Preoperative temporal summation is associated with impaired recovery following hip arthroscopy for femoroacetabular impingement syndrome

Articles in Press

Document Type : RESEARCH PAPER

Authors

1 Center for Health Outcomes and Interdisciplinary Research Department of Psychiatry Massachusetts General Hospital Harvard Medical School

2 Army - Baylor University DPT program

3 Department of Physical Therapy University of Kentucky

4 Department of Kinesiology & Health Promotion University of Kentucky

5 Department of Orthopaedics School of Medicine, West Virginia University

6 Department of Orthopaedic Surgery University of Kentucky

7 School of Health and Human Sciences University of North Carolina Greensboro

8 Department of Sports Medicine Mass General Brigham

10.22038/abjs.2024.78368.3607

Abstract

Objectives: Chronic pain is a risk factor for worse outcomes following hip arthroscopy for femoroacetabular impingement syndrome (FAIS). Central sensitization involves the central nervous system perceiving previously innocuous stimuli as noxious. Temporal summation can provide a surrogate measure of central sensitization. Temporal summation may be a clinical tool to identify patients at a higher risk for poor post-hip arthroscopy outcomes. Therefore, we aimed to 1) identify the prevalence of temporal summation in patients undergoing hip arthroscopy for FAIS, 2) determine if there a difference in postoperative improvement between individuals with and without preoperative temporal summation, and 3) examine preoperative predictors of poor postoperative recovery.

Methods: 51 participants undergoing hip arthroscopy for FAIS underwent preoperative temporal summation testing. Three months postoperatively, 38 participants completed the 12-item International Hip Outcome Tool (iHOT-12) and reported their overall symptomatic improvement (scale from 0% to 100%, with 100% being normal). Participants were categorized on the presence ( Numeric Pain Rating Scale; NPRS  2) or absence ( NPRS < 2) of temporal summation. A Mann-Whitney U test was used to determine the difference in improvement between groups (with temporal summation: TS, those with no temporal summation NTS), and a linear regression was used to explore predictors of improvement.

Results: 23 (45.1%) of 51 participants displayed preoperative temporal summation. In participants with postoperative data, those with temporal summation reported less improvement than those without (TS: 62.8%  29.7%; NTS: 82.7%  13.9%; p = 0.01; Cohen’s d = -0.86). Temporal summation (Beta = -0.48; 95% CI -36.6, -8.7) and mental health disorder (Beta = -0.30; 95% CI -28.0, -0.48) predicted 28.1% of the variance in postoperative improvement (p = 0.002).

Conclusion: The presence of preoperative temporal summation is common and related to worse postoperative recovery after hip arthroscopy for FAIS.

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The Archives of Bone and Joint Surgery

Articles in Press, Accepted Manuscript
Available Online from 01 June 2024

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History

  • Receive Date: 28 February 2024
  • Revise Date: 09 May 2024
  • Accept Date: 23 May 2024

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