finishing on my fellowship at Case Western out in Cleveland, presenting this on behalf of University of Utah where I did my residency. Thank you to AOSSM as well as all my co-authors. So I'll quickly go through these slides as everyone here knows the basics of femoracetabular impingement syndrome as well as the various treatment options out there. So the scope of health care as a whole has changed over the years. Popularized in 2013 by Michael Porter, an economist at the Harvard Business School, value-based health care is a delivery framework aimed to achieve the best outcomes and patient experiences at the lowest cost. Thus value itself is defined as quality over cost. Following a hip arthroscopy surgery, a major component to the post-operative rehabilitation or major component to a successful outcome is a post-operative rehabilitation. And at the University, our standard protocol was always to have patients enroll in a formal physical therapy program. However, the national average cost of physical therapy sessions in the United States ranges from $30 all the way to up to 400 plus per therapy session. And this can create quite the difficult situation for many of our patients for multiple reasons including the cost itself as well as time commitment with busy schedules and travel time. The role of formal therapy versus home exercise program has been examined in many other areas in orthopedics including but not limited to the hip replacement, knee replacement, shoulder replacement, as well as knee arthroscopy populations. All of which have shown that a well-designed home exercise program is just as effective as a formal therapy program in the post-operative rehabilitation. However, to our knowledge, there have been no studies to date that have examined the role of formal therapy versus home exercise in patient outcomes in the hip arthroscopy population. Thus, the purpose of our paper was to compare the short-term outcomes of patients treated for from rectabular impingement syndrome with hip arthroscopy enrolled in formal therapy versus home exercise program. Our hypothesis was that there would be no significant clinical differences in outcomes between the two groups. After obtaining IRB approval, we began enrolling in this prospective cohort study of patients undergoing hip arthroscopy surgery for ephemeris tabular impingement syndrome at a single surgery center by two treating surgeons who were trained in hip arthroscopy. Patients were allowed to self-select to either the formal therapy group or the formal group. Inclusion criteria listed here and a power analysis was performed stating we need 40 patients per group. All patients were contacted via telephone pre-operatively. The study rationale was explained to the patient as well as a brief description of what the formal and home exercise programs consisted of and then email addresses were confirmed and the preoperative survey was sent out which included consent for the study as well as the first survey itself. Surveys were completed at one month or sorry pre-op and then one month, three months, six months, and 12 months post-op and the components were listed here. Here you can see the home exercise program and in designing this program we did our best to keep the program as simple as possible. It was broken down into four phases with first three phases being in four week intervals starting from the time of surgery through week 12 and then with the fourth phase being from week 13 onward. As you can see we also listed any weight-bearing restrictions and or precautions to abide by during the respective phases. The expectation was for patients to complete the program a minimum of three days per week but they were encouraged to perform it as frequently as daily if they were feeling up for it. Including the home exercise program was access to MedBridge and this is an online platform used by the physical therapists at the University of Utah. Patients were given access codes that were unique for each phase of the home program and once that code was entered into the website they would have the option to see video demonstrations as well as written descriptions of each of the exercises. They needed some help as far as exactly what to do and then additionally if they wanted to they had the option to use the site to log their exercises as well. And because we knew that not everyone would be getting their physical therapy at the university we wanted to do our best to keep the therapy protocol as standardized as possible. So working with one of our university physical therapists this is the standard protocol that was designed and given to patients who chose a formal program to give to their therapist at their first visit. So we enrolled 148 patients in the study. Three of them withdrew prior to completion of the study and 36 were lost to follow-up leaving a final cohort size of 109 patients with 46 in the formal PT group and 63 in the home exercise program. There were no significant differences in patient demographics between the groups and additionally there were no differences in surgical characteristics in regards to management of the labrum or the capsule and then all patients underwent ephemeral osteoplasty. At 12 months post-op there were no significant differences between the formal and home exercise groups for any of the scores. In regards to patient satisfaction the vast majority of patients were satisfied with their choice of rehabilitation as well as overall care. Some of the additional questions that we asked patients had to do with deciding factors in regards to their choice between the two cohorts. Cost, COVID-19 concerns, time commitment, flexibility and transportation played a major role in patients decisions who chose the home program while having more oversight and structure played bigger roles for those who chose the formal therapy program. I should also mention since I did already that pre-operative scores were also similar between the two groups with no significant differences. And then here comparing the pre-op to post-operative scores you can see that both groups showed significant improvements in all scores at the 12-month mark compared to pre-op. Additionally both groups reached MCID for all scores as well. So in conclusion we found no significant differences in patient outcomes between formal therapy and home exercise groups at one year post-op with both groups demonstrating significant improvement compared to pre-operative scores. Thank you.

femoracetabular impingement syndrome

hip arthroscopy

physical therapy program

home exercise program

short-term outcomes