Changes in physical impairments in femoroacetabular impingement syndrome following arthroscopic surgery: a systematic review and meta-analysis.

Abstract

Femoroacetabular impingement syndrome (FAIS) is a motion-related condition causing hip pain in young active adults. Physical impairment measures of body function include objective and reproducible measures of hip mobility, muscle power, and movement coordination. Limited data on physical impairments and the effects of arthroscopic surgery exist. The aim of this systematic review was to investigate changes in physical impairments in those with FAIS, pre- and post-arthroscopic surgery. Six databases were searched for English-language studies reporting on pre- and postoperative physical impairments using physical outcome measures. Reporting quality was assessed using the Grading of Recommendations Assessment, Development and Evaluations (GRADE) framework, the Cochrane Risk of Bias tools and Methodological Index for Non-Randomized Studies (MINORS); for pooled data [standardized mean difference (SMD), and 95% confidence intervals (CI)]. Seventeen studies were included (two randomized controlled trials; fifteen pre/postintervention studies), varying from low-critical risk of bias, low-moderate on the MINORS, and very low reporting quality using the GRADE tool. Postoperatively, participants with FAIS walked with a higher peak hip flexion moment [SMD 0.5, 95% CI (0.12-0.88); heterogeneity I ² = 0%, P = .82] and reduced external rotation range [SMD -0.68, 95% CI (-1.34 to -0.01); heterogeneity I ² = 61%, P = .05]. Surgery increased participant hip flexion moment and impulse, hip strength and faster gluteus maximus contraction time. Patients demonstrated reduced hip extension, abduction and adduction angles during walking gait, and peak hip extension moments during gait and squatting. While this review found some physical impairments changed postoperatively, further research into specific subgroups of FAIS would enhance understanding and inform rehabilitation programs and optimize patient outcomes. Level of Evidence: IV (systematic review of III and IV evidence).