Advertisement

Osteochondroplasty Benefits the Pragmatic Patient With Femoroacetabular Impingement: Analysis From the Embedded Prospective Cohort of the Femoroacetabular Impingement RandomiSed Controlled Trial (FIRST)

      Purpose

      To determine whether arthroscopic osteochondroplasty demonstrated effectiveness in a pragmatic femoroacetabular impingement patient population embedded within FIRST (the Femoroacetabular Impingement RandomiSed controlled Trial).

      Methods

      All cohort patients were not randomized and were followed prospectively with a follow-up assessment protocol identical to that in FIRST. The primary outcome was hip pain using a 100-point visual analog scale. Secondary outcomes included hip function (Hip Outcome Score, International Hip Outcome Tool-12), health utility (EuroQol 5 Dimensions), and health-related quality of life (Short Form-12) at 12 months, as well as operatively and nonoperatively treated hip complications at 24 months. We performed multivariable regressions to compare these outcomes between 3 groups of patients: (1) those randomized to lavage in FIRST, (2) those randomized to osteochondroplasty in FIRST, and (3) those who received osteochondroplasty as part of the cohort study.

      Results

      All groups had improvements across all questionnaire outcomes from baseline to 12 months, with no significant differences. There were significantly more reoperations in the lavage trial group compared with those in the embedded cohort (adjusted odds ratio [aOR] 3.08; 95% confidence interval [CI] 1.23-7.73; P = .016). There were significantly more nonoperatively treated hip complications in the lavage trial group and in the osteochondroplasty trial group when compared with those in the embedded cohort (aOR 3.81; 95% CI 1.19-12.17; P = .024 and aOR 4.55; 95% CI 1.43-14.42; P = .010, respectively).

      Conclusions

      Hip arthroscopic osteochondroplasty and lavage led to improvement in hip pain, function, and health-related quality of life at 12 months across both randomized controlled trial (RCT) and cohort patients. The pragmatic cohort receiving osteochondroplasty had (1) significantly fewer complications than RCT patients, (2) significantly less reoperations than RCT patients randomized to arthroscopic lavage, and (3) fewer, although nonsignificant, reoperations than RCT osteochondroplasty patients.

      Level of Evidence

      II, therapeutic.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Ayeni O.R.
        • Wong I.
        • Chien T.
        • Musahl V.
        • Kelly B.T.
        • Bhandari M.
        Surgical indications for arthroscopic management of femoroacetabular impingement.
        Arthroscopy. 2012; 28: 1170-1179
        • Domb B.G.
        • Martin T.J.
        • Gui C.
        • Chandrasekaran S.
        • Suarez-Ahedo C.
        • Lodhia P.
        Predictors of clinical outcomes after hip arthroscopy: A prospective analysis of 1038 patients with 2-year follow-up.
        Am J Sports Med. 2018; 46: 1324-1330
        • Domb B.G.
        • Chen S.L.
        • Go C.C.
        • et al.
        Predictors of clinical outcomes after hip arthroscopy: 5-year follow-up analysis of 1038 Patients.
        Am J Sports Med. 2021; 49: 112-120
        • Griffin D.R.
        • Dickenson E.J.
        • Wall P.D.H.
        • et al.
        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
        • Palmer A.J.R.
        • Gupta V.A.
        • Fernquest S.
        • et al.
        Arthroscopic hip surgery compared with physiotherapy and activity modification for the treatment of symptomatic femoroacetabular impingement: Multicentre randomised controlled trial.
        BMJ. 2019; 364: l185
        • Mansell N.S.
        • Rhon D.I.
        • Meyer J.
        • Slevin J.M.
        • Marchant B.G.
        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
        • Almasri M.
        • Simunovic N.
        • Heels-Ansdell D.
        • et al.
        Femoroacetabular impingement surgery leads to early pain relief but minimal functional gains past 6 months: Experience from the FIRST trial.
        Knee Surg Sport Traumatol Arthrosc. 2021; 29: 1362-1369
        • Memon M.
        • Kay J.
        • Hache P.
        • et al.
        Athletes experience a high rate of return to sport following hip arthroscopy.
        Knee Surg Sport Traumatol Arthrosc. 2019; 27: 3066-3104
        • Minkara A.A.
        • Westermann R.W.
        • Rosneck J.
        • Lynch T.S.
        Systematic review and meta-analysis of outcomes after hip arthroscopy in femoroacetabular impingement.
        Am J Sports Med. 2019; 47: 488-500
        • Ayeni O.R.
        • Karlsson J.
        • Heels-Ansdell D.
        • et al.
        • FIRST Investigators
        Osteochondroplasty and labral repair for the treatment of young adults with femoroacetabular impingement: A randomized controlled trial.
        Am J Sports Med. 2021; 49: 25-34
        • FIRST Investigators
        A multi-centre randomized controlled trial comparing arthroscopic osteochondroplasty and lavage with arthroscopic lavage alone on patient important outcomes and quality of life in the treatment of young adult (18–50) femoroacetabular impingement.
        BMC Musculoskelet Disord. 2015; 16: 64
        • Sihvonen R.
        • Paavola M.
        • Malmivaara A.
        • Järvinen T.L.N.
        Finnish Degenerative Meniscal Lesion Study (FIDELITY): A protocol for a randomised, placebo surgery controlled trial on the efficacy of arthroscopic partial meniscectomy for patients with degenerative meniscus injury with a novel “RCT within-a-cohort” study design.
        BMJ Open. 2013; 3e002510
        • Simunovic N.
        • Heels-Ansdell D.
        • Thabane L.
        • et al.
        Femoroacetabular Impingement Randomised controlled Trial (FIRST)—a multi-centre randomized controlled trial comparing arthroscopic lavage and arthroscopic osteochondroplasty on patient important outcomes and quality of life in the treatment of young adu.
        Trials. 2018; 19: 588
        • Collins Sally L.
        • Moore RAM J.H.
        The visual analogue pain intensity scale: What is moderate pain in millimetres?.
        Pain. 1997; 72: 95-97
        • Jensen M.P.
        • Karoly P.
        • Braver S.
        The measurement of clinical pain intensity: A comparison of six methods.
        Pain. 1986; 27: 117-126
        • Ho K.
        • Spence J.
        • Murphy M.F.
        Review of pain-measurement tools.
        Ann Emerg Med. 1996; 27: 427-432
        • Schenker M.L.
        • Martin R.R.
        • Weiland D.E.
        • Philippon M.J.
        Current trends in hip arthroscopy: A review of injury diagnosis, techniques, and outcome scoring.
        Curr Opin Orthop. 2005; 16: 89-94
      1. Chahal J, Thiel GS Van, Mather RC, Lee S, Salata MJ, Nho SJ. The minimal clinical important difference (MCID) and patient acceptable symptomatic state (PASS) for the modified Harris Hip Score and Hip Outcome Score among patients undergoing surgical treatment for femoroacetabular impingement. Orthop J Sport Med 2014;2(7) (suppl 2).

        • Chahal J.
        • Thiel G.S. Van
        • Mather R.C.
        • et al.
        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
        • Griffin D.R.
        • Parsons N.
        • Mohtadi N.G.H.
        • Safran M.R.
        A short version of the International Hip Outcome Tool (iHOT-12) for use in routine clinical practice.
        Arthroscopy. 2012; 28: 611-616
        • Martin R.L.
        • Kivlan B.R.
        • Christoforetti J.J.
        • et al.
        Minimal clinically important difference and substantial clinical benefit values for the 12-item international hip outcome tool.
        Arthroscopy. 2019; 35: 411-416
        • Martin R.L.
        • Kivlan B.R.
        • Christoforetti J.J.
        • et al.
        Defining variations in outcomes of hip arthroscopy for femoroacetabular impingement using the 12-item International Hip Outcome Tool (iHOT-12).
        Am J Sports Med. 2020; 48: 1175-1180
        • Bosch B.L.
        • Hunink M.G.M.
        Comparison of the Health Utilities Index Mark 3 (HUI3) and the EuroQol EQ-5D in patients treated for intermittent claudication.
        Qual Life Res. 2000; 9: 591-601
        • Hurst N.P.
        • Kind P.
        • Ruta D.
        • Hunter M.
        • Stubbings A.
        Health-related quality of life in rheumatoid arthritis: Validity, responsiveness and reliability of EuroQol (EQ-5D).
        Br J Rheumatol. 1997; 36: 551-559
        • Walters S.J.
        • Brazier J.E.
        Comparison of the minimally important difference for two health state utility measures: EQ-5D and SF-6D.
        Qual Life Res. 2005; 14: 1523-1532
        • Maempel J.F.
        • Ting J.Z.
        • Gaston P.
        Assessing the outcome of hip arthroscopy for labral tears in femoroacetabular impingement using the minimum dataset of the British non-arthroplasty hip register: A single-surgeon experience.
        Arthroscopy. 2018; 34: 2131-2139
        • Cohen J.
        Statistical power analysis for the behavioral sciences.
        2nd ed. Lawrence Erlbaum Associates, Hillsdale, NJ1988
        • Ware J.E.
        • Sherbourne C.D.
        The MOS 36-item short-form health survey (Sf-36): I. Conceptual framework and item selection.
        Med Care. 1992; 30: 473-483
        • Khan W.
        • Khan M.
        • Alradwan H.
        • Williams R.
        • Simunovic N.
        • Ayeni O.R.
        Utility of intra-articular hip injections for femoroacetabular impingement: A systematic review.
        Orthop J Sport Med. 2015; 3: 1-8
        • Ayeni O.R.
        • Farrokhyar F.
        • Crouch S.
        • Chan K.
        • Sprague S.
        • Bhandari M.
        Pre-operative intra-articular hip injection as a predictor of short-term outcome following arthroscopic management of femoroacetabular impingement.
        Knee Surg Sport Traumatol Arthrosc. 2014; 22: 801-805
        • Krych A.J.
        • Sousa P.L.
        • King A.H.
        • Engasser W.M.
        • Levy B.A.
        Intra-articular diagnostic injection exhibits poor predictive value for outcome after hip arthroscopy.
        Arthroscopy. 2016; 32: 1592-1600
        • Kemp J.L.
        • Coburn S.L.
        • Jones D.M.
        • Crossley K.M.
        The physiotherapy for femoroacetabular impingement rehabilitation study (physioFIRST): A pilot randomized controlled trial.
        J Orthop Sports Phys Ther. 2018; 48: 307-315
        • Beck E.C.
        • Nwachukwu B.U.
        • Krivicich L.M.
        • et al.
        Preoperative hip extension strength is an independent predictor of achieving clinically significant outcomes after hip arthroscopy for femoroacetabular impingement syndrome.
        Sports Health. 2020; 12: 361-372
        • Nho S.J.
        • Beck E.C.
        • Nwachukwu B.U.
        • et al.
        Survivorship and outcome of hip arthroscopy for femoroacetabular impingement syndrome performed with modern surgical techniques.
        Am J Sports Med. 2019; 47: 1662-1669
        • Sardana V.
        • Philippon M.J.
        • De Sa D.
        • et al.
        Revision hip arthroscopy indications and outcomes: A systematic review.
        Arthroscopy. 2015; 31: 2047-2055
        • Domb B.G.
        • Battaglia M.R.
        • Perets I.
        • et al.
        Minimum 5-year outcomes of arthroscopic hip labral reconstruction with nested matched-pair benchmarking against a labral repair control group.
        Am J Sports Med. 2019; 47: 2045-2055
        • Utsunomiya H.
        • Storaci H.W.
        • Rosenberg S.I.
        • et al.
        The hip suction seal, part II: The effect of rim trimming, chondrolabral junction separation, and labral repair/refixation on hip distractive stability.
        Am J Sports Med. 2020; 48: 2733-2739