Clinical Outcomes Analysis of Conservative and Surgical Treatment of Patients With Clinical Indications of Prearthritic, Intra‐articular Hip Disorders

Objective To describe outcomes of the conservative treatment of patients who had the clinical presentation of a prearthritic, intra‐articular hip disorder, including acetabular labral tears, developmental hip dysplasia, and femoroacetabular impingement. Design Prospective observational clinical outcomes study. Setting Outpatient orthopedic clinic at a tertiary university hospital. Patients Patients presenting with prearthritic, intra‐articular hip disorders were recruited. Fifty‐eight consecutive patients were enrolled; 6 were lost to follow‐up, and 52 subjects completed the study. Methods Patients were recruited on the basis of symptoms, distribution of pain, and the findings of a physical examination. Radiographic measurements of the hip were obtained for all subjects to describe the presence or absence and extent of deformity and/or osteoarthritis. All subjects completed a directed course of conservative treatment. After 3 months of conservative care, subjects with continued limitations, reduction of symptoms with a diagnostic intra‐articular hip injection, and a surgically amenable lesion found on a magnetic resonance arthrogram proceeded to surgery. Main Outcome Measurements Numeric Pain Score (0‐10), Short Form‐12, Modified Harris Hip Score, Western Ontario and McMaster Universities Osteoarthritis Index, Nonarthritic Hip Score, Baecke Questionnaire of Habitual Activity, and patient choice to have surgery. Results Fifty‐eight patients (9 men and 49 women) with a mean age of 35 ± 11 years (range, 18‐50 years) enrolled in the study. Fifty‐two subjects completed the study. Twenty‐three subjects (44%) reported satisfaction with conservative care. Twenty‐nine subjects (56%) chose to have surgery. Both groups demonstrated equally significant improvement ( P value ranges: P = .03 to P = .0001) in all outcome measures from baseline to 1‐year follow‐up. Subjects who chose surgery had higher baseline activity scores compared with the conservative treatment group ( P = .02). Conclusion All subjects with signs and symptoms of prearthritic, intra‐articular hip disorders who were treated with conservative treatment alone and with conservative treatment followed by surgery demonstrated significant improvement in pain and functioning from baseline to 1 year. Forty‐four percent of patients improved with conservative care alone, and 56% chose to have surgery after receiving conservative care. Persons with more active lifestyles were more likely to choose surgery. These data suggest that a trial of conservative management for persons with prearthritic, intra‐articular hip disorders should be considered before engaging in surgical intervention.