Generic health status improves after non-surgically and surgically treated hip abductor tendon pathology: a retrospective study of ninety-seven female patients.

Abstract

Background: Insertional hip abductor tendon pathology (tendinopathy or tears of gluteus medius and/or minimus tendons) are increasingly recognized as the main cause of lateral hip pain. This study aims to evaluate generic health status in patients with lateral hip pain due to Magnetic Resonance Imaging (MRI) verified hip abductor tendon pathology using the EQ-5D-5L and compare these findings with a matched national population norm.

Methods: Data from patients with lateral hip pain, referred to our hospital from 2017-2023, was retrospectively reviewed. Females aged 18+ years, with positive clinical tests and MRI verified hip abductor tendon pathology, who had completed the EQ-5D-5L at relevant timepoints, were included. Our treatment algorithm consisted of a baseline physiotherapist led intervention (patient education followed by 3-months un-supervised training). Surgery was offered to patients who, after the intervention, had recalcitrant lateral hip pain and MRI verified tendon tears. Post hoc two treatment groups were identified. The EQ-index scores were calculated from individual health profiles using a national value set. The student's t-test was used to compare groups. Summary statistics are used, including numbers of patients and proportions of categorical responses for the five EQ-5D dimensions. To compare responses between groups, the Fisher's exact test was used.

Results: Ninety-seven female patients were included; 48 (57±12 years) received rehabilitation only (REHAB) and 49 (59±11 years) underwent subsequent surgery (SURG). At baseline, the mean EQ-index was inferior to population norms. After 3 months of rehabilitation, EQ-index (p<0.0001) and EQ-VAS (p=0.004) improved in REHAB, but not in SURG (EQ-index: p=0.32, EQ-VAS: p=0.22). Twelve months after surgery, EQ-index (p<0.0001) and EQ-VAS (p<0.0001) improved and, notably, the dimension "pain/discomfort" was comparable to population norms (p=0.788).

Conclusion: Generic health status in female patients suffering from lateral hip pain due to hip abductor tendon pathology is severely affected compared to a national population norm measured with the EQ-5D-5L. Generic health status may improve after three months of patient education and rehabilitation in some cases, while surgery may improve health status three months postoperative in the remaining cases.

Trial registration: The study is registered at the Central Denmark Region List of Research Projects (Jr nr: 1-16-02-761-17 and 1-16-02-125-19).