Operative Versus Nonoperative Treatment of Femoroacetabular Impingement Syndrome: A Meta-analysis of Short-Term Outcomes

  • Tim Dwyer
    Correspondence
    Address correspondence to Tim Dwyer, M.B.B.S., Ph.D., Women's College Hospital, 76 Grenville St, Toronto, M5S1B1, Canada.
    Affiliations
    Young Adult Hip Innovation Program, University of Toronto Orthopaedic Sports Medicine, Women's College Hospital, University of Toronto, and Mount Sinai Hospital, Toronto, Ontario, Canada

    Department of Paediatrics, University of Toronto, and Mount Sinai Hospital, Toronto, Ontario, Canada
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  • Daniel Whelan
    Affiliations
    Young Adult Hip Innovation Program, University of Toronto Orthopaedic Sports Medicine, Women's College Hospital, University of Toronto, and Mount Sinai Hospital, Toronto, Ontario, Canada
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  • Prakesh S. Shah
    Affiliations
    Department of Paediatrics, University of Toronto, and Mount Sinai Hospital, Toronto, Ontario, Canada

    Institute of Health Policy, Management and Evaluation, University of Toronto, and Mount Sinai Hospital, Toronto, Ontario, Canada

    University of Toronto, and Mount Sinai Hospital, Toronto, Ontario, Canada
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  • Prabjit Ajrawat
    Affiliations
    Young Adult Hip Innovation Program, University of Toronto Orthopaedic Sports Medicine, Women's College Hospital, University of Toronto, and Mount Sinai Hospital, Toronto, Ontario, Canada
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  • Graeme Hoit
    Affiliations
    Young Adult Hip Innovation Program, University of Toronto Orthopaedic Sports Medicine, Women's College Hospital, University of Toronto, and Mount Sinai Hospital, Toronto, Ontario, Canada
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  • Jaskarndip Chahal
    Affiliations
    Young Adult Hip Innovation Program, University of Toronto Orthopaedic Sports Medicine, Women's College Hospital, University of Toronto, and Mount Sinai Hospital, Toronto, Ontario, Canada
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      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.
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