Prehabilitation for patients undergoing hip arthroscopic surgery for Femoro-acetabular impingement syndrome- a feasibility study

Background Femoro-acetabular impingement syndrome (FAIS), resulting from abnormal acetabular or femoral head/neck morphology is a well-known pathological entity found in young active adults, and is considered a pre-disposing factor for early onset of osteoarthritis. Patients with FAIS often have pain, stiffness and functional limitations.

A recent epidemiological study (n=200, aged 16-65-years) reported a high prevalence of FAIS (47%) within the UK population.

Hip arthroscopy is often recommended when conservative management (e.g. physiotherapy, analgesia) has failed to address the symptoms.

Although hip arthroscopy has demonstrated improved outcomes for patients with FAIS, the road to recovery can be lengthy due to soft-tissue trauma sustained during the procedure and pre-existing muscle strength deficits associated with FAIS.

Additionally, delay in the diagnosis and referral to appropriate secondary or tertiary centres for surgical intervention may lead to the severity of the symptoms and further deconditioning of the individual.

Given the above, pre-operative intervention or 'prehabilitation' may optimise an individual's function and quality of life prior to the surgical intervention to subsequently enhance post-operative recovery and improve patient outcomes.

Aim To evaluate the feasibility, suitability and acceptability of a novel prehabilitation programme for FAIS to inform a future definitive randomised control trial to assess effectiveness.

Methods Sixty patients with FAIS will be recruited and randomly allocated to one of 2 treatment arms: Prehabilitation (intervention group) or usual care (control group).

The intervention group will attend one face-to-face educational session to improve knowledge, health behaviours and manage patient expectations.

They will commence 8 weeks of pre-operative exercise intervention aiming to improve muscle strength, proprioception, range of motion, cardiovascular fitness and address co-existing musculoskeletal pathologies. Interventions will be delivered face-to-face and at home, remotely monitored using Physitrack app.

Intensity and complexity of exercises will be gradually increased depending on each participant's individual progress as judged by the treating Physiotherapist.

Fidelity of intervention delivery will be analysed using self-reported checklist completed by the treating physiotherapists.

The usual care group will be advised to continue with their normal activities and maintain a record of their analgesia consumption, daily activities and any other interventions they receive (e.g., exercises, acupuncture) during the intervention period in a patient diary. Both groups will be provided with standard post-operative care.

The planned primary outcome measure is International Hip Outcome Tool (iHOT-12).

Outcome measures will be collected at baseline, at the end of the prehabilitation period before surgery and at 6 weeks, 6 months and 1-year post-operatively. Implications and Dissemination The role of exercise interventions prior to hip arthroscopy is unclear.

This study will evaluate the feasibility, suitability and acceptability of a novel prehabilitation programme within an NHS setting and inform the design of a future large-scale trial testing the effectiveness of prehabilitation in patients undergoing hip arthroscopy.

The results of this study will be disseminated to improve awareness and engagement of all key stakeholders in preparation for the future trial.

The study results will be shared with the research and scientific community via peer-reviewed publications, open access repositories and scientific meetings and conferences.