Summary of included between-group case–control studies evaluating the effect of FAI and associated pathologies on hip range of movement
| Paper (total score using modified Downs and Black appraisal) | Study characteristics | Sample characteristics | Results | ||||||||
| Inclusion pathology | Outcome measured | Method of measurement | Level of evidence | Sample size | Gender | Age (years)* | Hip group mean (SD) | Control group mean (SD) | Standardised mean difference (SMD) magnitude or standardised paired difference (SPD) (95% CI) | Overall main findings (if unable to calculate SMD) | |
| Audenaert et al
21
(8/17) | Male elite sportsman; cam or combined FAI presented with °typical° signs of FAI and confirmed with standard diagnostic imaging (radiographic and arthro-MRI) | % Cam engagement using 3-D bony models generated from MRI (flexion; abduction; IR in 90° flexion; N IR) | 3-D bony models | Cross sectional | 7 hip groups (13 hips) | 7 M/0 W | 25 (5) | n/a | n/a | n/a | Number of cases of cam engagement in flexion 54%; abduction 84%; IR in 90° flexion 77%; IR in N 0% ROM flexion 110.2 (7.4); abduction 50.5 (8.8); IR in 90° flexion 18.9 (6.2); IR in N 29.4 (8.7) |
| Audenaert et al
25
(13/17) | Chondropathy at arthroscopy | Simulated 3-D CT modelling of hip ROM (IR) during high flexion and impingement testing (cam patients; asymptomatic and controls) | 3-D CT models | Cross sectional | 10 hip groups/ 10 controls | 10 M/0 W | Range 18–35 | Cam: hip IR (high flexion)=12.9° (6.4); hip IR (impingement testing)=12.3° (6.5) | Asymptomatic: hip IR (high flexion)=20.9° (9.1); hip IR (impingement testing)=21.1° (8.8) Controls: hip IR (high flexion)=27.8° (7.6); hip IR ROM (impingement testing)=27.9° (7.4) |
Hip versus asymptomatic ROM
−0.97 (−1.91 to −0.03). Hip versus control ROM −2.03 (−3.15 to −0.91) | |
| Clohisy et al
3
(8/17) | One or more of the following: acetabular retroversions: coxa profunda; coxa protrusion; aspherical femoral head; or femoral head-neck offset <9 mm | ROM (Flex, Ext, Abd, Add, IR/ER at N and 90°) Active versus passive not specified | Goniometer | Cross sectional | 51 hip groups (52 hips) 51 controls | 29 M/22 W | 35 (range 15–61) | Symptomatic hip: Flex 97° (9); Ext 4° (6); Abd 38° (11); Add 17° (7); IR N 15° (9); ER N 26 (12); IR@90° 9 (8); ER@90° 28 (15) | Asymptomatic hip: Flex 101° (11); Ext 4° (6); Abd 41° (10); Add 19° (8); IR N 1518° (11); ER N 27 (12); IR@90° 12 (8); ER@90° 30 (16) |
Symptomatic versus asymptomatic hip
Flex −0.40 (−0.79 to 0.00), Ext 0 (−0.39 to 0.39), Abd −0.28 (−0.67 to 0.11), Add −0.26 (−0.65 to 0.12), IR@90 −0.37 (−0.76 to 0.02), ER@90 −0.13 (−0.52 to 0.26) | |
| Emara et al
22
(8/17) | Unilateral FAI (clinical and radiological diagnosis) | ROM (Flex, Ext, Abd, Add, IR/ER at N and 90') Active versus passive not specified | Not specified | Case series (control=opposite leg) | 37 | 37 M/10 W | 33 (5) | Symptomatic hip: Flex 95' (0.4); Ext 4' (1.6); Abd 37' (0.4); Add 17' (7); ER in Flex 28.5 (0.5); ER in Ext 25.3 (0.3); IR in Flex 9.4 (0.3); IR in Ext 15.8 (0.4) | Asymptomatic hip: Flex 103' (3); Ext 4' (2); Abd 43' (3); Add 19' (8); ER in Flex 34 (4); ER in Ext 30 (3); IR in Flex 15 (3); IR in Ext 19 (3) |
Symptomatic versus asymptomatic hip
Flex −3.70 (−4.46 to −2.94), Ext 0.0 (−0.46 to 0.46), Abd −2.77 (−3.42 to −2.13), Add −0.26 (−0.72 to 0.20), ER@90 −1.70 (−2.23 to −1.16), IR@90 −2.79 (−3.43 to −2.14), ER@0 −2.32 (−2.92 to −1.73), IR@0 −1.39 (−1.90 to −0.88) | |
| Harris-Hayes et al
30
(10/17) | Chronic hip joint or anterior groin pain >3 months+positive FADIR | ROM | Not stated | Cross sectional | 35 hip groups/35 controls | 7 M/28 W | 37 (12) | ER@90° flexion 40 (10); IR@90° flexion 39 (7); ER in N 42 (8); IR in N 32 (10) | ER@90° flexion 39 (7); IR@90° flexion 39 (6); ER in N 40 (10); IR in N 31 (9) | ER@90 0.12 (−0.35 to 0.58), IR@90 0 (−0.47 to 0.47), ER in N 0.22 (−0.25 to 0.69), IR in N −0.10 (−0.37 to 0.57) | |
| Kapron et al
36
(10/17) | Female athletes | ROM | Goniometer | Cross sectional | 63 hip groups | 0 M/63 W | 19.6 (1.4) | IR@90° flexion 31.2 (10.2); ER@90° flexion 43.8 (10.7) | n/a | n/a | |
| Kemp et al
4
(14/17) | Chondrolabral pathology at arthroscopy | 12–24 months after arthroscopy—ROM measured with inclinometer (°) | Inclinometer | Cross sectional | 84 hip groups/ 60 controls | 42 M/42 W | 36 (10) | Flex ROM men 105 (10); women 108 (17); Ext ROM men 23 (10); women 25 (10); ER ROM men 43 (10); women 33 (10); IR ROM men 29 (8); women 31 (12) | Flex ROM men 112 (12), women 116 (9); Ext ROM men 20 (9); 21 (7); ER ROM men 44 (8), women 36 (8); IR ROM men 35 (8), women 36 (7) |
Men versus controls
Flex −0.65 (−1.20 to 0.09), Ext −0.31 (−0.24 to 0.85), ER −0.10 (−0.65 to 0.44), IR −0.74 (−1.30 to −0.18) Women versus controls Flex −0.58 (−1.02 to −0.14), Ext −0.46 (0.02 to 0.89), ER −0.33 (−0.76 to 0.11), IR −0.50 (−0.94 to −0.07) | |
| Kennedy et al
33
(11/17) | Cam FAI: pain on WOMAC; had positive FADIR; alpha angle >50.5 on AP or Dunn, controls—no hip pain and no cam on X-ray | 3-D kinematic dynamic ROM measured in standing | Vicon | Cross sectional | 17 hip groups/ 14 controls | 10 M/7 W | 36 (11) | Flex 110 (10); Ext 21 (10); total sagittal 131 (14); Abd 38 (9); Add 23 (8); total frontal 63 (12); IR 8 (3); ER 20 (4); total transverse 28 (7) | Flex 114 (9); Ext 27 (5); total sagittal 141 (9); Abd 48 (6); Add 23 (8); total frontal 63 (12); IR 12 (5); ER 26 (7); total transverse 39 (10) | Flex −0.41 (−1.12 to 0.31), Ext −0.78 (−1.52 to −0.04), Abd −1.25 (−2.03 to −0.47), Add 0.0 (−0.71 to 0.71), ER −1.05 (−1.81 to −0.29), IR −0.97 (−1.72 to −0.22) | |
| Kubiak-Langer et al
29
(11/17) | People awaiting hip scope with pain, positive FADIR and positive radiology. Controls=contralateral leg of people awaiting THA | 3-D CT modelling measure of hip ROM simulated pre-op to simulated post-op and to controls | 3-D CT models | Case–control | 28 hip groups/33 controls | 24 M/4 W | 35 (10) | Flex 105 (12); Ext 61 (32); Abd 52 (12); Add 35 (12); IR 11 (7); ER 83 (33) | Flex 122 (16); Ext 57 (20); Abd 64 (11); Add 33 (12); IR 35 (7); ER 103 (14) | Flex −1.17 (−1.72 to 0.63), Ext 0.15 (−0.35 to 0.66), Abd −0.95 (−1.48 to −0.41), Add 0.17 (−0.34 to 0.67), IR −3.39 (−4.18 to −2.59), ER −0.78 (−1.31 to −0.26) | |
| Lahner et al
38
(11/17) | Volunteers with no history of hip pathology | Radiograph (alpha angle of Nötzli). Active IR ROM |
| Cross sectional | 24 hip groups | 8 M/16 W | 46.8 (10.6) | 24.2 (8.5) | 27.6 (5.1) | 0.6 (−3.24 to 4.4) | |
| Nussbaumer et al
34
(10/17) | Unilateral FAI (clinical and radiological Dx) | Passive ROM hip |
| Cross sectional | 15 hip groups/ 15 controls | 8 M/7 W | 35 (11) | Goniometer: Flex 104 (16); Abd 30 (7); Add 23 (4); IR 26 (11); ER 36 (10) ETS: Flex 85 (15); Abd 29 (7); Add 22 (4); IR 24 (10); ER 30 (8) | Goniometer: Flex 112 (11); Abd 39 (7); Add 27 (6); IR 34 (10); ER 45 (5) ETS: Flex 94 (8); Abd 37 (8); Add 22 (3); IR 29 (9); ER 35 (4) |
Goniometer ROM versus controls
Flex −0.57 (−1.30 to 0.17), Abd −1.25 (−2.04 to −0.46), Add −0.76 (−1.51 to −0.02), ER −1.11 (−1.88 to 0.33), IR −0.74 (−1.48 to 0.00) ETS ROM versus controls Flex −0.73 (−1.47 to 0.01), Abd −1.04 (−1.80 to −0.27), Add 0.0 (−0.72 to 0.72), ER −0.77 (−1.52 to −0.02), IR −0.51 (−1.24 to 0.22) | |
| Philippon et al
20
(14/17) | FAI and chondrolabral pathology at arthroscopy | ROM hip (active/passive not specified) | Goniometer | Cross sectional | 112 operated hips/112 non-operated hips | 50 M/62 W | 41 | n/a | n/a | n/a |
Pain versus non-pain leg ROM MD (95% CI)
Flex −10 (−13 to −7) p<0.001; IR −5 (−7 to −3) p<0.001; ER −3 (−1 to −3) p=0.001; Add −4 (−7 to −3) p<0.001; Abd −5 (−6 to −3) p<0.001 |
| Ross et al
37
(10/17) | Ice hockey players who underwent arthroscopic correction for symptomatic FAI | Simulated 3-D CT hip ROM (Flex; IR@90° flexion) | 3-D CT models | Prognostic case series | 44 hip groups (68 hips) | Not specified | 21.1 (5.7) | n/a | n/a | n/a |
Goalies Flexion 121.3 (77–149); abduction 69.7 (41–82); IR@90° 26.4 (0–54); FADIR 17.8 (0–45); butterfly 33.5 (2–65) Positional players Flexion 115.6 (93–138); abduction 70.8 (58–84); IR 90° 29 (3–51); FADIR 20.1 (0–41); butterfly 40 (15–67) |
| Tannast et al
35
(11/17) | FAI (cam n=12, pincer n=7, combined n=12) CT diagnosis | 3-D CT modelling measure of hip ROM simulated | 3-D CT models | Cross sectional | 31 hip groups/ 36 controls | 27 M/4 W | 31 (10) | All hips: Flex 105 (16); Ext 60 (32); Abd 52 (12); Add 34 (13); IR 12 (7); ER 83 (33). Cam—Flex 111 (18); Ext 86 (30); Abd 47 (13); Add 41 (14); IR 10 (6); ER 99 (27) | Flex 121 (12); Ext 58 (20); Abd 63 (11); Add 33 (12); IR 35 (12); ER 101 (15) |
All hips versus controls
Flex −1.13 (−1.65 to 0.61), Ext 0.08 (−0.41 to 0.56), Abd −0.95 (−1.46 to −0.44), Add 0.08 (−0.40 to 0.56), IR −2.27 (−2.89 to −1.65), ER −0.71 (−1.21 to −0.22) Cam versus controls Flex −0.72 (−1.39 to −0.05), Ext 1.21 (0.51 to 1.91), Abd −1.37 (−2.08 to −0.65), Add 0.63 (−0.04 to 1.30), IR −2.26 (−3.07 to −1.46), ER −0.11 (−0.76 to 0.55) | |
No randomised clinical trials were available to include in this review. Significant positive SMDs indicate greater ROM in the hip group.
*Mean (SD).
3-D, three dimensional; AP, anterior/posterior; Abd, abduction; Add, adduction; ER, external rotation; Ext, extension; FADIR, flex/adduction/internal rotation; FAI, femoral acetabular impingement; Flex, flexion; IR, internal rotation; M, male; MD, mean difference; N, neutral hip position; n/a, not applicable; ROM, range of movement; THA, total hip arthroplasty; W, woman; WOMAC, Western Ontario and McMaster Universities Osteoarthritis Index.