Femoroacetabular impingement surgery leads to early pain relief but minimal functional gains past 6 months: experience from the FIRST trial.

Abstract

To understand the early outcomes after hip arthroscopy and better define the trajectory of improvement in a prospective cohort of patients who have undergone hip arthroscopic osteochondroplasty for femoroacetabular impingement (FAI) syndrome. Data were analyzed from the Femoroacetabular Impingement RandomiSed controlled Trial (FIRST) on the 108 study patients who underwent osteochondroplasty, with or without labral repair. Study outcomes included patient-reported pain (using a 100-point Visual Analogue Scale (VAS)), hip function (using the Hip Outcome Score (HOS) and International Hip Outcome Tool (iHOT-12)), and health-related quality of life (using the EuroQol 5 Dimensions (EQ-5D)) measured at baseline, 2weeks, 3months, 6months, and 12months post-operatively. There was a decrease in mean post-operative pain VAS scores from baseline. The first 2weeks post-operative yielded the greatest reduction in pain with a mean (SD) VAS score of 37.8 (23.4), with score stabilization between 6months (26.9 (26.9)) and 12months (25.3 (27.6)). Mean HOS (activities of daily living) scores improved from baseline (59.7 (16.2)) starting at 6weeks post-operative (64.1 (19.1)). The HOS (Sports) showed no improvement from baseline (41.2 (20.4)) until 3months (49.1 (27.9)), and continued to improve at 6months (64.1 (28.7)) and 12months (68.6 (30.5)). The iHOT-12 scores showed functional improvement from baseline (31.3 (18.8)), as early as 6weeks (44.9 (22.4)) up to and including 12months (67.1 (29.7)). EQ-5D index scores showed modest steady improvement from 6weeks to 12months post-operative, while the EQ-5D VAS component similarly showed modest and steady improvements from 3months onward. Results from this study highlight that hip arthroscopic osteochondroplasty with or without labral repair for FAI leads to early pain relief. While all scores improved from baseline, functional gains appear to plateau from 6months onwards. These data can be used to inform decision-making about timelines for rehabilitation and return to sport, a knowledge gap in the current FAI literature. II.