Postoperative Hip Bracing After Hip Arthroscopy

Study Overview
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Brief Summary
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Hip arthroscopy for treatment of femoroacetabular impingement syndrome (FAIS) involves reshaping of the osseous sources of impingement (osteoplasty) and treatment of impingement-associated labral tears with labral repair. Postoperative hip braces are advocated to decrease postoperative pain by offloading hip musculature. However there are no studies looking at efficacy of hip braces after hip arthroscopy, and on average 50% of high-volume hip arthroscopists use bracing. The objective of this study is to use a randomized controlled trial to test the cited benefits of postoperative hip bracing on short term patient reported pain scores, validated hip-specific pain scores, and physical exam findings of hip flexor tendonitis.

Detailed Description
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Hip arthroscopy for treatment of femoroacetabular impingement syndrome (FAIS) involves reshaping of the osseous sources of impingement (osteoplasty) and treatment of impingement-associated labral tears with labral repair. The hip joint is subluxated with traction to accomplish this procedure. The diagnoses of FAIS and the incidence of hip arthroscopy have both increased dramatically in the last 20 years in the US -- in a recent study using IBM Marketscan to evaluate rates of hip arthroscopic treatment of FAIS, the investigators found this incidence doubled from 1.2 to 2.1 per 100,000 person-years in just a 3-year period. Despite the increasing incidence of hip arthroscopy in the US, on a recent review the investigators have found few evidence-based studies on postoperative care. A particular area of debate is the use of postoperative hip braces. Postoperative hip braces are advocated to decrease postoperative pain by offloading hip musculature. They may also prevent overuse of the hip flexors by supporting the hip during gait. However there are no studies looking at efficacy of hip braces after hip arthroscopy, and on average 50% of high-volume hip arthroscopists use bracing. The utility of bracing is important because hip braces are expensive (averaging $350-$600): if there are over 7000 hip arthroscopies performed nationwide and 50% of surgeons use hip braces, this amounts to over $2,000,000. The investigator's overall objective is to use a randomized controlled trial to test the cited benefits of postoperative hip bracing on short term patient reported pain scores, validated hip-specific pain scores, and physical exam findings of hip flexor tendonitis.

Official Title
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A Randomized Controlled Pilot Trial of Postoperative Hip Bracing After Arthroscopic Osteoplasty and Labral Repair for Femoroacetabular Impingement Syndrome

Conditions
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Femoroacetabular Impingement Syndrome, Acetabular Labral Tear

Intervention / Treatment
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* Device: Hip brace


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patient age 14-60 on date of surgery Patient seen at the institution for the study Patient scheduled to undergo arthroscopic osteoplasty and labral repair for femoroacetabular impingement syndrome. Exclusion Criteria: Any patient anyone who cannot follow up in person in clinic for the 6-week postoperative visit. Any patient with planned iliopsoas tendon release for tendonitis at the time of surgery, or who undergoes iliopsoas tendon release on the day of surgery (this may be a confounding variable as this is study looking at ability of the hip brace to prevent hip flexor tendonitis after surgery). Non-English speaking patients (due to limited validation of the patient reported outcome measures in non-English speaking populations).

Ages Eligible for Study
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Minimum Age: 14 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Patients randomized to wearing a hip brace after surgery 36 Patients randomized to not wearing a hip brace after surgery 36
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Hip Brace<br>This group will be assigned to wear a hip brace post surgery. | Device: Hip brace<br>* Hip brace<br>|
| No Intervention: No Intervention<br>This group will not be assigned a hip brace after surgery. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| patient numerical pain ranking scale (NPRS) | Validated pain scale, subject reported. Min 0, Max 10, Higher score means worse outcome. | 6 weeks after surgery date | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| HOOS - Hip disability and Osteoarthritis Outcome Score | questionnaire used to assess the patient's opinion about their hip and associated problems and to evaluate symptoms and functional limitations related to the hip during a therapeutic process. Min 0, Max 100. Lower score means worse outcome. | at 6 week and 6 month after surgery date | 
| VR12 - Veteran RAND 12 item health survey | general health outcome survey. The results of the VR-12 are summarized as two scores - a Mental Component Score (MCS) and a Physical Component Score (PCS). The scores may be reported as Z-scores (difference compared to the population average, measured in standard deviations). The United States population average PCS and MCS are both 50 points. The United States population standard deviation is 10 points. Therefore, each increment of 10 points above or below 50 corresponds to one standard deviation away from the population average. | at 6 week and 6 month after surgery date | 
| Patient using non-steroidal medication | yes / no | 6 week and 6 month after surgery date | 
| Patient received cortisone injection to hip flexor sheath or bursa | yes / no | 6 week and 6 month after surgery date | 
| Patient using opioid medication | yes / no | 6 week and 6 month after surgery date | 
| NPRS - numerical pain ranking scale | Validated pain scale, subject reported. Min 0, Max 10, Higher score means worse outcome. | 3 weeks and 6 months after surgery date |