Keaton Andra

Influence Of Hip Arthroscopy For Femoral Acetabular Impingement Syndrome On Walking Gait: A Systematic Review

Mentor: Stephan Bodkin, PHD

Department: Orthopedics

Femoroacetabular impingement syndrome (FAIS) is a common pathology that inhibits sport and activity participation. Though non-operative treatments are the primary approach, superior outcomes have been observed following hip arthroscopy (HA). To promote proper assessments that may strengthen return to full wait bearing walking, running, and sport; knowledge of gait deficits following HA for FAIS are needed. PURPOSE: To systematically review the literature to identify deficits in hip kinematics and kinetics prior to 2 years following HA in FAIS patients. METHODS: A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Our search utilized Pubmed, EMBASE, CINAHL, and Cochrane Library. Studies reporting outcomes of hip kinematics or kinetics during walking gait in patients less than two years following HA for FAIS were included. Comparisons were hip kinematics or kinetics prior to HA (pre-surgery vs post-surgery) and to healthy controls (pre-surgery vs controls, post-surgery vs controls). Cohen’s d effect sizes were calculated for all comparisons. RESULTS: A total of seven articles met our study purpose and were included for data extraction. Pre-operative strength was reported in 100% (7/7) of the articles extracted and healthy control gait was reported in 71% (5/7) of the articles. Time from HA to gait analysis ranged from 6-21 months. Compared to pre-surgery, the operated FAIS hip demonstrated the greatest changes in transverse plane kinematics (internal rotation: d= -1.74 to .16; external rotation: d=2.11 to -.46), though results demonstrated high variability amongst studies. Compared to healthy controls, pre-operative gait kinematics consistently demonstrated a lower peak knee extension angle during gait (d=-.25 to -.96). Peak knee extension angle improved following HA, through remained lower than healthy controls (d=-.02 to -.82). Gait kinetics following HA resulted in inconsistent results compared to both pre-surgical values and to healthy controls. CONCLUSIONS: The literature reports inconsistent findings on hip kinematics and kinetics following HA for FAIS. Compared to pre-operative measures, hip kinematics increased following HA, though deficits are still observed up to 2 years post-HA compared to healthy controls.