title: Prospective 12-month functional and vocational outcomes of hip arthroscopy for femoroacetabular impingement as part of an evidence-based hip pain rehabilitation pathway in an active military population.
abstract: BACKGROUND
  Femoroacetabular impingement (FAI) is common with an estimated prevalence of 10-15% among young active individuals. The natural history of the disorder is progression to early osteoarthritis. Hip arthroscopy is recommended if conservative treatments fail; however, outcomes are unclear, particularly in highly active populations.
  
  
  OBJECTIVE
  To evaluate the functional and vocational outcome of hip arthroscopy, as part of an evidence-based rehabilitation hip pain pathway, for the treatment of FAI in an active military population.
  
  
  METHODS
  All patients in the defence rehabilitation hip pain pathway, with a confirmed diagnosis of FAI who failed conservative treatment, were assessed prior to surgery and at 2, 6 and 12 months postsurgery. Outcome measures included the Visual Analogue Scale (VAS) for hip pain, Non-Arthritic Hip Score (NAHS) for function, and vocational assessments including functional activity assessment (FAA) and Joint Medical Employment Standard for military employability and deployability.
  
  
  RESULTS
  101 patients completed the study (mean age=33 years) (male:female:75:26) (Royal Navy/British Army/Royal Air Force: 13%/48%/39%). Outcomes demonstrated significant improvements with large effect size. Preoperative NAHS mean=62.9 (SD 16.4), 12-month postoperative NAHS mean=78.8 (18.3), mean improvement in NAHS=15.9 (95% CI 12.3 to 19.5, p<0.001). Preoperative VAS pain mean=51.3 (20.9), 12-month postoperative VAS pain=25.6 (24.5). Mean improvement 25.7 (95% CI 19.4 to 31.99, p<0.001). 73% of patients had a deployable medical category at 12 months postoperative.
  
  
  CONCLUSIONS
  These data confirm that hip arthroscopy as part of a structured evidence-based multidisciplinary care pathway produces significant and continued symptomatic, functional and vocational improvements over a 12-month period in a military population exposed to high intensity, weight-bearing exercise in uncontrolled and unforgiving environments.
authors.affiliation: Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Epsom, Surrey, UK; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.
authors.forename: A N
authors.initials: AN
authors.lastname: Bennett
authors.affiliation: Centre for Lower Limb Rehabilitation, Defence Medical Rehabilitation Centre , Epsom, Surrey , UK.
authors.forename: J
authors.initials: J
authors.lastname: Nixon
authors.affiliation: Academic Department of Military Rehabilitation , Defence Medical Rehabilitation Centre , Epsom, Surrey , UK.
authors.forename: A
authors.initials: A
authors.lastname: Roberts
authors.affiliation: Centre for Lower Limb Rehabilitation, Defence Medical Rehabilitation Centre , Epsom, Surrey , UK.
authors.forename: R
authors.initials: R
authors.lastname: Barker-Davies
authors.affiliation: Department of Trauma and Orthopaedics , Wellington Hospital , London , UK.
authors.forename: R
authors.initials: R
authors.lastname: Villar
authors.affiliation: Centre for Lower Limb Rehabilitation, Defence Medical Rehabilitation Centre , Epsom, Surrey , UK.
authors.forename: J M
authors.initials: JM
authors.lastname: Houghton
keywords: Arthroscopy; Hip; Rehabilitation