Treatment of Patients With Femoroacetabular Impingement Syndrome Using a Pelvic Tilt–Focused Exercise Program: A Prospective Cohort

Background: The rates of hip arthroscopy are increasing worldwide for femoroacetabular impingement syndrome (FAIS). There is a lack of literature examining outcomes of modern nonoperative treatment of patients with FAIS. Purpose: To develop and assess the effectiveness of a pelvic tilt–focused exercise program for nonoperative management for patients with FAIS. Study Design: Cohort study; Level of evidence, 2. Methods: Eligible patients included those aged 16 to 55 years who met radiographic and clinical criteria for FAIS. Enrolled patients participated in a 10-minute standardized pelvic tilt–focused home exercise program (HipFit10) at least 4 times per week over 6 months. Self-reported adherence was tracked weekly. Patient-reported outcomes were collected at baseline and 3 and 6 months. The International Hip Outcome Tool–33 (iHOT-33) score was measured at baseline and 3 and 6 months, with the primary outcome being the iHOT-33 change score between baseline and 6 months. Secondary outcomes included the Hip Outcome Score–Activities of Daily Living (HOS-ADL), pain visual analog scale (pain VAS) score, crossover to surgical management, and complications. Results: A total of 214 patients were enrolled between August 2020 and October 2021. The mean age was 34.2 ± 10.2 years, and 121 (57%) patients were female. Within the study period, 19 of 214 (9%) patients dropped out or were lost to follow-up. By 6 months, 153 of 195 (78%) patients completed the intervention and elected to avoid surgery, and 42 of 195 (22%) patients signed up for or underwent surgery. The final iHOT-33 score was completed by 192 of 195 (98%) participants with mean improvement from baseline to 6 months of 11.7 (95% CI, 9.2 to 14.1; P < .001). By 6 months, 103 of 192 (54%) participants achieved the iHOT-33 minimal clinically important difference of 6.8. Significant improvements also were seen in the iHOT-33 score from baseline to 3 months (mean difference MD, 7.6; 95% CI, 5.7 to 9.6) and from 3 months to 6 months (MD, 3.7; 95% CI, 1.8 to 5.6), as well as in the HOS-ADL (0-3 months: MD, 2.65; 95% CI, 0.8 to 4.4) and pain VAS score (0-3 months: MD, −7.7 95% CI, −4.8 to −10.5; 3-6 months: MD, −3.5 95% CI, −0.6 to −6.3). No adverse events were reported. Conclusion: In this study of patients with FAIS, pelvic tilt–focused physical therapy was utilized to improve patient function with 78% avoiding surgery. These results suggest the HipFit10 program is a safe and effective nonoperative option for patients with FAIS.