Surgeon Recommendations for Physical Activity in Patients With Pediatric Hip Conditions

Area of Science:

• Pediatric Orthopaedics
• Sports Medicine
• Rehabilitation Science

Background:

• Physical activity (PA) is crucial for youth, but guidance for pediatric hip patients (developmental dysplasia of the hip [DDH], Legg-Calvé-Perthes disease [LCPD], slipped capital femoral epiphysis [SCFE]) post-healing is unclear.
• Orthopaedic surgeons' current practices, opinions, and consensus on advising these patients regarding PA are not well-documented.

Purpose of the Study:

• To examine orthopaedic surgeons' role in advising pediatric hip patients on recommended physical activity (PA) post-healing.
• To assess surgeons' practices, opinions, and consensus on PA recommendations for children with DDH, LCPD, or SCFE.

Main Methods:

• A survey was distributed to orthopaedic surgeons from four hip study groups.
• The survey included surgeon demographics, opinions on PA, and 10 case scenarios assessing recommendations for activity duration, intensity, and type restrictions for pediatric hip conditions.
• Consensus was evaluated using a scale from 0 (no agreement) to 1 (complete agreement).

Main Results:

• 94% of 51 respondents agreed that school-aged hip patients should return to PA, yet 53% believed PA could compromise the hip or lead to osteoarthritis.
• High consensus (0.92) existed for recommending some PA, but lower consensus was found for the daily 60-minute moderate-to-vigorous physical activity (MVPA) minimum (0.44) and activity type restrictions (0.33).
• Most frequent restrictions included avoiding impact (93%) and contact (58%) activities. Surgeons were unaware of existing PA guidelines, with 57% expressing interest in adopting them.

Conclusions:

• While orthopaedic surgeons agree on the importance of PA for pediatric hip patients, significant variability exists in recommending specific MVPA levels and activity restrictions.
• There is a clear need and expressed interest among surgeons for evidence-based PA guidelines to optimize outcomes for children with hip conditions.