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A randomized controlled trial protocol for an interdisciplinary evaluation of non-arthritic hip disease

Lindsey Brown, Marcie Harris-Hayes, Randi Foraker, Kathryn Glaws, W Kelton Vasileff, Stephanie Di Stasi


Background: Non-arthritic hip disease (NAHD) is a clinical condition often accompanied by painful movement. Current literature is lacking regarding how movement abnormalities are evaluated and treated in this population, which may be key to identifying which patients may respond to non-operative versus operative treatment. Combining the expertise of a hip arthroscopist and physical therapist may better inform treatment decisions for persons with NAHD. The primary objective of this study is to identify the extent to which an interdisciplinary evaluation between a physical therapist and surgeon influences treatment decisions of persons presenting to a hip preservation clinic.

Rationale for study design: A prospective, randomized controlled trial provides the ability to identify cause and effect of this new evaluation type.

Methods: Ninety-six adults with unilateral, NAHD presenting to a hip preservation clinic for initial evaluation will be randomized to receive either a standard evaluation with a surgeon or an interdisciplinary evaluation by a physical therapist and surgeon. Regardless of group, the surgeon conducts a standard-care examination. For participants in the interdisciplinary group, the physical therapist conducts an assessment of 6 postures and movements to identify asymmetrical, abnormal, or painful strategies. Treatment selection(s) and decisional conflict will be compared between groups after the evaluations.

Discussion: Persons with NAHD may experience considerable decisional conflict because of prolonged duration of symptoms and minimal evidence to compare operative and non-operative treatment for this population. The findings of this study have the potential to improve patient experience and produce more informed and supported treatment decisions for persons considering surgical treatment for NAHD.


Decisional conflict, decision quality, evaluation, interdisciplinary, non-arthritic hip disease, non-operative management, operative management, patient outcomes, patient satisfaction, person-centered healthcare, physical therapy, RCT, shared decision-mak

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Enseki, K., Harris-Hayes, M., White, D.M., Cibulka, M.T., Woehrie, J., Fagerson, T.L., Clohisy, J.C. & Orthopaedic Section of the American Physical Therapy Association. (2014). Nonarthritic Hip Joint Pain. Journal of Orthopaedic and Sports Physical Therapy 44 (6) A1-A32.

Griffin, D., Dickenson, E., O’Donnell, J. et al. (2016). The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. British Journal of Sports Medicine 50 (19) 1169-1176.

Maradit Kremers, H., Schilz, S.R., Van Houten, H.K., Herrin, J., Koenig, K.M., Bozic, K.J. & Berry, D.J. (2017). Trends in Utilization and Outcomes of Hip Arthroscopy in the United States Between 2005 and 2013. Journal of Arthroplasty 32 (3) 750-755.

Levy, D.M., Kuhns, B.D., Chahal, J., Philippon, M.J., Kelly, B.T. & Nho, S.J. (2016). Hip arthroscopy outcomes with respect to patient acceptable symptomatic state and minimal clinically important difference. Arthroscopy 32 (9) 1877-1886.

Hunt, D., Prather, H., Hayes, M.H. & Clohisy, J.C. (2012). Clinical outcomes analysis of conservative and surgical treatment of patients with clinical indications of prearthritic, intra-articular hip disorders. PM&R 4 (7) 479-487.

Smeatham, A., Powell, R., Moore, S., Chauhan, R. & Wilson, M. (2017). Does treatment by a specialist physiotherapist change pain and function in young adults with symptoms from femoroacetabular impingement? A pilot project for a randomised controlled trial. Physiotherapy 103 (2) 201-207.

Wright, A.A., Hegedus, E.J., Taylor, J.B., Dischiavi, S.L. & Stubbs, A.J. (2016). Non-operative management of femoroacetabular impingement: A prospective, randomized controlled clinical trial pilot study. Journal of Science and Medicine in Sport 19 (9) 716-721.

Harris-Hayes, M., Czuppon, S., Van Dillen, L.R., Steger-May, K., Sahrmann, S., Schootman, M., Salsich, G.B., Clohisy, J.C. & Mueller, M.J. (2016). Movement Pattern Training To Improve Function in People With Chronic Hip Joint Pain: A Feasibility Randomized Clinical Trial. Journal of Orthopaedic and Sports Physical Therapy 46 (6) 1-48.

Mansell, N.S., Rhon, D.I., Marchant, B.G., Slevin, J.M. & Meyer, J.L. (2016). Two-year outcomes after arthroscopic surgery compared to physical therapy for femoracetabular impingement : A protocol for a randomized clinical trial. BMC Musculoskeletal Disorders 4 (17) 60.

Samaan, M.A., Schwaiger, B.J., Gallo, M.C., Sada, K., Link, T.M., Zhang, A.L., Majumdar, S. & Souza, R.B. (2017). Joint loading in the sagittal plane during gait is associated with hip joint abnormalities in patients with femoroacetabular impingement. American Journal of Sports Medicine 45 (4) 810-818.

Diamond, L.E., Dobson, F.L., Bennell, K.L., Wrigley, T.V., Hodges, P.W. & Hinman, R.S. (2015). Physical impairments and activity limitations in people with femoroacetabular impingement : a systematic review. British Journal of Sports Medicine 49 (4) 230-242.

Hunt, M.A., Gunether, J.R. & Gilbart, M.K. (2013). Kinematic and kinetic differences during walking in patients with and without symptomatic femoroacetabular impingement. Clinical Biomechanics 28 (5) 519-523.

Rylander, J., Shu, B., Favre, J., Safran, M. & Andriacchi, T. (2013). Functional testing provides unique insights into the pathomechanics of femoroacetabular impingement and an objective basis for evaluating treatment outcome. Journal of Orthopaedic Research 31 (9) 1461-1468.

Brisson, N., Lamontagne, M., Kennedy, M.J. & Beaulé, P.E. (2013). The effects of cam femoroacetabular impingement corrective surgery on lower-extremity gait biomechanics. Gait & Posture 37 (2) 258-263.

Rylander, L., Froelich, J.M., Novicoff, W. & Saleh, K. (2010). Femoroacetabular impingement and acetabular labral tears. Orthopedics 33 (5) 342-352.

Kennedy, M.J., Lamontagne, M. & Beaulé, P.E. (2009). Femoroacetabular impingement alters hip and pelvic biomechanics during gait. Walking biomechanics of FAI. Gait & Posture 30 (1) 41-44.

Hammond, C.A., Hatfield, G.L., Gilbart, M.K., Garland, S.J. & Hunt, M.A. (2017). Trunk and lower limb biomechanics during stair climbing in people with and without symptomatic femoroacetabular impingement. Clinical Biomechanics 42, 108-114.

Diamond, L.E., Bennell, K., Wrigley, T., Hinman, R., O’Donnell, J. & Hodges, P. (2017). Squatting biomechanics in individuals with symptomatic femoroacetabular impingement. Medicine & Science in Sports & Exercise 49 (8) 1520-1529.

Lamontagne, M., Kennedy, M.J. & Beaule, P.E. (2009). The effect of cam FAI on hip and pelvic motion during maximum squat. Clinical Orthopaedics and Related Research 467 (3) 645-650.

Lamontagne, B.M., Brisson, N., Kennedy, M.J. & Beaulé, P. (2011). Preoperative and postoperative lower-extremity joint and pelvic kinematics during maximal squatting of patients with cam femoro-acetabular impingement. Journal of Bone and Joint Surgery American Volume 93 (Supplement 2) 40-45.

Ayeni, O.R., Belzile, E.L., Musahl, V., Naudie, D., Crouch, S., Sprague, S. & Bhandari, M. (2014). Results of the PeRception of femOroaCetabular impingEment by Surgeons Survey (PROCESS). Knee Surgery, Sports Traumatology, Arthroscopy 22 (4) 906-910.

Boye, G.N., Murray, K., Clohisy, J.C. & Kim, Y. (2015). Feasibility of a randomized clinical trial for treatment of femoroacetabular impingement of the hip. Orthopaedic Journal of Sports Medicine 3 (7) 2325967115592844. doi:10.1177/2325967115592844.

Clohisy, J.C., Knaus, E.R., Hunt, D.M., Lesher, J.M., Harris-Hayes, M. & Prather, H. (2009). Clinical presentation of patients with symptomatic anterior hip impingement. Clinical Orthopaedics and Related Research 467 (3) 638-644.

O’Connor, A.M. (1994). Validation of a decisional conflict scale. Medical Decision Making 15 (1) 25-30.

Sun, Q. (2005). Predicting downstream effects of high decisional conflict: meta-analyses of the Decisional Conflict Scale. Available at:

Elwyn, G., Stiel, M., Durand, M. & Boivin, J. (2011). The design of patient decision support interventions: addressing the theory – practice gap. Journal of Evaluation in Clinical Practice 17 (4) 565-574.

Boss, E.F., Mehta, N., Nagarajan, N., Links, A., Benke, J.R., Berger, Z., Espinel, A., Meier, J. & Lipstein, E.A. (2016). Shared decision making and choice of elective surgical care: a systematic review. Otolaryngology - Head and Neck Surgery 154 (3) 405-420.

Samaan, M.A., Schwaiger, B.J., Gallo, M.C., Link, T.M., Zhang, A.L., Majumdar, S. & Souza, R.B. (2017). Abnormal joint moment distributions and functional performance during sit-to-stand in femoroacetabular impingement patients. PM&R 9 (6) 563-570.

Lewis, C.L. & Sahrmann, S.A. (2015). Effect of posture on hip angles and moments during gait. Manual Therapy 20 (1) 176-182.

Lewis, C.L., Loverro, K. & Khuu, A. (2018). Kinematic differences during single-leg step-down between individuals With femoroacetabular impingement syndrome and individuals without hip pain. Journal of Orthopaedic and Sports Physical Therapy 48 (4) 270-279.

Harris, P.A., Taylor, R., Thielke, R., Payne, J., Gonzalez, N. & Conde, J.G. (2009). Research electronic data capture (REDCap)-A metadata-driven methodology and workflow process for providing translational research informatics support. Journal of Biomedical Informatics 42 (2) 377-381.

Richard, H.M., Nguyen, D.C., Podeszwa, D.A., De La Rocha, A. & Sucato, D.J. (2016). Perioperative Interdisciplinary Intervention Contributes to Improved Outcomes of Adolescents Treated With Hip Preservation Surgery. Journal of Pediatric Orthopaedics 38 (5) 254-259.

Charles, C., Gafni, A. & Whelan, T. (1997). Shared decision-making in the medical encounter: What does it mean? (Or it takes, at least two to tango). Social Science & Medicine 44 (5) 681-692.

Chandrasekaran, S., Darwish, N., Gui, C., Lodhia, P., Suarez-Ahedo, C. & Domb, B. (2016). Outcomes of hip arthroscopy in patients with Tönnis grade-2 osteoarthritis at a mean 2-year follow-up: evaluation using a matched-pair analysis with Tönnis grade-0 and grade-1 cohorts. Journal of Bone and Joint Surgery American Volume 98 (12) 973-982.

Pascual-Garrido, C., Harris, M.D. & Clohisy, J.C. (2017). Innovations in Joint Preservation Procedures for the Dysplastic Hip “The Periacetabular Osteotomy.” Journal of Arthroplasty 32 (Supplement 9) S32-S37.

Martin, R.L. & Philippon, M.J. (2008). Evidence of reliability and responsiveness for the Hip Outcome Score. Arthroscopy 24 (6) 676-682.

Martin, R.L. & Philippon, M.J. (2007). Evidence of Validity for the Hip Outcome Score in Hip Arthroscopy. Arthroscopy 23 (8) 822-826.

Mohtadi, N.G.H., Griffin, D.R., Pedersen, M.E., et al. The development and validation of a self-administered quality-of-life outcome measure for young, active patients with symptomatic hip disease: The International Hip Outcome Tool (iHOT-33). Arthroscopy 28 (5) 595-610.

Fritz, J.M. & Irrgang, J.J. (2001). A Comparison of a Modified Oswestry Low Back Pain Disability Questionnaire and the Quebec Back Pain Disability Scale. Physical Therapy 81 (2) 776-788.



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