Purpose
To compare the outcomes of patients with femoroacetabular impingement (FAI) syndrome
treated with hip arthroscopy versus those treated with physical therapy alone.
Methods
The PubMed, Embase, and Cochrane Library databases were searched from inception to
February 15, 2019. All randomized controlled trials (RCTs) that compared operative
versus nonoperative treatment in the management of FAI for a minimum 6-month follow-up
period were included. The primary outcome was the International Hip Outcome Tool 33.
The CLEAR NPT (Checklist to Evaluate a Report of a Nonpharmacological Trial) was used
to evaluate the methodologic quality of included studies.
Results
Three RCTs (Level I) were included with a total of 650 patients (323 randomized to
surgery and 327 randomized to physical therapy), follow-rate of 90% (583 patients,
295 operative and 288 nonoperative), and average of 11.5 months' follow-up. Regarding
participation, 222 of 350 patients (63%) in the FAIT (Femoroacetabular Impingement
Trial) study, 348 of 648 (54%) in the FASHIoN (Full UK RCT of Arthroscopic Surgery
for Hip Impingement Versus Best Conservative Care) study, and 80 of 104 (77%) in the
study by Mansell et al. agreed to participate. The mean age was 35 years, and 51.5%
of patients were male patients. All 3 RCTs represented high methodologic quality and
a low risk of bias. The frequency-weighted mean follow-up period was 10 months. A
meta-analysis of the 3 randomized trials showed that patients treated with operative
management had improved preoperative-to-postoperative change scores on the International
Hip Outcome Tool 33 compared with the nonoperative group (standardized mean difference,
3.46; 95% confidence interval, 0.07-6.86;
P < .05). One study reported on the achievement of clinically relevant outcomes at
the individual level, with 51% of the operative group and 32% of the nonoperative
group achieving the minimal clinically important difference and with 48% and 19%,
respectively, achieving the patient acceptable symptomatic state for the Hip Outcome
Score–Activities of Daily Living.
Conclusions
The results of this meta-analysis show that patients with FAI syndrome treated with
hip arthroscopy have statistically superior hip-related outcomes in the short term
compared with those treated with physical therapy alone.
Level of Evidence
Level I, meta-analysis of Level I RCTs.
To read this article in full you will need to make a payment
Subscribe to Arthroscopy
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Hip arthroscopy in the United States: An update following coding changes in 2011.J Hip Preserv Surg. 2017; 4: 250-257
- Trends and demographics in hip arthroscopy in the United States.Arthroscopy. 2013; 29: 661-665
- Arthroscopic labral repair versus selective labral debridement in female patients with femoroacetabular impingement: A prospective randomized study.Arthroscopy. 2013; 29: 46-53
- Arthroscopic debridement versus refixation of the acetabular labrum associated with femoroacetabular impingement: Mean 3.5-year follow-up.Am J Sports Med. 2012; 40: 1015-1021
- Radiographic comparison of surgical hip dislocation and hip arthroscopy for treatment of cam deformity in femoroacetabular impingement.Am J Sports Med. 2011; 39: 20S-28S
- Should the capsule be repaired or plicated after hip arthroscopy for labral tears associated with femoroacetabular impingement or instability? A systematic review.Arthroscopy. 2018; 34: 303-318
- Arthroscopic versus open treatment of femoroacetabular impingement: A systematic review of medium- to long-term outcomes.Am J Sports Med. 2016; 44: 1062-1068
- Complication rates for hip arthroscopy are underestimated: A population-based study.Arthroscopy. 2017; 33: 1194-1201
- Complications and survival analyses of hip arthroscopies performed in the National Health Service in England: A review of 6,395 cases.Arthroscopy. 2015; 31: 836-842
- Complications following arthroscopic surgery of the hip: A systematic review of 36 761 cases.Bone Joint J. 2017; 99-B: 1577-1583
- Systematic review and meta-analysis of outcomes after hip arthroscopy in femoroacetabular impingement.Am J Sports Med. 2019; 47: 488-500
- Surgery for treating hip impingement (femoroacetabular impingement).Cochrane Database Syst Rev. 2014; : CD010796
- Does femoroacetabular impingement contribute to the development of hip osteoarthritis? A systematic review.Sports Med Arthrosc Rev. 2015; 23: 174-179
- Nonoperative management of femoroacetabular impingement: A prospective study.Am J Sports Med. 2018; 46: 3415-3422
- Physical impairments and activity limitations in people with femoroacetabular impingement: A systematic review.Br J Sports Med. 2015; 49: 230-242
- Femoroacetabular impingement alters hip and pelvic biomechanics during gait: Walking biomechanics of FAI.Gait Posture. 2009; 30: 41-44
- Impairment of dynamic single-leg balance performance in individuals with hip chondropathy.Arthritis Care Res (Hoboken). 2014; 66: 709-716
- The management of symptomatic femoroacetabular impingement: What is the rationale for non-surgical treatment?.Br J Sports Med. 2016; 50: 511-512
- Hip muscle weakness in patients with symptomatic femoroacetabular impingement.Osteoarthritis Cartilage. 2011; 19: 816-821
- Physical impairments in symptomatic femoroacetabular impingement: A systematic review of the evidence.Br J Sports Med. 2016; 50: 1180
- Is hip range of motion and strength impaired in people with hip chondrolabral pathology?.J Musculoskelet Neuronal Interact. 2014; 14: 334-342
- Anterior hip joint force increases with hip extension, decreased gluteal force, or decreased iliopsoas force.J Biomech. 2007; 40: 3725-3731
- Effect of intensive exercise on patients with active rheumatoid arthritis: A randomised clinical trial.Ann Rheum Dis. 2000; 59: 615-621
- A prospective, randomized, controlled trial comparing conservative treatment with trunk stabilization exercise to standard hip muscle exercise for treating femoroacetabular impingement: A pilot study.Clin J Sport Med. 2019; 29: 267-275
- Conservative treatment for mild femoroacetabular impingement.J Orthop Surg (Hong Kong). 2011; 19: 41-45
- Nonoperative treatment for femoroacetabular impingement: A systematic review of the literature.PM R. 2013; 5: 418-426
- Effects of arthroscopy for femoroacetabular impingement syndrome on quality of life and economic outcomes.Am J Sports Med. 2018; 46: 1205-1213
- Cochrane handbook for systematic reviews of interventions. Ed 5.5.0. The Cochrane Collaboration, London2011
- The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration.PLoS Med. 2009; 6: e1000100
- The development and validation of a self-administered quality-of-life outcome measure for young, active patients with symptomatic hip disease: The International Hip Outcome Tool (iHOT-33).Arthroscopy. 2012; 28 (quiz 606-610.e1): 595-605
- Evidence of validity for the hip outcome score in hip arthroscopy.Arthroscopy. 2007; 23: 822-826
- EuroQol—A new facility for the measurement of health-related quality of life.Health Policy. 1990; 16: 199-208
- The estimation of a preference-based measure of health from the SF-12.Med Care. 2004; 42: 851-859
- Evidence of reliability and responsiveness for the hip outcome score.Arthroscopy. 2008; 24: 676-682
- 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
- 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
- Identification of a patient acceptable symptomatic state score for the International Hip Outcome Tool in people undergoing hip arthroscopy.Arthroscopy. 2018; 34: 3024-3029
- A checklist to evaluate a report of a nonpharmacological trial (CLEAR NPT) was developed using consensus.J Clin Epidemiol. 2005; 58: 1233-1240
- Measuring inconsistency in meta-analyses.BMJ. 2003; 327: 557-560
- Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome (UK FASHIoN): A multicentre randomised controlled trial.Lancet. 2018; 391: 2225-2235
- Arthroscopic surgery or physical therapy for patients with femoroacetabular impingement syndrome: A randomized controlled trial with 2-year follow-up.Am J Sports Med. 2018; 46: 1306-1314
- Arthroscopic hip surgery compared with physiotherapy and activity modification for the treatment of symptomatic femoroacetabular impingement: Multicentre randomised controlled trial.BMJ. 2019; 364: l185
- Two-year outcomes after arthroscopic surgery compared to physical therapy for femoracetabular impingement: A protocol for a randomized clinical trial.BMC Musculoskelet Disord. 2016; 17: 60
- Protocol for the Femoroacetabular Impingement Trial (FAIT): A multi-centre randomised controlled trial comparing surgical and non-surgical management of femoroacetabular impingement.Bone Joint Res. 2014; 3: 321-327
- UK FASHIoN: Feasibility study of a randomised controlled trial of arthroscopic surgery for hip impingement compared with best conservative care.Health Technol Assess. 2016; 20: 1-172
- Personalised hip therapy: Development of a non-operative protocol to treat femoroacetabular impingement syndrome in the FASHIoN randomised controlled trial.Br J Sports Med. 2016; 50: 1217-1223
- Movement-pattern training to improve function in people with chronic hip joint pain: A feasibility randomized clinical trial.J Orthop Sports Phys Ther. 2016; 46: 452-461
- The Physiotherapy for Femoroacetabular Impingement Rehabilitation STudy (physioFIRST): A pilot randomized controlled trial.J Orthop Sports Phys Ther. 2018; 48: 307-315
- Does treatment by a specialist physiotherapist change pain and function in young adults with symptoms from femoroacetabular impingement? A pilot project for a randomised controlled trial.Physiotherapy. 2017; 103: 201-207
- Non-operative management of femoroacetabular impingement: A prospective, randomized controlled clinical trial pilot study.J Sci Med Sport. 2016; 19: 716-721
- Anterior femoroacetabular impingement: Part I. Techniques of joint preserving surgery.Clin Orthop Relat Res. 2004; : 61-66
- The fragility of statistically significant findings from randomized trials in sports surgery: A systematic survey.Am J Sports Med. 2017; 45: 2164-2170
- Cam deformities and limited hip range of motion are associated with early osteoarthritic changes in adolescent athletes: A prospective matched cohort study.Am J Sports Med. 2017; 45: 3036-3043
- Does duration of symptoms affect clinical outcome after hip arthroscopy for labral tears? Analysis of prospectively collected outcomes with minimum 2-year follow-up.J Hip Preserv Surg. 2017; 4: 308-317
- Survivorship and outcomes 10 years following hip arthroscopy for femoroacetabular impingement: Labral debridement compared with labral repair.J Bone Joint Surg Am. 2017; 99: 997-1004
- Debridement versus re-attachment of acetabular labral tears: A review of the literature and quantitative analysis.Bone Joint J. 2014; 96-B: 24-30
- 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
- Defining the learning curve for hip arthroscopy: A threshold analysis of the volume-outcomes relationship.Am J Sports Med. 2018; 46: 1284-1293
- Risk of failure of primary hip arthroscopy-a population-based study.J Hip Preserv Surg. 2017; 4: 214-223
- Perceptions of equipoise are crucial to trial participation: A qualitative study of men in the ProtecT study.Control Clin Trials. 2003; 24: 272-282
- Factors affecting patient participation in orthopaedic trials comparing surgery to non-surgical interventions.Contemp Clin Trials Commun. 2016; 3: 153-157
Article Info
Publication History
Accepted:
July 16,
2019
Received:
March 8,
2019
Footnotes
See commentary on page 274
The authors report that they have no conflicts of interest in the authorship and publication of this article. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2019 by the Arthroscopy Association of North America
