EP8.39 Baseline factors associated with success for non-operative management of femoroacetabular impingement syndrome – analysis from a prospective cohort

Abstract

Abstract Background There is a lack of literature examining which patients with femoroacetabular impingement syndrome (FAIS) may benefit most from non-operative care. Purpose To determine baseline factors associated with success of non-operative management of patients with FAIS. Methods An analysis of results from a prospective, non-operative cohort of patients with FAIS was conducted. Eligible patients included those aged 16-55 who met radiographic and clinical criteria for FAIS. Enrolled patients participated in a standardized pelvic-tilt focused, home physiotherapy regimen over 6 months. Patient-reported and clinical outcomes were collected at 6 months. Associations between baseline factors of interest (age, sex, modified Tegner Activity Scale [mTAS], pain location, prior physiotherapy, baseline abdominal strength, acetabular retroversion, sport injury adherence scale [SIRAS] - a physical therapist’s baseline evaluation of the patient’s engagement in the program, MODEMS pre-treatment expectations survey, and pain severity) and “treatment success” were explored using multivariable logistic regression. Treatment success was defined as both improvements on the International Hip Outcome Tool-33 (iHOT-33) by at least the minimal clinically important difference (MCID) (a change in score of 6.8) and the avoidance of surgery. Results 214 patients enrolled in the study between August 2020 and October 2021. Mean age was 34.2 years (+10.2), and 121 patients (57%) were female. Within the study period 19/214 (9%) patients dropped out or were lost to follow-up. Of the remaining 195 patients, 42 patients (22%) elected to undergo hip arthroscopy. 192/195 patients completed their outcome questionnaires. In all, 96/192 patients (50%) met the definition of “treatment success”. Patients with a higher baseline mTAS (OR 1.24[1.01-1.54]), those who engaged in prior physiotherapy (OR 2.78 [1.30-5.88), and those with a primary pain location other than groin (OR 4.57[1.19-17.55]) were more likely to achieve treatment success. Conclusion In this non-operative study of patients with FAIS, higher baseline activity, prior engagement in physiotherapy and a primary pain location other than the groin were baseline factors associated with treatment success. These characteristics can be utilized by practitioners to forecast which patients with FAIS would likely benefit from a trial of pelvic tilt-based physiotherapy prior to considering hip arthroscopy.