Correlating Biomechanical Gait Analysis With Patient-Reported Outcomes After Hip Arthroscopy for Femoroacetabular Impingement Syndrome

Abhishek S Kannan; Matthew J Hartwell; Trevor Grace; Eric Hammond; Kylen K J Soriano; Richard B Souza; Alan L Zhang

doi:10.1177/23259671221121352

Correlating Biomechanical Gait Analysis With Patient-Reported Outcomes After Hip Arthroscopy for Femoroacetabular Impingement Syndrome

Orthop J Sports Med. 2022 Sep 5;10(9):23259671221121352. doi: 10.1177/23259671221121352. eCollection 2022 Sep.

Authors

Abhishek S Kannan¹, Matthew J Hartwell¹, Trevor Grace¹, Eric Hammond², Kylen K J Soriano¹, Richard B Souza², Alan L Zhang¹

Affiliations

¹ Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA.
² Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA.

Abstract

Background: Postoperative biomechanics after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) are an outcome of interest, but correlation with patient-reported outcomes (PROs) remains unclear.

Purpose/hypothesis: The purpose of this study was to assess the correlation between changes in hip biomechanics in FAIS patients after hip arthroscopy and changes in PRO scores. We hypothesized that gait analysis would demonstrate significant correlations between pre- and postoperative changes in biomechanics and changes in PRO scores.

Study design: Descriptive laboratory study.

Methods: FAIS patients without dysplasia or arthritis who underwent primary hip arthroscopy for labral repair and femoroplasty underwent preoperative and 1-year postoperative 3-dimensional motion tracking and biomechanical testing during normal gait. Joint kinematics calculated included flexion/extension (sagittal plane), abduction/adduction (frontal plane), and internal/external rotation (transverse plane). Peak hip angles and moments were compared between baseline and 1-year postoperative measures. At baseline, 1-year, and 2-year postoperatively, patients completed the following PRO surveys: 12-Item Short Form Health Survey (SF-12), modified Harris Hip Score (mHHS), and Hip disability and Osteoarthritis Outcome Score (HOOS). Joint kinematics that significantly improved 1 year after surgery were assessed for correlations with PRO scores.

Results: A total of 10 patients (12 hips) were enrolled prospectively. PROs significantly improved at 1 and 2 years postoperatively compared with baseline values for HOOS, mHHS, and SF-12 Physical Component Score, with all patients achieving the minimal clinically important difference (MCID) on the HOOS Sport/Recreation and Quality of Life subscales. From preoperatively to 1-year postoperatively, significant improvements were seen in peak hip abduction angle (from -2.3° ± 1.8° to -4.6° ± 1.8°; P = .0058) and peak hip extension moment (from -1.03 ± 0.19 to -0.85 ± 0.20 N·m/kg; P = .014); however, there were no significant correlations between these changes and the pre- to postoperative changes on any PRO scores.

Conclusion: Gait analysis of FAIS patients after hip arthroscopy demonstrated small, albeit significant, changes in postoperative hip kinetics and kinematics; however, these changes did not correlate with the large, clinically significant improvements in PROs at 1 year after surgery.

Clinical relevance: The results of this study suggest that the degree of improvement in short-term PROs after hip arthroscopy for FAIS may not be related to small changes in biomechanics postoperatively.

Keywords: biomechanics; femoroacetabular impingement; gait analysis; hip arthroscopy; outcome.