BACKGROUND: Hip preservations surgeries are a type of surgical intervention used to often delay or prevent arthritis in patients before damage has occurred. A hip arthroscopy, a type of hip preservation surgery, allows for a minimally invasive method by using an arthroscope, a small fiber-optic tube with a camera attached, and surgical tools to perform the surgery. Hip preservation surgeries are often linked with moderate to severe postoperative pain, often leading to the use of substantial anesthesia. Nerve blocks have become increasingly popular for certain procedures as there may be advantages with postoperative pain and other same-day recovery advantages. Nerve blocks continue to be investigated in their role in lowering postoperative pain, postoperative opioid consumption, length of stay/time in postoperative anesthesia care unit, and patient satisfaction of pain control. OBJECTIVE: The objective of this systematic review was to determine the efficacy of nerve blocks for postoperative pain management in hip arthroscopies. METHODS: Two reviewers (J.A., E.B.) independently conducted a literature search in January 2022 with adjudication by a third reviewer using the databases Pubmed, EMBASE, and Medline. The included studies were systematically screened and reviewed, and data was analyzed. RESULTS: With a quadratus lumborum block, a study showed a significant difference in postoperative VAS pain scores in the study group with a block compared to the control from admission into the PACU through 24 hours after the operation (P<.001). In postoperative opioid consumption, another significant difference was reported in the group with a lumbar plexus block compared to control from the PACU all the way to 24 hours post operation (P<.001). When comparing a fascia iliaca block versus a local infiltration analgesia, a study found that 1 hour post operation the patients reported a significantly lower mean pain level. However, it was found that a fascia iliaca block may be less effective in reducing the number of opioids consumed in the PACU compared to a lumbar plexus block (P=.020). With a femoral nerve block, reports show a significant reduction in postoperative pain using VAS at 30 minutes (P=.009), 1 hour (P=.004), 2 hours(P=.003), 4 hours(P=.006) and 6 hours (P=.0002). Patients who receive a femoral nerve block consumed a mean amount of 47.6 milligrams of morphine equivalents compared to 59.2 milligrams of morphine equivalents in the control group which is significantly less (P=.006). Patients with a lumbar plexus block reported a lower mean pain score compared to a combined spinal epidural (P=.048) at 48 hours (YaDeau et al., 2012). There was no difference observed in pain scores when a lumbar plexus block was compared to a pericapsular injection. The lumbar plexus block had no differences in opioid consumption when compared to both combined spinal epidural and pericapsular injection. CONCLUSION: The use of nerve blocks provides sufficient pain management in hip arthroscopies. The effectiveness of these blocks may be more than other types of analgesic methods in lowering postoperative pain and postoperative opioid consumption.

Femoral acetabular impingement (FAI) is a bony hip condition that often results in tears to the acetabular labrum. Patients with FAI experience pain, decreased function, and quality of life. FAI and its’ sequela are treated definitively with hip arthroscopy. Hip arthroscopy is being performed with increasing frequency, and while most patients respond favorably, a subset of 10-20% of patients have suboptimal outcomes. Previous research suggests that mental status may be a primary driver in the way patients with FAI respond to and feel pain. Measures of mental status include the presence of mood disorders and psychosocial patient reported outcomes (PROs). Psychosocial constructs that have yet to be examined in patients with FAI include self-efficacy, kinesophobia, and pain catastrophizing. The Pain Self-Efficacy Questionnaire (PSEQ) gauges an individual’s confidence, or self-efficacy, in their ability to complete tasks despite their current pain. Previous research has established that a patient’s self-efficacy is an important determinant of long-term success following orthopedic surgery. Kinesophobia, measured via the Tampa Scale for Kinesiophobia (TSK), is a measure of movement-related fear. In contrast to self-efficacy, fear of movement has been identified as a predictor of early success following orthopedic surgery. Lastly, pain catastrophizing is a set of maladaptive behaviors including ruminating on pain, feeling helpless to overcome painful situations, and magnifying the circumstances surrounding the painful experience. Catastrophizing behaviors, measured via the Pain Catastrophizing Scale (PCS), have been repeatedly linked to increased pain and decreased functionality in a variety of orthopedic populations. To date, the relationship between these psychosocial variables and pain has not been examined in patients with FAI. The primary aim of this dissertation was to evaluate the role of psychosocial factors on pre and postoperative pain in patients with FAI undergoing hip arthroscopy. To accomplish this aim we performed a series of three studies. The first study was a retrospective chart review to determine the prevalence of mental health disorders and compare preoperative clinical presentation between patients with and without mental health disorders. The second was a cross-sectional study designed to determine if any psychosocial variables could predict preoperative hip pain. The final study utilized a longitudinal, cohort design. Patients were tested preoperatively and at 12-weeks postoperative. The primary outcomes measured were self-efficacy, kinesiophobia, pain catastrophizing, and hip pain at rest and during activity measured via a visual analog scale (VAS). The purpose of this study was to determine the effect of preoperative psychosocial variables on postoperative pain, and to determine if these variables were predictive of persistent postoperative pain three months following hip arthroscopy. Based on the results from these studies we can conclude the following: 1) Mental health disorders are more common in patients with FAI than other orthopedic populations, and self-reported pain and function are worse in this subset of patients, but neither symptom chronicity nor the severity of joint deformity differs; 2) Low self-efficacy is predictive of worse preoperative pain in patients with FAI; and 3) Patients with high preoperative pain catastrophizing or low self-efficacy are more likely to have increased postoperative pain. Low preoperative self-efficacy is predictive of persistent hip pain during activity three months following hip arthroscopy, while low self-efficacy and mental health disorders are predictive of persistent hip pain at rest. Future studies are necessary to develop and implement interventions targeting low self-efficacy and elevated catastrophizing in patients undergoing hip arthroscopy to improve patient outcomes for this high-risk group.

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Background: This study aimed to evaluate physical function, measured with self-reported outcomes and performance-based measures (PBMs), in patients 6-10 months following hip arthroscopy (HA) compared to an asymptomatic control group.   Methods: A cross-sectional comparison (21 patients, 22 controls) based on self-reported outcomes (HAGOS), range of motion (ROM), muscle strength and PBMs (The Y-balance test (cm), medial and lateral triple hop test (cm) and Illinois agility test (s)). Independent sample t test was performed to asses between-group differences.   Results: HA-patients reported significantly worse self-reported outcomes in all HAGOS subscales, greatest difference was in QoL (-37,3 (95% CI -47,9; -26,8) p&lt;0.001). HA-patients also reported significantly lower results (p&lt;0.05) in active and passive flexion (ROM) and external rotation (strength). No significant differences were observed regarding PBMs.   Conclusions: HA-patients reported significantly lower hip function following HA compared with the control group. Lower muscle strength and ROM were observed in patients however, few differences were significant. No significant differences were observed regarding PBMs. This could indicate that physical function is re-established in patients 6-10months after surgery or that tests were not sensitive enough to detect potential remaining functional limitations in this patient group.

Hip arthroscopy is a minimally invasive alternative to open hip surgery. Despite its minimally invasive nature, there can still be significant reported pain following these procedures. The impact of combined sciatic and lumbar plexus nerve blocks on postoperative pain scores and opioid consumption in patients undergoing hip arthroscopy was investigated. A retrospective analysis of 176 patients revealed that compared with patients with no preoperative peripheral nerve block, significant reductions in pain scores to 24 hours were reported and decreased opioid consumption during the post anesthesia care unit (PACU) stay was recorded; no significant differences in opioid consumption out to 24 hours were discovered. A subgroup analysis comparing two approaches to the sciatic nerve block in patients receiving the additional lumbar plexus nerve block failed to reveal a significant difference for this patient population. We conclude that peripheral nerve blockade can be a useful analgesic modality for patients undergoing hip arthroscopy.