Written by Amanda Nelson
University of Kentucky researchers are in search of answers for those who suffer from a painful hip condition known as Femoroacetabular Impingement Syndrome (FAIS). A study in the January issue of Clinical Biomechanics helps shed light on the short-term outcome of anthroscopic surgery for the condition.
Although FAIS can be experienced at any age, it often impacts the young and athletic, bringing their active lifestyles to a halt, said study author Michael Samaan, an assistant professor of biomechanics at the UK College of Education Department of Kinesiology and Health Promotion.
“Not too long ago, the standard treatment involved physical therapy and methods to relieve pain, such as cortisone shots,” Samaan said. “Today, many FAIS patients experience pain-relief by undergoing surgery.”
FAIS is characterized by extra bone growth around the hip joint. The abnormal growth creates friction, which can damage the joint and cause severe pain. Hip surgery typically corrects the problem and alleviates hip pain, but the surgery’s impact on gait mechanics and cartilage health have not been studied extensively. Samaan’s work contributes to evidence researchers and clinicians can use to develop rehabilitation protocols to help patients safely return to previous activity levels following surgery, while preserving hip joint cartilage health.
His most recent study, co-authored by colleagues at the University of California San Francisco, used gait analysis to analyze FAIS patients’ walking patterns. Researchers also took images of the FAIS patients’ surgical hip joint using magnetic resonance imaging (MRI) to quantify the chemical composition of the hip joint cartilage. FAIS patients in the study underwent gait analysis and MRI before surgery and seven months after surgery. The FAIS patients’ pre- and post- surgical data was compared to 10 matched asymptomatic healthy control participants.
“We found that hip joint kinematics during walking, or the position of the hip joint during walking, was not changed at seven months post surgery,” Samaan said. “However, there is a shift in the way the hip joint is loaded in the FAIS patients after surgery. FAIS patients who walked with higher hip joint loading after surgery exhibited better cartilage health.”
While studies have been conducted utilizing longer follow-up (more than seven months), Samaan’s is among the first to look at short-term outcomes of anthroscopic surgery. Researchers say this may be important in developing post-surgical rehabilitation protocols aimed at preventing the onset of hip joint degeneration, as this is the time period around when FAIS patients are cleared for full activity.
Samaan, who came to the university in 2018, joined a team working to gain a better understanding of how FAIS develops and the long-term impact on patients who have surgery for FAIS. They hope their work will lead to better treatments, or perhaps even prevention, in patients shown to be at-risk of bone and cartilage problems in the hip.
“I talk to patients who say ‘I have so much pain, I cannot squat to pick up my kid when I get home from work,’” he said.
As a father, Samaan has developed a better understanding of the daily difficulties his research subjects report.
“The first person who runs to the door is my son,” he said. “If I wasn’t able to squat down and pick him up, that would destroy me.”
Samaan, who was most recently a post-doctoral fellow at the University of California San Francisco, was attracted to UK as he explored faculty positions across the country. During his postdoctoral fellowship, Samaan gained the expertise and skills needed to apply advanced musculoskeletal imaging techniques which allow for a quantitative understanding of the effects of FAIS on hip joint cartilage health. He saw the university as being uniquely positioned to study a condition like FAIS. As one of a handful of universities across the nation with a land-grant mission and a medical center and academic units on one contiguous campus, UK provides researchers the opportunity to more easily collaborate across specialty areas.
“Working as part of a multi-disciplinary research team was a priority of mine,” Samaan said. “It is the best way of obtaining a comprehensive understanding of the effects of FAIS on hip joint bone and cartilage health and mechanics.”
At UK he joined faculty specializing in FAIS, including an orthopedic surgeon who performs surgical intervention for the condition, radiologists with expertise in assessing images of conditions such as FAIS, a physical therapist/biomechanist who conducts extensive work with patients who have undergone ACL reconstruction, engineers with expertise in advanced biomechanical modeling and researchers who are examining the psychosocial aspects of FAIS.
Samaan, who is trained as a mechanical and biomedical engineer, specializes in biomechanics, which involves applying mechanical principles to the human body. At UK, he has access to the Human Performance Laboratory, which consists of the Biodynamics and Biomotion Labs, as well as the Magnetic Resonance Imaging and Spectroscopy Center (MRISC) where extensive and sophisticated research is conducted, such as 3-D motion analysis and advanced musculoskeletal imaging.
Samaan’s research received a boost when he received a career-development award in early 2019 from the UK Center for Clinical and Translational Science’s (CCTS) KL2 program. The KL2 program is supported by a Clinical and Translational Science Award from the National Center for Advancing Translational Science.It provides research training and mentorship to junior faculty in developing a clinical/translational research program. Ultimately, the goal of the program is to aid junior faculty in obtaining the skills needed to obtain large-scale federal research funding.
Serving as Samaan’s primary mentor for career development is Brian Noehren, an established researcher in the UK College of Health Sciences and former CCTS KL2 trainee himself. He is a physical therapist with a Ph.D. in biomechanics and movement science, and Samaan says their research aligns nicely.
As a faculty member in the Department of Kinesiology and Health Promotion, Samaan teaches courses that are helping undergraduates learn about biomechanics and graduate students study musculoskeletal modeling.
Whether as a teacher, researcher, or scholar, Samaan makes it a priority to make connections with people. Behind the advanced technologies and interventions, he always keeps in mind the human lives that are impacted.
“Anyone who comes through my lab as a study participant, I always ask them what their story is,” Samaan said. “Conditions like FAIS take a toll on people physically, emotionally, and mentally. We need to consider all the patient is going through. At the end of the day, you want people to be happy in their lives.”