Return to Dance and Predictors of Outcome After Hip Arthroscopy for Femoroacetabular Impingement Syndrome


      To investigate the rate of return to dance and factors influencing this primary outcome after hip arthroscopy for the treatment of femoroacetabular impingement syndrome.


      A consecutive series of self-identified dancers with femoroacetabular impingement syndrome was included. To assess for the impact of hypermobility on outcomes, patients were classified as having either generalized joint laxity (GJL) or no GJL based on the Beighton-Horan Joint Mobility Index. A return-to-dance survey, the modified Harris Hip Score, and the Hip Outcome Score (HOS)–Activities of Daily Living and HOS–Sports-Specific subscales were collected preoperatively and postoperatively at 6, 12, 24, and 36 months. The preoperative-to-postoperative outcome score change was compared using the minimal clinically important difference and patient acceptable symptomatic state. Return to dance was evaluated regarding (1) return to any dance activity, (2) return to prior level of dance, and (3) number of hours of dance participation after surgery. Clinical and demographic predictors and return to dance were analyzed using univariate or bivariate analysis where appropriate.


      The study included 64 consecutive dancers (62 female and 2 male patients) (mean age, 22.3 ± 9.4 years; body mass index, 22.8 ± 4.1) with a mean follow-up period of 23.0 months. Postoperatively, 62 patients (97%) returned to dance at an average of 6.9 ± 2.9 months; 40 patients (62.5%) reported that they returned to a better level of participation, whereas 20 dancers (31%) returned to the same level of participation. Statistically significant increases were observed for the HOS–Activities of Daily Living subscale (60.5 ± 19.5 vs 92.4 ± 11.8, P < .001), HOS–Sports-Specific subscale (40.3 ± 20.3 vs 83.5 ± 19.4, P < .001), and modified Harris Hip Score (57.0 ± 13.6 vs 86.6 ± 13.9, P < .001). There was, however, a significant decrease in the number of hours of dance postoperatively: 11.5 ± 8.2 h/wk preoperatively versus 9.0 ± 7.3 h/wk postoperatively (P = .041). All postoperative hip outcome measures showed statistically significant (P < .001) and clinically relevant improvements. Patient-reported outcomes and return time showed no significant differences between the patient groups with GJL and without GJL (P = .1 and P = .489, respectively). For competitive dancers, a correlation was shown with a shorter time to return to dance (r2 = 0.45, P = .001), but there were no significant differences by skill level in patient-reported outcomes or dance hours.


      After hip arthroscopy, 97% of dancers returned to dance at an average of 6.9 months, with most dancers dancing at a level higher than their preoperative status. Dance experience level was the only significant factor influencing return-to-dance outcomes, with competitive dancers showing a faster return to dancing.conclusion

      Level of Evidence

      Level IV, therapeutic case series.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Dy C.J.
        • Thompson M.T.
        • Crawford M.J.
        • Alexander J.W.
        • McCarthy J.C.
        • Noble P.C.
        Tensile strain in the anterior part of the acetabular labrum during provocative maneuvering of the normal hip.
        J Bone Joint Surg Am. 2008; 90: 1464-1472
        • Hetsroni I.
        • Dela Torre K.
        • Duke G.
        • Lyman S.
        • Kelly B.T.
        Sex differences of hip morphology in young adults with hip pain and labral tears.
        Arthroscopy. 2013; 29: 54-63
        • Nilsson C.
        • Leanderson J.
        • Wykman A.
        • Strender L.E.
        The injury panorama in a Swedish professional ballet company.
        Knee Surg Sports Traumatol Arthrosc. 2001; 9: 242-246
        • Weber A.E.
        • Bedi A.
        • Tibor L.M.
        • Zaltz I.
        • Larson C.M.
        The hyperflexible hip: Managing hip pain in the dancer and gymnast.
        Sports Health. 2015; 7: 346-358
        • Steinberg N.
        • Siev-Ner I.
        • Peleg S.
        • et al.
        Injuries in female dancers aged 8 to 16 years.
        J Athl Train. 2013; 48: 118-123
        • Harris J.D.
        • Gerrie B.J.
        • Lintner D.M.
        • Varner K.E.
        • McCulloch P.C.
        Microinstability of the hip and the splits radiograph.
        Orthopedics. 2016; 39: e169-e175
        • Harris J.D.
        • Gerrie B.J.
        • Varner K.E.
        • Lintner D.M.
        • McCulloch P.C.
        Radiographic prevalence of dysplasia, cam, and pincer deformities in elite ballet.
        Am J Sports Med. 2016; 44: 20-27
        • Mitchell R.J.
        • Gerrie B.J.
        • McCulloch P.C.
        • et al.
        Radiographic evidence of hip microinstability in elite ballet.
        Arthroscopy. 2016; 32: 1038-1044.e1
        • Griffin D.R.
        • Dickenson E.J.
        • O'Donnell J.
        • et al.
        The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): An international consensus statement.
        Br J Sports Med. 2016; 50: 1169-1176
        • Locks R.
        • Utsunomiya H.
        • Briggs K.K.
        • McNamara S.
        • Chahla J.
        • Philippon M.J.
        Return to play after hip arthroscopic surgery for femoroacetabular impingement in professional soccer players.
        Am J Sports Med. 2018; 46: 273-279
        • Naal F.D.
        • Schar M.
        • Miozzari H.H.
        • Notzli H.P.
        Sports and activity levels after open surgical treatment of femoroacetabular impingement.
        Am J Sports Med. 2014; 42: 1690-1695
        • Degen R.M.
        • Fields K.G.
        • Wentzel C.S.
        • et al.
        Return-to-play rates following arthroscopic treatment of femoroacetabular impingement in competitive baseball players.
        Phys Sportsmed. 2016; 44: 385-390
        • Alradwan H.
        • Philippon M.J.
        • Farrokhyar F.
        • et al.
        Return to preinjury activity levels after surgical management of femoroacetabular impingement in athletes.
        Arthroscopy. 2012; 28: 1567-1576
        • Philippon M.
        • Schenker M.
        • Briggs K.
        • Kuppersmith D.
        Femoroacetabular impingement in 45 professional athletes: Associated pathologies and return to sport following arthroscopic decompression.
        Knee Surg Sports Traumatol Arthrosc. 2007; 15: 908-914
        • Philippon M.J.
        • Kuppersmith D.A.
        • Wolff A.B.
        • Briggs K.K.
        Arthroscopic findings following traumatic hip dislocation in 14 professional athletes.
        Arthroscopy. 2009; 25: 169-174
        • Nwachukwu B.U.
        • Bedi A.
        • Premkumar A.
        • Draovitch P.
        • Kelly B.T.
        Characteristics and outcomes of arthroscopic femoroacetabular impingement surgery in the National Football League.
        Am J Sports Med. 2018; 46: 144-148
        • Naal F.D.
        • Hatzung G.
        • Muller A.
        • Impellizzeri F.
        • Leunig M.
        Validation of a self-reported Beighton score to assess hypermobility in patients with femoroacetabular impingement.
        Int Orthop. 2014; 38: 2245-2250
        • Clohisy J.C.
        • Carlisle J.C.
        • Beaule P.E.
        • et al.
        A systematic approach to the plain radiographic evaluation of the young adult hip.
        J Bone Joint Surg Am. 2008; 90: 47-66
        • Harris J.D.
        • Slikker III, W.
        • Gupta A.K.
        • McCormick F.M.
        • Nho S.J.
        Routine complete capsular closure during hip arthroscopy.
        Arthrosc Tech. 2013; 2: e89-e94
        • Frank R.M.
        • Lee S.
        • Bush-Joseph C.A.
        • Kelly B.T.
        • Salata M.J.
        • Nho S.J.
        Improved outcomes after hip arthroscopic surgery in patients undergoing T-capsulotomy with complete repair versus partial repair for femoroacetabular impingement: A comparative matched-pair analysis.
        Am J Sports Med. 2014; 42: 2634-2642
        • Outerbridge R.E.
        The etiology of chondromalacia patellae.
        Clin Orthop Relat Res 2001. 1961; 389: 5-8
        • Nwachukwu B.U.
        • Fields K.
        • Chang B.
        • Nawabi D.H.
        • Kelly B.T.
        • Ranawat A.S.
        Preoperative outcome scores are predictive of achieving the minimal clinically important difference after arthroscopic treatment of femoroacetabular impingement.
        Am J Sports Med. 2017; 45: 612-619
        • Chahal J.
        • Van Thiel G.S.
        • Mather III, R.C.
        • et al.
        The patient acceptable symptomatic state for the modified Harris Hip Score and Hip Outcome Score among patients undergoing surgical treatment for femoroacetabular impingement.
        Am J Sports Med. 2015; 43: 1844-1849
        • Menge T.J.
        • Bhatia S.
        • McNamara S.C.
        • Briggs K.K.
        • Philippon M.J.
        Femoroacetabular impingement in professional football players: Return to play and predictors of career length after hip arthroscopy.
        Am J Sports Med. 2017; 45: 1740-1744
        • Duthon V.B.
        • Charbonnier C.
        • Kolo F.C.
        • et al.
        Correlation of clinical and magnetic resonance imaging findings in hips of elite female ballet dancers.
        Arthroscopy. 2013; 29: 411-419
        • Kocher M.S.S.R.
        • Lee M.
        • Micheli L.J.
        • Solomon J.
        • Stubbs A.
        Arthroscopic debridement of hip labral tears in dancers.
        J Dance Med Sci. 2006; 10: 99-105
        • Kolo F.C.
        • Charbonnier C.
        • Pfirrmann C.W.
        • et al.
        Extreme hip motion in professional ballet dancers: Dynamic and morphological evaluation based on magnetic resonance imaging.
        Skeletal Radiol. 2013; 42: 689-698
        • Larson C.M.
        Editorial commentary: Ligamentum teres tears and femoroacetabular impingement: Complex coexistence of impingement and instability.
        Arthroscopy. 2016; 32: 1298-1299
        • Leunig M.
        CORR insights: Femoroacetabular impingement predisposes to traumatic posterior hip dislocation.
        Clin Orthop Relat Res. 2013; 471: 1944-1945
        • Frank R.M.
        • Ukwuani G.
        • Allison B.
        • Clapp I.
        • Nho S.J.
        High rate of return to yoga for athletes after hip arthroscopy for femoroacetabular impingement syndrome.
        Sports Health. 2018; 10: 434-440
        • Frank R.M.
        • Ukwuani G.
        • Chahla J.
        • Batko B.
        • Bush-Joseph C.A.
        • Nho S.J.
        High rate of return to swimming after hip arthroscopy for femoroacetabular impingement.
        Arthroscopy. 2018; 34: 1471-1477
        • Ardern C.L.
        • Webster K.E.
        • Taylor N.F.
        • Feller J.A.
        Return to sport following anterior cruciate ligament reconstruction surgery: A systematic review and meta-analysis of the state of play.
        Br J Sports Med. 2011; 45: 596-606
        • Naal F.D.
        • Muller A.
        • Varghese V.D.
        • Wellauer V.
        • Impellizzeri F.M.
        • Leunig M.
        Outcome of hip impingement surgery: Does generalized joint hypermobility matter?.
        Am J Sports Med. 2017; 45: 1309-1314
        • Pontiff M.
        • Ithurburn M.P.
        • Ellis T.
        • Cenkus K.
        • Stasi S.D.
        Pre- and post-operative self-reported function and quality of life in women with and without generalized joint laxity undergoing hip arthroscopy for femoroacetabular impingement.
        Int J Sports Phys Ther. 2016; 11: 378-387