Summary

Although 30% of patients progressed toward arthroscopic hip surgery, a significant improvement in hip pain, symptoms and physical function is observed, combined with a high rate of overall satisfaction, in the majority of patients with non-arthritic hip pain undergoing a targeted non-operative management pathway consisting of an intra-articular injection and a structured exercise program.

Abstract

Introduction

The initial treatment recommendations for non-arthritic hip pain often include non-surgical therapies such as injections and rehabilitation, though evidence is lacking and many patients undergo isolated injections or a rudimentary exercise regime. This study sought to investigate the benefit of a combined intra-articular hip injection and concomitant structured exercise rehabilitation program in patients with non-arthritic hip pain =6 months.

Methods

This study prospectively recruited 54 patients with a mean age of 33.2 years (range 16-56) and symptoms =6 months in duration (range 6-250 months) associated with femoroacetabular impingement syndrome (FAIS), borderline dysplasia and/or labral pathology. Pathology was confirmed in all patients via magnetic resonance imaging (MRI) and x-ray. Patients underwent a guided intra-articular injection of corticosteroid and local anaesthetic, followed by a structured and progressive 12-week rehabilitation program. Patients were assessed pre- and post-injection (8 weeks, 4, 6, 12 and 24 months) with a range of patient-reported outcome measures (PROMs), range of motion (ROM), peak isometric hip strength and hop tests. Absolute scores and Limb Symmetry Indices (LSIs) were calculated. The percentage of patients transitioning toward surgery over the 24-month period was evaluated.

Results

Overall, 50 patients underwent the injection and completed the initial 8-week rehabilitation component, of which 15 (30%) progressed toward surgical intervention over the 24-month post-injection period due to dissatisfaction and/or symptom recurrence. Patients that progressed toward surgery, compared to those that did not, reported significantly worse (p<0.05) PROMs pre-surgery and more pain within the first 4 weeks post-injection. A significant improvement (p<0.05) in all PROMs was observed and, of the 34 patients that had not progressed toward surgery and were available for final 24-month clinical review, 94% were satisfied. A significant increase (p<0.05) in all hip ROM and most isometric strength measures were observed to 8 weeks, maintained over 24 months. Bilateral improvements in hop capacity were observed, with all hop test LSIs significantly improving (p<0.05).

Conclusions

A significant improvement in hip pain, symptoms and physical function was observed in the majority of patients with non-arthritic hip pain as a result of a targeted non-operative management pathway that consisted of an intra-articular injection and a structured exercise program. Overall, 30% of patients progressed toward surgery.