Targeted Exercise and Changes in Femoroacetabular Impingement in Symptomatic Patients With Acetabular Retroversion
Condition: Acetabular Dysplasia
MeSH terms: Femoracetabular Impingement; Developmental Dysplasia of the Hip; Hip Dislocation, Congenital
Study type: Interventional

Summary: 
      The objective of this study is to investigate the effectiveness of an 8-week home-based
      targeted training intervention aiming at reducing FAI related pain, anterior pelvic tilt and
      improve hip joint function in a cohort of 40 patients (18 to 40 years), with acetabular
      retroversion and anterior pelvic tilt not eligible for surgery (Ganz osteotomy) from the
      hospital outpatient clinic.
    

Detailed description: 
      Acetabular retroversion is a variation of hip dysplasia, reported in the normal population
      from 6 % to 48 %, enhancing the risk of femoroacetabular impingement (FAI) in especially hip
      flexion and is associated with pain, reduced level of function, decreased health-related
      quality of life and early development of osteoarthritis (OA) of the hip. A higher degree of
      anterior pelvic tilt increases the risk of FAI and especially in standing, sitting and
      squatting positions it has been found to correlate with FAI. Periacetabular osteotomy (Ganz
      osteotomy) is performed as a surgical joint preserving reorientation of the entire acetabulum
      with a subsequently long period of rehabilitation. There is currently no existing alternative
      (i.e. non-surgical) treatment to surgery for this patient group. Therefore, the objective of
      this study is to test a targeted training intervention aiming at reducing anterior pelvic
      tilt and improve hip joint function in patients with symptomatic acetabular retroversion.

      A prospective cohort study of 40 patients will undergo an 8-week targeted exercise
      intervention executed as progressive home-based training with supervised booster-sessions.
      Patients (18 to 40 years) with acetabular retroversion and anterior pelvic tilt not eligible
      for surgery (Ganz osteotomy) will be recruited from the outpatient clinic.

      Time points for testing are at 1) minus 8-weeks (beginning of control-period) 2) baseline
      (beginning of training period) 3) plus 8-weeks (end of training period) and 4) plus 26 weeks
      from baseline (follow up).

      The primary outcome measure is self-perceived level of hip related pain (HAGOS questionnaire
      subscale). Secondary outcome measures are self-perceived level of function and quality of
      life (remaining HAGOS-subscales), EQ-5D-3Levels questionnaire and radiographic degree of
      pelvic tilt in standing posture (EOS-scanning). Explorative outcome measures include
      additional radiographic measurements, patient-reported outcome measurements (PROM´s),
      functional testing and physical performance. The primary endpoint for assessing the outcome
      of the intervention will be 8 weeks after start of intervention. At 26-week follow up, only
      the PROM´s will be applied. All participants must fill in a mandatory exercise related dairy
      concerning adherence, level of pain and potential adverse events.

      The study is approved by the Regional Committees on Health Research Ethics for Southern
      Denmark, Project ID: S-20160072 Forty participants in total will be enrolled from the hip
      outpatient clinic at Odense University Hospital, Denmark. Paired means sample size
      calculation = 36 (10 % pre-posttest difference on HAGOS pain-subscale, SD=20.6, alpha = 0.05,
      power = 80 %), plus 10 % dropout = 4.

      A list generated of 20 randomly found numbers from 1-40 will be used to select participants
      to be investigated in the motion laboratory. The number on the list corresponds to the order
      the participants are recruited into the study. In the motion laboratory, the explorative
      outcomes Functional testing (3D motion capture) and Physical performance (isometric muscle
      strength, joint range-of-motion, and single-leg hop for distance) will be tested.

      To our knowledge, this is the first study investigating a targeted training intervention
      aiming at reducing FAI related pain, anterior pelvic tilt and improve hip joint function in
      patients with acetabular retroversion. Consequently, the study will provide knowledge that
      may help to develop non-surgical treatment strategies for this group of patients.
    

Intervention name(s): Targeted training intervention
Intervention type(s): Other
Intervention description(s): An 8-week progressive homebased training intervention with supervised booster-sessions
Intervention model: Single Group Assignment
Intervention model description: Prospective cohort study
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Femoroacetabular Impingement; Anterior Pelvic Tilt