Summary

Hip MUA is an effective, non-invasive treatment for patients with pericapsular scarring post-hip arthroscopy for FAI.

Abstract

Background

Pericapsular scarring is one etiology of pain after hip arthroscopy for the treatment of femoroacetabular impingement (FAI). Hip manipulation under anesthesia (MUA) has been proposed as a potential treatment. Hip MUA is a quick, outpatient procedure where the patient is sedated, and the hip is manipulated through various movements to break up pericapsular adhesions. This study aimed to evaluate the efficacy of hip MUA in improving hip range of motion (ROM), symptoms, and function in patients with pericapsular scarring post-hip arthroscopy for FAI.

Methods

This retrospective cohort study included 41 patients who underwent hip MUA from June 2020 to July 2023. ROM (flexion, internal rotation at 90°, and external rotation at 90°) and various patient-reported outcomes (PROs; International Hip Outcome Tool-12 [iHOT-12], Modified Harris Hip Score [mHHS], Hip Outcome Score [HOS], Single Assessment Numeric Evaluation [SANE], and Patient-Reported Outcome Measurement Information System [PROMIS]) were assessed pre-index arthroscopy and at 3, 6, 9, and 12 months post-operatively. Wilcoxon signed-rank tests assessed changes in post-MUA ROM and PROs. Mixed modeling was also used to look at repeated ROM measures on a continuous scale with time and MUA as predictor. LSmeans estimates were compared between MUA groups at each time point.

Results

Significant improvements in all ROM assessments were observed immediately after MUA (p ≤ 0.001), with gains sustained for over 9 months (p < 0.0175). Twenty-eight patients had sufficient data for PRO analysis. Post-MUA, patients had statistically significant improvements in mHHS (p = 0.0475), iHOT-12 (p = 0.0036), SANE-ADL (p = 0.0103), and HOS-Sport (p = 0.0386).

Conclusions

Hip MUA is an effective, non-invasive treatment for patients with pericapsular scarring post-hip arthroscopy for FAI. The improvements in ROM and PROs suggest that hip MUA can alleviate patients’ pain while improving their hip ROM, sports performance, and ability to execute activities of daily living.