Weight Bearing Status Post-hip Arthroscopy

Study Overview
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Brief Summary
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This study is being proposed to examine weight bearing precautions following hip arthroscopic labral repair, femoroplasty, and capsular closure. Standard post operative protocols limit weight bearing for 2-6 weeks depending on individual surgeons. Cadaveric studies demonstrate that minimal force during weight bearing is distributed through labrum. Therefore, progressing weight bearing earlier in these patients post operatively may help progress faster and improve outcomes. Data collected will include demographic information, radiological data, operative procedures and PRO data.

Detailed Description
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The study will be conducted at UPMC St. Margaret's Hip Preservation Program. Consented patients who undergo acetabular labral repair and femoroplasty will be included in randomization of weight-bearing status. Two separate protocols will be created to indicate weight bearing status, either WBAT immediately post-op or FFWB immediately post-op, to distribute to rehabilitation staff to ensure compliance. Immediately after the surgical procedure, the surgeon will be blinded and a randomized pamphlet with post-operative instructions with weight bearing education will be given to PACU nursing staff to educate patients and fit crutches.

Official Title
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Weight Bearing as Tolerated (WBAT) Following Hip Arthroscopic Labral Repair and Femoroplasty.

Conditions
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Hip Impingement Syndrome, Acetabular Labral Tear

Intervention / Treatment
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* Other: Weight Bearing as tolerated (WBAT) immediately following surgery.
* Other: Flat foot weight bearing (FFWB) immediately following surgery


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age>= 12 years Diagnoses: femoroacetabular impingement and hip labral tears. Surgical procedures performed: Hip arthroscopy with femoroplasty and labral repair. Surgery completed at UPMC Children's or UPMC St. Margaret's Hospital unilateral and bilateral hip patients Exclusion Criteria: MSK tumor-related FAI or dysplasia generalized hypermobility revision surgeries

Ages Eligible for Study
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Minimum Age: 12 Years
Maximum Age: 65 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: Subjects will be enrolled into either Weight bearing as tolerated group immediately or Flat foot weight bearing group for 2 weeks. Currently, flat foot weight bearing for the first 2 weeks is standard of care.
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Weight bearing as tolerated (WBAT) immediately following surgery.<br>Subjects will be able to self-select weight bearing based on pain and confidence in surgical hip. | Other: Weight Bearing as tolerated (WBAT) immediately following surgery.<br>* Subject will be provided standard of care physical therapy following surgical intervention, except will be able to self-select weight bearing based on pain and confidence.<br>|
| Active Comparator: Flat foot weight bearing (FFWB) for 2 weeks after surgery.<br>Subjects will be limited to FFWB, approx 20lbs through the surgical hip. | Other: Flat foot weight bearing (FFWB) immediately following surgery<br>* Subject will be provided standard of care physcial therapy following surgical intervention except<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| International Hip Outcome Tool 12 (iHot-12) | Scoring ranges from 0-100 each question is rated from 0-100 and final score is the mean of all questions answered by subject higher scoring indicating higher quality of life due to hip function | up to 6 months post-operative | 
| Hip and Groin Outcome Score (HAGOS) | This outcome includes 6 subscales, these are scored independently, and no aggregate scoring is calculated as each section assesses different dimensions separately. Subscales (raw scores for each subscale converted to a 0-100 scale with higher score indicating higher level of function): Pain Symptoms Activities of Daily Life Function in Sport and recreation Participation in Physical Activities hip and groin-related quality of life | up to 6 months post-operative | 
| Hip Outcome Score (HOS) ADL | Outcome assessing function with activities of daily living. Higher score is given for higher level of function and lower score indicating reduced function. 0-68 aggregate scoring converted to 0-100 scale. | up to 6 months post-operative | 
| Hip Outcome Score (HOS) Sport | Outcome assessing function/difficulty completing dynamic activities associated with sports participation. Higher score is given for higher level of function and lower score indicating reduced function. 0-36 aggregate scoring converted to 0-100 scale. | up to 6 months post-operative | 
| Tampa Scale for Kinesiophobia-11 | Outcome measure assessing fear of pain with movement. Scores range from 11 to 44. Higher scores indicate greater fear of movement | up to 6 months post-operative | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Isometric strength measures hip add, abd, ER, and extension | Strength measures will be taken isometrically at post-operative follow ups. | 6-week, 3 months, and 6-month post-operative | 
| Diagnostic ultrasound assessment of bilateral anterior hip capsule thickness | Physician while blinded will perform ultrasound evaluation of the hip capsule to ensure healing. Ultrasound will measure the following: 1.Assess the bilateral hip anterior capsule in all patients, assessing for internal consistency or changes in capsular thickness from side to side. Normal hip capsular thickness has been reported as 7-8 mm, dysplastic hips range 3.2 +/- 0.5 mm, and femoroacetabular impingement subjects 4.7 +/- 0.6 mm. | 3 months post-operative | 
| Diagnostic ultrasound assessment of incision widening | Physician while blinded will perform ultrasound evaluation of the hip capsule to ensure healing. 1. Evaluation of capsular incision widening, cyst, attenuation and thinning from established norms. Normal hip capsular thickness has been reported as 7-8 mm, dysplastic hips range 3.2 +/- 0.5 mm, and femoroacetabular impingement subjects 4.7 +/- 0.6 mm | 3 months post-operative | 
| Diagnostic ultrasound for focal echogenic adhesions | Physician while blinded will perform ultrasound evaluation of the hip capsule to ensure healing. 1. Evaluate for focal echogenic adhesions or dyskinetic motion between capsule and overlying iliopsoas complex with activation of hip flexion. | 3 months post-operative |