Qualitative Assessment of Return to Sport After Hip Arthroscopy for
Femoroacetabular Impingement

Tjong VK, Cogan CJ, Riederman BD, & Terry
MA.  Orthop
J Sports Med. 
2016 Nov

Home Message:  An optimistic outlook,
positive coping strategies, and strong external social support are common
characteristics found in individuals who returned to sport after hip
arthroscopy for femoroacetabular impingement. 

Return to sport outcomes for femoro acetabular impingement (FAI) is relatively under researched as
compared to that of anterior cruciate ligament reconstruction or shoulder
instability.  To better understand the
factors that influence a patient’s decision to return to sport after surgery
for FAI, the authors conducted a qualitative study with 23 patients (18 and 60
years old) who underwent hip surgery for FAI.
An experienced interviewer conducted a 45-minute semi-structured interview
with individuals who underwent hip surgery at least 2 years before and who
participated in recreational sport prior to injury/surgery.  Thirteen participants returned to preinjury
level of sport. Researchers continued enrollment until no new emerging themes
were discovered.  They also compared interview
data with validated patient-reported outcomes (
modified Harris Hip Score, International Hip Outcome Tool, sport-specific subscale of the Hip Outcome Score, and a modified
coping mechanism psychology score).  Interview
data were coded and grouped into categorical commonalities. The authors found 3
key themes that influenced a person’s return to sport: self-efficacy, social
support, and a resetting of expectations. 
Participants who returned to play commonly cited an internal motivation
to succeed, which was driven by innate characteristics such as optimism and
determination along with the ability to use adaptive coping strategies
(acceptance, humor, planning, and reframing). 
Social support from family members, teammates, and healthcare providers
was also an integral part of their ability to return to sport. Many people who
never returned to sport discussed resetting their expectations. Participants
who returned to sport also had better patient-reported outcomes. 

The findings from this study are important
because clinical outcomes are mixed regarding return to activity for
individuals recovering from FAI surgery. 
Quantitative measurements have thus far yielded little explanation as to
why some individuals are able to return to sport while others are not.  The authors found patient-reported differences
that coincide with the patient-derived themes that emerged from the interviews.
This suggests that psychosocial factors may play a large role in a patient’s
ability to return to sport following hip arthroscopy for FAI. Hence, clinicians
should adopt a holistic approach to treatment and consider if a patient is
resetting their expectations. If an athlete wants to return to play then
clinicians should encourage self-efficacy, positive coping strategies, and
ensure they receive sufficient social support.

for Discussion:  Do you notice a
difference in your patients’ rehabilitative outcomes based upon
personality/psychosocial characteristics? 
What traits do you notice in your patients who achieve the best
outcomes?  Is there some other factor you
believe plays a role in return to sport after injury?

Reviewed by: Jeffrey Driban

Related Posts:

The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement
Time and Cost of Diagnosis for Symptomatic Femoroacetabular Impingement

Tjong, V., Cogan, C., Riederman, B., & Terry, M. (2016). A Qualitative Assessment of Return to Sport After Hip Arthroscopy for Femoroacetabular Impingement Orthopaedic Journal of Sports Medicine, 4 (11) DOI: 10.1177/2325967116671940