Physical impairments in symptomatic femoroacetabular impingement: a systematic review of the evidence

Background: Femoroacetabular impingement (FAI) and accompanying pathologies are associated with pain and reduced quality of life. Physical impairments can be associated with worse symptoms and may be an important target of rehabilitation programmes in this patient group. Knowledge regarding physical impairments in individuals with symptomatic FAI is limited.

Hypothesis: In adults aged 18-50 years with symptomatic FAI, to: (1) identify physical impairments in range of motion (ROM), hip muscle function and functional tasks; (2) to compare physical impairments with healthy controls; and (3) to evaluate the effects of interventions targeting physical impairments.

Study design: Systematic review.

Methods: A systematic review of the literature was conducted in accordance with the PRISMA statement. The modified Downs and Black checklist was used for quality appraisal. Studies of adults aged 18-50 years with symptomatic FAI that examined ROM, hip muscle function and functional tasks were included. Standardised mean differences (SMDs) were calculated where possible or best evidence synthesis and study conclusions were presented.

Results: 22 studies fulfilled all inclusion criteria. Methodological quality was varied (47-82% using Downs and Black Appraisal Criteria). Hip joint ROM did not differ in individuals with symptomatic FAI compared with control participants. Individuals with symptomatic FAI demonstrated deficits in hip muscle strength and reduced dynamic balance on 1 leg when compared with control participants. For hip joint ROM, there were no significant within-group differences between preintervention and postintervention time points. Hip muscle strength improved significantly from prehip to posthip arthroscopy in a single case series. No randomised controlled trails evaluated the effect of different types of interventions for symptomatic patients with symptomatic FAI.

Conclusions: Individuals with symptomatic FAI demonstrate impairments in hip muscle strength and dynamic single leg balance. This information may assist therapists in providing targeted rehabilitation programmes for individuals with FAI and associated pathology. Further research is needed to determine whether symptomatic FAI affects other aspects of functional performance; and to evaluate whether targeted interventions are effective in symptomatic FAI.

Clinical relevance: This information may assist therapists in providing targeted rehabilitation programmes for individuals with symptomatic FAI.