The Dancers Hip: The Hyperflexible Athlete: Anatomy & Arthroscopic Clinical Outcomes

OBJECTIVES: Competitive Dance places high demands on the hips joints and return to these activities after surgical management of intra-articular pathology is not well documented. METHODS: Between 2008 and 2016, hip arthroscopy was performed for 63 competitive dancers (78 hips) with a mean age 21.0 years. Specific types of dance performed included 54 studio dance and 43 high kick dance. Morphology included Cam-type FAI (99%), Pincer-type FAI (45%), Subspine impingement (83%), Borderline dysplasia (9%), Dysplasia (10%), and Normal (5%). The mean preoperative LCE angle was 29.9 deg, alpha angle was 52.3 deg (Lateral), and offset ratio was 0.16. A positive Cross-over (COS) and Posterior Wall (PW) sign were present in 60% of hips, and the mean Tonnis angle was 3.2 deg. Outcomes were evaluated with MHHS, SF-12 scores, VAS scores. RESULTS: At mean 19.7 months follow-up, the mean outcome improvements were 23.5 points (MHHS), 10.4 points (SF-12), 3.8 points (VAS), (p<.01 for each). MHHS improved from 60.5 points, preoperatively, to 84.0 points at most recent f/u (p<0.01). Sixty-seven percent returned to their prior level of competitive dance, 22% returned to limited or modified dance, and 10% were unable to return to dance, included 1 retirement. Procedures performed included 95% labral repairs, 10% labral debridements, 99% femoral resections, 55% rim resections, 83% subspine decompressions, and 68% capsular plications. CONCLUSION: Hip pain in dancers can be challenging secondary to high demands placed on the hips. A specific arthroscopic approach addressing subtle osseous abnormalities and capsular laxity led to significantly improved outcomes for competitive dancers. Eighty Nine percent of Dancers ultimately returned to competitive Dance, although only 67% returned to their pre-injury competitive level.