Hip and Pelvis Movement Patterns in Patients With Femoroacetabular Impingement Syndrome Differ From Controls and Change After Hip Arthroscopy During a Step-Down Pivot-Turn Task

Abstract

Background: Alterations in hip kinematics during functional tasks occur in positions that cause anterior impingement in patients with femoroacetabular impingement (FAI) syndrome. However, tasks that do not promote motions of symptomatic hip impingement remain understudied. Purpose: To compare movement patterns of the hip and pelvis during a step-down pivot-turn task between patients with FAI and controls as well as in patients with FAI before and after hip arthroscopy. Study Design: Controlled laboratory study. Methods: Three-dimensional motion capture was acquired in 32 patients with FAI and 27 controls during a step-down pivot-turn task. An FAI subsample (n = 14) completed testing 9.2 ± 2.0 months (mean ± SD; range, 5.8-13.1 months) after hip arthroscopy. Statistical parametric mapping analysis was used to analyze hip and pelvis time series waveforms (1) between the FAI and control groups, (2) in the FAI group before versus after hip arthroscopy, and (3) in the FAI group after hip arthroscopy versus the control group. Continuous parametric variables were analyzed by paired t test and nonparametric variables by chi-square test. Results: There were no significant differences in demographics between the FAI and control groups. Before hip arthroscopy, patients with FAI demonstrated reduced hip flexion ( P = .041) and external rotation ( P = .027), as well as decreased anterior pelvic tilt ( P = .049) and forward rotation ( P = .043), when compared with controls. After hip arthroscopy, patients demonstrated greater hip flexion ( P < .001) and external rotation of the operative hip ( P < .001), in addition to increased anterior pelvic tilt ( P≤ .036) and pelvic rise ( P≤ .049), as compared with preoperative values. Postoperatively, the FAI group demonstrated greater hip flexion ( P≤ .047) and lower forward pelvic rotation ( P = .003) as compared with the control group. Conclusion: Movement pattern differences between the FAI and control groups during the nonimpingement-related step-down pivot-turn task were characterized by differences in the sagittal and transverse planes of the hip and pelvis. After hip arthroscopy, patients exhibited greater hip flexion and external rotation and increased pelvic anterior tilt and pelvic rise as compared with presurgery. When compared with controls, patients with FAI demonstrated greater hip flexion and lower pelvic forward rotation postoperatively. Clinical Relevance: These findings indicate that hip and pelvis biomechanics are altered even during tasks that do not reproduce the anterior impingement position.