staged bilateral, and unilateral hip arthroscopy offer comparable short- to midterm outcomes and complication rates in FAI patients. Simultaneous bilateral arthroscopy may represent a safe and efficient option for appropriately selected patients. Surgical approaches should be individualized based on patient symptoms, goals, and risk profile. PROSPERO (CRD420251039957).

Introduction Squatting is an important activity of daily living which can be particularly useful in the management of Femoroacetabular Impingement Syndrome (FAIS). However, double-leg squat protocols can vary significantly, potentially impacting biomechanical outcomes. A squat with a “hold” before the ascent phase represents one variation which increases muscular endurance demands and may elucidate such impacts. The purpose of this study was to identify biomechanical differences between a traditional squat (TSquat) and squat with a hold (HSquat) in adolescents and young adults with pre-operative FAIS. Methods Participants ( N = 46; 35 females; 16.5 ± 1.7 years) undergoing primary unilateral hip preservation surgery for FAIS completed two squat types assessed via 3D motion analysis. The TSquat was performed with descent immediately followed by ascent. The HSquat included a three second pause at participants’ lowest comfortable position. Joint range of motion, moments, powers, and squat depth in participants’ pre-operative limb were compared between each technique. Results Participants squatted lower in the TSquat than the HSquat (42.6% ± 12.8% vs. 36.0% ± 13.0%, p < 0.001). Maximum hip, knee, and ankle flexion were greater in the TSquat (mean difference: 4.2 ± 0.7°, 10.2 ± 1.2°, 1.4 ± 0.1°, respectively; p < 0.05). Peak sagittal moment at the hip/knee (mean difference: 0.10 ± 0.05 Nm/kg, 0.09 ± 0.08 Nm/kg, respectively; p < 0.001) and peak power generation at the knee (mean difference: 0.40 ± 0.16 W/kg; p = 0.001) were also greater in the TSquat. Discussion Participants with FAIS squatted to a shallower depth during the HSquat compared to the TSquat and displayed altered biomechanics, accordingly. Given these findings, greater standardization of squatting techniques is warranted as technique variations may affect outcomes, and researchers must consider potential adjustments made by those with FAIS in their natural squat movement.

Hip arthroscopy has demonstrated favorable short- and mid-term outcomes for femoroacetabular impingement syndrome (FAIS) in patients with borderline hip dysplasia (BHD). However, long-term outcomes in patients with FAIS and BHD treated with hip arthroscopy remain understudied. To evaluate hip survivorship and patient-reported outcomes (PROs) in patients with FAIS and BHD compared with those without BHD at a minimum 10-year follow-up. Cohort Study; Level of evidence, 4. A retrospective matched-cohort study was conducted on patients undergoing primary hip arthroscopy for FAIS by a single surgeon (2012-2024). BHD was defined as a lateral center-edge angle (LCEA) of 20° to 25°. Patients with BHD were matched 1 to 2 to controls without BHD based on age, sex, body mass index, and preoperative modified Harris Hip Score (mHHS). Radiographic parameters (eg, alpha angle, LCEA) were assessed pre- and postoperatively. PROs-including mHHS, Non-Arthritic Hip Score (NAHS), and hip survivorship (revision arthroscopy, conversion to total hip arthroplasty [THA])-were compared. The study included 23 patients with BHD (mean age, 33.6 years; 69.6% women) and 46 controls (mean age, 32.7 years; 65.2% women). Both groups showed significant improvements in mHHS and NAHS at 10 years (all P < .001), with no differences in postoperative scores or minimal clinically important difference achievement (BHD group, 91.3% vs control group, 97.5%; P = .55). There were no conversions to THA in the BHD group and 2 in the control group (4.3%; P = .189). Revision arthroscopy rates were 0% in the BHD group and 8.7% in the control group (P = .549). Patients with BHD exhibited significantly greater reductions in alpha angles on 45° Dunn views (-13° vs -1.9°; P = .01). At a minimum 10-year follow-up, patients with BHD who underwent hip arthroscopy for FAIS achieved comparable PROs and hip survivorship to those without BHD. These findings support the use of hip arthroscopy as a durable and effective treatment for FAIS in this population.

Age has been shown to play a role in patient outcomes after hip arthroscopy for the treatment of femoroacetabular impingement syndrome (FAIS), but little is known regarding this relationship in the population with borderline dysplasia. To compare patient outcomes and reoperation rates in patients aged ≥40 years and <40 years with borderline hip dysplasia (BHD) undergoing hip arthroscopy for FAIS at 2- and 5-year follow-up. Cohort study; Level of evidence, 3. Patient-reported outcomes (PROs) were acquired preoperatively and at 2 and 5 years postoperatively for patients undergoing surgery between January 2012 and June 2019. PROs included the Hip Outcome Score-Activities of Daily Living, Hip Outcome Score-Sports Subscale (HOS-SS), modified Harris Hip Score, and visual analog scale for pain and satisfaction. Clinically significant outcomes included the minimal clinically important difference and Patient Acceptable Symptom State (PASS). Patients diagnosed with BHD (lateral central-edge angle, 18°-25°) were stratified into cohorts ≥40 and <40 years old. Older patients were propensity matched 1:1 to younger patients controlling for sex, body mass index (BMI), and acetabular cartilage grade. PROs, clinically significant outcomes, and survivorship were compared between groups. Ninety-three patients aged ≥40 years with BHD (mean ± SD age, 48.4 ± 5.7 years; 68.8% female; BMI, 26.6 ± 5.3 kg/m2) were successfully matched to 93 patients aged <40 years with BHD (age, 26.8 ± 7.6 years; 76.3% female; BMI, 25.9 ± 5.3 kg/m2). Older patients had lower rates of weekly physical activity as compared with younger patients (P < .001). Older patients with BHD had significantly lower HOS-SS scores than younger patients preoperatively (P = .021) and at 5 years postoperatively (P = .040). However, there were no differences in improvement of any PRO from presurgery to 5-year follow-up between groups. Older patients had similar achievements of the minimal clinically important difference (P > .188) but achieved the PASS at a significantly lower rate for the HOS-SS (61.1% vs 79.7%; P = .024). Older patients also underwent conversion to total hip arthroplasty at a significantly higher rate (12.8% vs 1.4%; P = .010) when compared with younger patients, with a mean conversion time of 4.58 years. This study concludes that patients with BHD aged ≥40 years treated with contemporary hip arthroscopy for FAIS achieved similar function, pain, and satisfaction at 5-year follow-up but worse sports function and sports-related PASS achievement when compared with patients with BHD aged <40 years. Furthermore, while patients ≥40 years old had a higher rate of total hip arthroplasty conversion, they demonstrated similar overall reoperation rates as compared with younger patients at 5 years.

Iliopsoas strengthening increases hip joint forces during gait: A simulation study.

Master athletes (MAs), defined as those aged ≥35 years actively participating in sports, have demonstrated superior short-term outcomes and reoperation-free survivorship after hip arthroscopy (HA) for femoroacetabular impingement syndrome (FAIS) compared with nonathletic counterparts; however, their mid- and long-term outcomes remain unclear. The purpose was to evaluate patient-reported outcomes (PROs), achievement of clinically significant outcomes (CSOs), and reoperation-free survivorship at long-term follow-up after primary HA for FAIS in MAs in comparison with a propensity-matched control group of nonmaster athletes (NMAs), defined as those aged ≥35 years who denied weekly sports activity. We hypothesized that MAs would demonstrate superior PROs, CSO achievement, and reoperation-free survivorship compared with NMAs. Cohort study, Level of evidence, 3. Patients with minimum weekly preoperative sports participation aged ≥35 years who underwent HA for FAIS between January 2012 and October 2014 with long-term follow-up were propensity-matched 1:1 to patients aged ≥35 years who denied weekly preoperative sports participation, controlling for age, sex, and body mass index (BMI). PROs collected preoperatively and at 2-, 5-, and 10-year follow-up time points included the Hip Outcome Score-Activities of Daily Living (HOS-ADL) and Hip Outcome Score-Sports Subscale (HOS-SS), 12-item International Hip Outcome Tool (iHOT-12) score, modified Harris Hip Score (mHHS), and visual analog scale scores for pain and satisfaction. Cohort-specific minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) thresholds were compared. Survivorship was compared using Kaplan-Meier analysis. In total, 70 MAs were matched to 70 NMAs. Patient characteristics were similar between MAs and NMAs, including age (44.89 ± 7.7 vs 45.77 ± 6.9 years; P = .473), sex (60.0% vs 58.6% female; P = .496), and BMI (26.19 ± 4.9 vs 26.79 ± 4.4 kg/m2; P = .444). The mean follow-up duration was 10.32 ± 0.3 years. Preoperative PROs were similar between groups (P ≥ .114). MAs demonstrated superior 2-year HOS-ADL and iHOT-12 values (P ≤ .049). By the 5-year follow-up with durability to 10-year follow-up, PROs were similar between groups (P ≥ .065). Both groups demonstrated similar MCID and PASS achievement for all PROs (P ≥ .111). Both groups demonstrated similar time-dependent reoperation-free survivorship (P = .6). MAs undergoing primary HA for FAIS achieve comparable PROs, CSOs, and reoperation-free time-dependent survivorship to NMAs at long-term follow-up.

To compare mid- to long-term outcomes of the three major capsular management strategies-capsule preserved (CP), capsule repaired (CR) and capsule unrepaired (CU)-following hip arthroscopy (HAS) for femoroacetabular impingement syndrome (FAIS). A systematic search was conducted in PubMed, Embase, CENTRAL, and Epistemonikos for studies published up to 31 May 2025. Studies were eligible if they reported ≥2-year outcomes after HAS with clearly described capsular techniques. Outcomes included the modified Harris Hip Score (mHHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL) and Sports Subscale (HOS-SSS) and Visual Analogue Scale (VAS) for pain. Multilevel meta-analyses were performed using random-effects models with Hartung-Knapp adjustment. Failure-related outcomes (complications, reoperations, total hip arthroplasty [THA] conversions) were inconsistently reported across studies and could only be summarised descriptively. Seven studies with a total of 948 patients were included. Pooled mean mHHS was 81.14 (95% confidence interval [CI]: 77.72-84.56), with CP: 84.90, CR: 80.66 and CU: 80.25 (p = 0.67). HOS-ADL pooled mean was 87.94 (95% CI: 84.79-91.09), with CP: 89.30, CR: 87.36, CU: 88.31 (p = 0.90). HOS-SSS pooled mean was 78.59 (95% CI: 72.69-84.48), with CP: 75.70, CR: 78.89, CU: 80.22 (p = 0.84). VAS pooled mean was 2.42 (95% CI: 2.08-2.77), with CP: 2.46, CR: 2.27, CU: 2.76 (p = 0.51). No statistically significant subgroup differences were detected. CR showed the highest cumulative numbers of reoperations and THA conversions, whereas CP and CU demonstrated lower but heterogeneous event counts. CP, CR and CU demonstrated comparable mid- to long-term patient-reported outcome measure (PROM) outcomes following HAS for FAIS. Failure-related events varied descriptively across techniques, but inconsistent reporting prevented comparative survivorship assessment. Level II, systematic review and multilevel meta-analysis of predominantly Level III studies, with additional contributions from Level I and II studies.

PurposeThe impact of femoroacetabular impingement syndrome (FAIS) on gait has been reported; however, no studies have documented the effects of Borderline Developmental Dysplasia of the Hip (BDDH) combined with FAIS on gait. This study aimed to evaluate the kinematic and kinetic abnormalities of the lower extremities in patients with combined FAIS and BDDH during level walking.MethodsA total of 42 participants were included, consisting of 14 patients with FAIS+BDDH, 14 with isolated FAIS and 14 healthy controls. Full-cycle kinematic and kinetic data were collected via motion capture and force plates. Gait analysis was performed in three planes (sagittal, coronal and transverse) for the hip, knee, ankle and pelvis joints. The range of motion (ROM), kinematics and kinetics were compared across the three groups.ResultsCompared with isolated FAIS patients, FAIS+BDDH patients presented a significantly greater hip flexion angle during terminal stance and significantly smaller hip extension angles during preswing (P < 0.05). Moreover, the hip abduction moment was significantly reduced in the loading response and midstance phases in FAIS+BDDH patients (P < 0.05). The knee extension moment was significantly reduced during terminal stance in both FAIS groups (P < 0.05). The ankle dorsiflexion angle was significantly greater during midstance in FAIS+BDDH patients than in healthy controls, with concomitant reductions in the ankle dorsiflexion moment (P < 0.05). No significant differences were found in the range of motion (ROM) of the pelvis or hip joints among the three groups (P > 0.05).ConclusionCompared with patients with isolated FAIS, patients with FAIS combined with BDDH exhibit a gait pattern characterized by biomechanical defects of the hip joint similar to developmental dysplasia of the hip (DDH), increased knee stiffness, and compensatory alterations in the ankle joint.

Femoroacetabular Impingement Syndrome (FAIS) is a prevalent source of hip pain in active young adults. Although it can be managed with hip preservation surgery, functional limitations and physical impairments can remain post-arthroscopic surgery. Whist utilisation of telehealth has grown exponentially, there is a paucity of literature on hip tele-assessment measuring the effects of hip arthroscopic surgery. This study aimed to investigate patient-reported outcome measures (PROMs), hip range of motion (ROM) and functional performance following FAIS arthroscopic surgery, utilising tele-assessment technology. The primary outcome targeted differences in measures at 6-months in participants post-surgery for FAIS and in a cohort of healthy controls.Participants required radiographic confirmation of either cam or pincer impingement, or combined morphology; symptoms of hip pain; a positive clinical test (flexion-adduction-internal rotation (FADIR) pain provocation test); and were scheduled for surgery. Outcome measures were conducted over Zoom and assessed in the surgical group pre-surgery (baseline), and 6-weeks, 12-weeks and 6-months post-surgery. Healthy controls were included if they had no history of hip pain/injury or surgery, no history of lower limb injuries in the last three months, and a negative FADIR test; their assessment was recorded over Zoom. Primary PROMs included iHOT-33, HAGOS and HOS; physical measures included hip ROM (hip flexion in supine, hip internal rotation (prone and sitting), and external rotation (prone and sitting)) calculated using a video analysis software Tracker. Functional measures included the 30-second Chair Stand Test (30s CST), and the modified Copenhagen adductor squeeze test.Fifteen FAIS participants (nfemale=4) and fifteen healthy participants (nfemale=4) were included in this pilot study. Hip mean range of motion improved, with statistically significant changes in internal rotation in sitting (p=0.016), flexion in supine (p<0,001) and all PROMS post-surgery. However, statistically significant differences in the 30s CST (p<0.001) and internal rotation in sitting (p=0.025) were still present in FAIS participants 6-months post-surgery compared to healthy controls. Whilst ranges of motion and functional performance measures were restored after-surgery, evidence of differences at 6-months in the FAIS population remain. This study suggests telehealth is a suitable tool that can provide measures of hip ROM and functional performance following arthroscopic surgery.

IntroductionIdentifying predictors of achieving Minimal Clinically Important Difference (MCID) following hip arthroscopy offers valuable insights for clinical decision-making and prognosis in patients with Femoroacetabular Impingement Syndrome (FAIS). While previous studies have highlighted the benefits of labral and capsular repair on postoperative clinical outcomes, limited evidence exists regarding the role of preoperative hip function in predicting short-term achievement of MCID.ObjectiveTo identify preoperative factors that predict achievement of MCID at 6 months following hip arthroscopy for treating patients with FAIS.MethodsThe study included 109 patients diagnosed with FAIS who underwent preoperative assessments between 2011 and 2022. The MCID was determined using the distribution-based method based on the international hip outcome tool-12 (iHOT12) scores collected preoperatively and at 6 month postoperatively. Patients were categorized into two groups: those who achieved MCID and those who did not. Univariate analysis compared demographic characteristics (age, gender, Body Mass Index, sports participation), radiographic parameters (center-edge angle, alpha angle, Sharp angle, Tönnis angle, vertical-center-anterior angle), arthroscopic procedures, and hip function (range of motion, muscle strength) between groups. Significant variables were further analyzed using logistic regression to identify preoperative predictors of MCID achievement.ResultsUnivariate analysis revealed significant differences between groups in hip flexion strength (achievement vs. non-achievement group (0.94±0.34 vs. 0.76±0.19, p=0.02, 95% Confident Interval (CI): 0.22-0.34) and extension. Logistic regression analysis identified hip flexion strength as a significant predictor (p=0.03, Odds ratio3.5).DiscussionThe findings suggest that preoperative hip flexion strength is significantly associated with the likelihood of achieving MCID, highlighting the importance of muscle function in postoperative outcomes. Previous studies have demonstrated the role of hip flexors in athletic performance, patient-reported outcomes, and the severity of labral pathology. The current study supports the hypothesis that enhanced hip flexor strength contributes to improved joint stability and biomechanics, which may positively impact postoperative recovery..ConclusionPreoperative hip flexion strength may serve as a reliable predictor for achieving MCID in iHOT12 scores at 6 months after hip arthroscopy for treating patients with FAIS. Incorporating hip flexor strengthening into preoperative rehabilitation programs may enhance postoperative outcomes and should be considered as part of pre-surgical planning.

BackgroundPatients with Femoroacetabular Impingement Syndrome (FAIS) may experience persistent hip problems following arthroscopic FAIS surgery (HA), with total hip replacement surgery (THR) being the last option.PurposeTo 1) investigate the conversion rate of HA-treated FAIS-patients from a Danish cohort. 2) investigate factors that might affect conversion: age, sex, joint space width, hip osteoarthritis degree (Tönnis grading system), cam morphology (radiographic alpha angle measurement) and chondral damage of the femoral head and the acetabulum. 3) Describe patient reported outcomes after THR.Materials and MethodsPatients above 18 years registered with arthroscopic surgery due to FAIS between January 2012 and November 2023 were identified in (DHAR). Cases registered with a positive impingement test, radiological cam and/or pincer morphology on a standing anterior-posterior radiograph, no signs of hip osteoarthritis were eligible. All patients were invited to participate in a REDCap controlled survey. If they responded “yes” to the entry question: Have you had total hip replacement? they were immediately hereafter asked to complete the Copenhagen Hip and Groin Outcome Score (HAGOS) and Hip Osteoarthritis Outcome Score (HOOS) questionnaires (0-100 scores, 100 being no problems).Results5113 patients were eligible and received the survey. 2364 (46%) responded. 406 patients (8%) had a THR at 1 to 10 years after their primary hip arthroscopy, 199 responded the questionnaires. Converted cases reported median HAGOS scores of: Pain: 75, Symptoms: 75, Activities of daily living: 70, Sport: 53, Participation in Sport: 50, Quality of life: 50. HOOS scores were: Pain: 80, Symptoms: 81, Sport: 63 and Quality of life: 50. Compared to patients undergoing primary hip arthroscopy and primary THR, hip-related quality of life was inferior in converted cases. Higher age at HA, joint space width below 3 mm, Tönnis arthrosis grade > 1 and high grades of femoral cartilage injury might be risk factors for receiving THR after FAIS surgery.ConclusionsA low number of conversions to THR (8%) was demonstrated. Converted cases reported good outcomes after THR surgery, similar to those who underwent primary FAIS surgery and primary THR, although an inferior Hip-related quality of life was found in the studied patient group.

BackgroundObjective assessment of hip range of motion (ROM) is essential in evaluating femoroacetabular impingement syndrome (FAIS), yet most studies focus on passive ROM or laboratory-based analyses. Our team previously validated a portable, single-sensor inertial measurement unit (IMU) system for accurate hip ROM assessment (Sensors 2023, 23, 8782). Building on this, we conducted the first study to use IMUs for clinical evaluation of active hip ROM in FAIS patients.PurposeTo compare active ROM between FAIS patients and healthy controls using IMUs, and to explore whether deficits are present even in positions not typically limited by mechanical impingement.MethodsA total of 53 FAIS patients scheduled for hip arthroscopy were compared to 49 healthy matched controls. Active ROM was assessed using inertial measurement unit (IMU) sensors, with measurements taken in standing and prone positions. Outcomes included flexion, external rotation, internal rotation, and total rotation ROM.ResultsFAIS patients demonstrated significant reductions in active ROM across most parameters. Notably, internal rotation in the prone position—a posture not mechanically limited by femoroacetabular contact—was also significantly restricted. Additionally, the contralateral (non-symptomatic) hip in FAIS patients exhibited reduced ROM compared to controls.ConclusionThis study demonstrates the first clinical use of IMUs to capture active ROM deficits in FAIS, revealing functional limitations even in non-conflict positions. These findings may indicate broader neuromuscular or biomechanical adaptations beyond mechanical impingement.Clinical Relevance: IMU-based assessment provides a practical tool for identifying functional impairments in FAIS patients, supporting more targeted diagnosis and individualized rehabilitation strategies.

PurposeTo compare hip survivorship and patient-reported outcomes (PROMs) after primary hip arthroscopy with a minimum of 10-year follow-up between patients with femoroacetabular impingement syndrome (FAIS) with and without radiographic signs of global acetabular retroversion.MethodsThis retrospective matched-cohort study utilized data from a single surgeon's hip arthroscopy database. Inclusion criteria included patients who underwent primary hip arthroscopy for FAIS, had preoperative hip radiographs, and a follow-up of at least 10 years. Global retroversion was identified by the ischial spine sign, posterior wall sign, and crossover sign on anteroposterior radiographs. FAIS patients with global retroversion were matched 1:1 with FAIS controls by age, sex, and BMI. The modified Harris Hip Score (mHHS) and Non-Arthritic Hip Score (NAHS) were assessed preoperatively and at follow-up. Paired t-tests and Wilcoxon signed-rank tests compared PROMs between groups and improvements from baseline. Linear regressions identified predictors of poor outcomes. A p-value < 0.05 was statistically significant.ResultsOf the 163 eligible patients, 53 had global retroversion and were matched with 53 controls. Baseline characteristics, including age, sex, BMI, laterality, symptom duration, and preoperative radiographic measurements, were similar between groups. Both groups showed significant improvements in mHHS and NAHS scores from baseline to 5 and 10 years (p<0.001). There was no difference in achieving MCID, 5- or 10-year outcome scores, or changes in outcome scores between groups. Subgroup analysis indicated that within the global retroversion group, increased age predicted worse 10-year mHHS and NAHS scores (p<0.001, p=0.003). Increased BMI was correlated with worse PROs in both groups.ConclusionPatients with global retroversion undergoing hip arthroscopy for FAIS show significant improvement in outcome scores at 5 and 10 years, achieving MCID at rates similar to those without global retroversion.

BackgroundPrevious studies have reported reduced lumbar spine-pelvis-hip range of motion in patients with femoroacetabular impingement syndrome (FAIS). We have previously shown that the total hip-pelvic-lumbar range of motion is associated with the patient-reported outcome measures (PROMs) in this population. However, it remains unclear whether the individual contributions of lumbar and pelvic ranges of motion independently influence PROMs.PurposeThis study aimed to investigate whether the ranges of motion of the lumbar and pelvis are individually associated with PROMs in patients with FAIS.MethodsA total of 91 patients (60 males and 31 females) diagnosed with FAIS and functionally evaluated at our institution from February 2019 to December 2020 were included in this study. Patients with bilateral FAIS, revision surgery, or hip osteoarthritis were excluded. Posterior pelvic tilt mobility was assessed using the Pelvic Mobility test (PM test), with patients categorized into PM-negative (good mobility) group and PM-positive (poor mobility) group. Lumbar kyphosis mobility was measured using the modified-modified Schober test (MMST). PROMs including the modified Harris Hip score (mHHS), Nonarthritis Hip Score (NAHS), and International Hip Outcome Tool 12 (iHOT-12) were compared between the two groups using Student’s t-test. Correlation between MMST and PROMs were evaluated using the Pearson’s correlation coefficient. A p-value < 0.05 was considered statistically significant.ResultsAmong the participants, 54 patients were PM-positive and 37 were PM-negative. The PM-positive group showed significantly lower mHHS (66.5±16.4 vs 76.4±19.5, p<0.05), NAHS (47.9±13.4 vs 58.2±15.1, p<0.01), and iHOT-12 (35.7±24.3 vs 47.2±28.2, p<0.05) compared to the PM-negative group. No significant correlations were found between MMST and any of the PROMs (mHHS; r=0.159 p=0.137, NAHS; r=0.146 p=0.172, iHOT-12; r=0.052 p=0.630).ConclusionPelvic mobility, as assessed by the PM test, was significantly associated with PROMs, while lumbar kyphosis was not. These findings suggest that interventions targeting pelvic mobility may be beneficial for improving patient-reported outcomes in physiotherapeutic management for FAIS.

PurposeThe aim of the present study was to evaluate the association between femoral neck version and clinical outcomes after hip arthroscopy in patients with femoroacetabular impingement syndrome (FAIS).Methods326 hips with FAIS who underwent primary arthroscopic treatment were retrospectively evaluated from January 2015 to December 2019. Femoral neck version was measured on computed tomography. The patients were divided into 3 groups: retroversion, normal version, and excessive anteversion. The normal version group was considered to have a value within 1 SD of the mean femoral version value. Patient-reported outcomes (PROs) were evaluated at preoperatively and minimum of two years postoperatively. PROs utilized were the modified Harris Hip Score, Non-Arthritic Hip Score, and Hip Outcome Score-Activity of Daily Living Scale. The Visual Analogue Scale (VAS) pain score and patient satisfaction score (0-10) with arthroscopy outcomes were rated. All complications and re-operations were noted.Results228 hips (77 female, 151 male) among the 326 hips were satisfied the study inclusion criteria. The mean age of the patients was 35 years (range, 16 to 69 years). Mean femoral neck version was 8.7° ± .8.9° (range, -10° to 41°): retroversion group was -8.1° ± 5.8° (21 hips, 9.2%), normal group was 8.7° ± 5.1° (180 hips, 79.0%), and excessive anteversion group was 26.2° ± 7.6° (27 hips, 11.8%). In all group, PROs and VAS pain score was improved significantly (P <0.001). No differences in preoperative, postoperative, or change in PROs and VAS pain scores between the groups were noted. The mean patient satisfaction was scored at 8.4.ConclusionsFemoral neck version did not show a difference in the clinical outcomes compared to patients with normal femoral version when undergoing hip arthroscopic surgery in patients with FAIS. Three groups had similar improvements from the preoperative state.

ObjectiveIn patients with femoroacetabular impingement syndrome (FAIS), posterior pelvic tilt mobility is important and relation to thoracic rotation range of motion and abdominal trunk muscle strength. Furthermore, in these patients who combined with pain of posterior superior iliac spine (PSIS) region may be unchanged/poor outcomes to conservative therapy. This study examined treatment outcomes, physical findings at the initial intervention, and the relationships between these.MethodsWe included 24 patients with FAIS (10 males, 14 females, 55.0±15.5 years) diagnosed based on imaging and hip injection effects, who started outpatient conservative therapy between December 2023 and January 2025. We investigated (1) Treatment outcomes (hip arthroscopy rates), patients were divided into two groups (hip arthroscopy: surgery group, and non-surgery group: conservative therapy group) and compared the following items (2): (2) as physical function, thoracic rotational range of motion was measured, and abdominal trunk strength was measured using a trunk training device (RECORE®), (3) incidence of PSIS region pain, and additionally, we compared physical function between patients with and without PSIS region pain. Both statistical analyses used unpaired t-test.ResultsOf 24 patients, eleven patients (45.8%) underwent hip arthroscopy, while 13 (54.2%) received conservative treatment. The surgery group had significantly lower thoracic spine rotation range of motion (37.6±12.0° vs. 55.3±16.2°, p=0.007), while abdominal trunk muscle strength showed no significant difference (9.6±4.0 kPa vs. 8.8±3.9 kPa, p=0.620).Incidence of PSIS region pain on the affected side were observed in 9 of the 24 patients (37.5%), which were in the surgery group (4 patients) vs. the conservative therapy group (5 patients). No significant differences in thoracic spine rotation range of motion or abdominal trunk muscle strength were found between patients with and without PSIS region pain.ConclusionPatients with FAIS who had PSIS region pain did not show significant differences in physical function. However, reduced mobility of the thoracic spine rotation range of motion in patients with FAIS increases the likelihood of undergoing surgery, highlighting the importance of improving thoracic spine rotation range of motion in conservative therapy.

PurposeTo investigate the consecutive changes in effusion-synovitis after primary arthroscopic treatment for patients with femoroacetabular impingement syndrome (FAIS) and to determine the effect of postoperative effusion-synovitis on clinical outcomes.MethodsData from March 2021 through January 2022 was reviewed. Patients diagnosed with FAIS and undergoing hip arthroscopic treatment were included. MRI (noncontrast 3.0 T) was performed preoperatively and 3, 6, and 12 months postoperatively, and the measurement of the largest femoral neck fluid thickness (FTM) and cross-sectional area (CSA) of the effusion-synovitis were collected. Preoperative and minimum of 2-year postoperative patient-reported outcome (PRO) scores including visual analog scale (VAS), modified Harris Hip Score (mHHS), and International Hip Outcome Tool, 12-component form (iHOT-12) were collected and compared. Postoperative Tegner Activity Scale was also collected. The PROs and achievements of minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) were compared between patients with and without postoperative effusion-synovitis.ResultsA total of 61 patients (61 hips) were included in the study. The 3-month postoperative FTM, CSA, and grade of effusion-synovitis presented a significant increase compared with the preoperative values (all P < .05). No significant differences were observed in the 6-month postoperative measurements compared with the preoperative values (all P > .05). At the 12-month follow-up, although there was a significant decrease in all measurements compared with the preoperative values (all P < .001), 39 patients (63.9%) still presented effusion-synovitis. Compared with the other 22 patients (36.1%) without effusion-synovitis, these patients presented inferior mHHS, iHOT-12 (all P < .05), as well as lower achievement of PASS of mHHS (82.1% vs 100%, P = .035) and iHOT-12 (38.5% vs 81.8%, P = .001). The achievement of MCID of mHHS (79.5% vs 77.3%, P = .839) and iHOT-12 (89.7% vs 95.5%, P = .839) were comparable between patients with and without effusion-synovitis.ConclusionsAfter arthroscopic treatment for FAIS, the level of effusion-synovitis presented an initial increase, then followed by a subsequent decrease. Effusion-synovitis was significantly alleviated at 12 months compared with the preoperative level. Patients with postoperative effusion-synovitis had inferior clinical outcomes and lower achievement of PASS compared to those without.

ObjectiveThe Single Leg Squat (SLS) task is an effective tool for assessing clinical, biomechanical, and athletic performance. However, the short-term biomechanical changes in SLS for patients with Femoroacetabular Impingement Syndrome (FAIS) post-surgery remain unclear. This study aims to evaluate the kinematic changes of the hip, knee, and ankle joints during single-leg squats at 3 and 6 months post-surgery in FAIS patients.MethodsA total of 20 participants were included, comprising 10 FAIS patients and 10 age-, gender-, and BMI-matched healthy controls. Kinematic data were collected throughout the squat cycle using motion capture and force plates. Kinematic changes in the hip, knee, and ankle joints were analyzed. Repeated measures ANOVA was used to compare differences between 3 months, 6 months post-surgery, and baseline, while independent samples t-tests were used to compare baseline, 3 months post-surgery, 6 months post-surgery, and the matched healthy control group.ResultsCompared to pre-surgery, the hip flexion angle at 3 months post-surgery was significantly lower than that of the healthy control group (54.18° vs 83.29°, p=0.026). The hip adduction angle at 3 months post-surgery was significantly lower than baseline (5.32° vs 11.66°, p=0.013), 6 months post-surgery (5.32° vs 8.45°, p=0.005), and the healthy control group (5.32° vs 11.24°, p=0.030). The hip adduction angle at 6 months post-surgery was also significantly lower than baseline (8.45° vs 11.66°, p=0.004). Additionally, the ankle dorsiflexion angle at baseline was significantly lower than at 3 months post-surgery (11.21° vs 15.16°, p=0.006), 6 months post-surgery (11.21° vs 15.66°, p=0.001), and the healthy control group (11.21° vs 18.51°, p=0.002). The knee flexion angle at 3 months post-surgery was significantly lower than that of the healthy control group (63.57° vs 79.85°, p=0.016).ConclusionFAIS patients exhibited limited ankle dorsiflexion pre-surgery, which showed significant improvement post-surgery. At 3 months post-surgery, the hip adduction angle, hip flexion angle, and knee flexion angle were all lower, indicating an unstable state of the lower limb joints, which significantly improved by 6 months post-surgery.

PurposeTo investigate the clinical outcomes following arthroscopic chondral nail fixation for acetabular cartilage delamination (ACD) in patients with femoroacetabular impingement syndrome (FAIS), and the presentation of ACD on MRI at follow-up.MethodsA retrospective review was performed between March 2021 and March 2022 at our institute. Patients undergoing primary hip arthroscopy for FAIS and diagnosed with ACD intraoperatively were included. Exclusion criteria were incomplete data or loss of minimum 2-year follow-up, and concomitant hip conditions including hip osteoarthritis with a Tönnis grade > 1, avascular necrosis, Legg-Calvé-Perthes disease, osteoid osteoma, synovial chondromatosis, pigmented villonodular synovitis, and developmental dysplasia of the hip (DDH). Patients who underwent chondral nail fixation were matched 1:1 with a control cohort of patients who only underwent simple debridement. Preoperative and minimum 2-year postoperative patient-reported outcome (PRO) scores including Visual Analog pain Scale (VAS), modified Harris Hip Score (mHHS), and percentage of achieving minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) were collected and compared. MRI was performed preoperatively and at final follow-up to assess ACD.ResultsFifty-eight patients were included in the study (29 patients in each group). Both groups demonstrated improved VAS and mHHS following surgery (all with P < .05). The chondral nail group demonstrated better postoperative VAS (P = .022) compared to the control group, while the postoperative mHHS was comparable between the two groups (P = .852). No significant difference was found in the achievement of MCID between the two groups (all with P > .05). More patients in the chondral nail group, achieved PASS of VAS compared to the control group (75.9% vs 48.3%, P = .030). No patient underwent revision surgery or conversion to total hip arthroplasty (THA). The chondral nail group demonstrated significantly higher rate of ACD healing on MRI compared to the control group (P < .001).ConclusionPatients undergoing arthroscopic chondral nail fixation for treating ACD demonstrated significant pain relief, more achievement of PASS of VAS, and higher rate of ACD healing on MRI compared to those undergoing simple debridement.

PurposeTo prospectively determine the relationship between preoperative measures of grit and pain tolerance and hip-specific symptoms in patients with Femoroacetabular Impingement Syndrome (FAIS).MethodsThis is a prospective comparative investigation of individuals with FAIS undergoing primary hip arthroscopy (n=59; 37.2 ± 9.9 years; 56% female; labral preservation, cam/pincer/sub-spine correction, capsular closure) with a single surgeon fellowship-trained in hip preservation and eligible adult healthy volunteers (HV; control n=48). Subjects underwent a cold pressor test (CPT; hands and wrists submerged in 1.1° Celsius water) to objectively determine pain tolerance and completed self-reported surveys to determine grit, pain perception, catastrophizing, kinesiophobia, and other psychosocial behaviors and attitudes before surgery. Subjects were dichotomized into two groups: Group 1 (CPT 3 minutes), Group 2 (CPT <3 minutes). Descriptive and comparative statistics were performed.ResultsForty-six surgical patients self-reported high pain tolerance (46/59=78%) versus 30 HV (30/48=63%; p=0.079). Surgical patients demonstrated significantly higher preoperative kinesiophobia, fear avoidance, and catastrophizing than HV but similar demographics, self-reported pain tolerance, pain during CPT, and CPT time. Twenty-four (50%) HV completed the 3-minute CPT. Only 27 patients (46%; 12 females) completed the 3-minute CPT. The other 32 patients (54%, 21 females) had a mean CPT time of 49.3 ± 32.7 seconds. Twenty-two patients (22/59=37%) had CPT less than 60 seconds; 17 of those 22 (77%) had self-reported high pain tolerance; 13 of those 17 (76%) were female. Nine patients (9/59=15%) had CPT less than 30 seconds; seven of those nine (78%) had self-reported high pain tolerance; six of those seven (86%) were female.ConclusionsNearly four out of five patients (78%) who underwent arthroscopic hip preservation surgery for FAIS self-reported high pain tolerance, despite this being statistically improbable (Lake Wobegon and Dunning-Kruger effects). However, 54% failed to successfully complete three minutes on the CPT. Interestingly, in patients with CPT less than 60 and 30 seconds (objectively low pain tolerance), most of them self-reported a high pain tolerance (77% and 78%, respectively). Clearly, pain perception is highly subjective, prone to overestimation in hip preservation patients, and requires careful interpretation by surgeons.