Pain worsens peripartum after hip arthroscopy for femoroacetabular impingement and may not return to pre-pregnancy improvement

Abstract

Purpose

To assess hip symptomatology during the perioperative and peripregnancy periods and postoperative outcomes among reproductive age females undergoing arthroscopic treatment for femoroacetabular impingement syndrome (FAIS) and pregnancy complications in females after hip arthroscopy.

Methods

Females aged 18–44 years who underwent hip arthroscopy for the treatment of FAIS with a single surgeon were included in the study. Postoperatively, patients were surveyed regarding obstetric history, hip symptomology, and post-surgery pregnancy experiences. Subjects were classified as nulligravid (Group 1), pregnant at least once before hip surgery but never again following surgery (Group 2), or pregnant at least once following hip surgery (Group 3). Hip pain intensity was reported on a 10-point Visual Analog Scale (VAS) and hip function was reported using the modified Harris Hip Score (mHHS). Patients self-reported pregnancy outcomes and complications.

Results

85 patients were enrolled with a mean age of 32.3 ± 6.5 years at the time of surgery. Mean follow-up time was 51.9 ± 34.5 months. There were 39 subjects in Group 1 (45.9 %), 20 in Group 2 (23.5 %), and 26 in Group 3 (30.6 %). There were no significant inter-group differences in mHHS preoperatively or at final follow-up (p = 0.95). Group 3 subjects reported that both postoperative and post-pregnancy VAS remained significantly lower than the preoperative baseline (p < 0.001). 69.2 % and 73.1 % report worsened hip pain during the third trimester and postpartum, respectively. 57.9 % reported that their hip pain returned to the pre-pregnancy baseline by time of survey completion.

Conclusion

Females of reproductive age with FAIS can expect clinical improvements relative to their baseline after hip arthroscopy regardless of pregnancy timing relative to surgical intervention. A majority of patients who become pregnant post-arthroscopy experience a peripartum recurrence of their symptoms. Most but not all of these patients return to the level of maximal improvement they had initially experienced postoperatively.