Abstract
BackgroundArthroscopic surgery for femoroacetabular impingement syndrome (FAI) is known to lead to self-reported symptom improvement. In the context of surgical interventions with known contextual effects and no true sham comparator trials, it is important to ascertain outcomes that are less susceptible to placebo effects. The primary aim of this trial was to determine if study participants with FAI who have hip arthroscopy demonstrate greater improvements in delayed gadolinium-enhanced magnetic resonance imaging (MRI) of cartilage (dGEMRIC) index between baseline and 12 months, compared to participants who undergo physiotherapist-led management.MethodsMulti-centre, pragmatic, two-arm superiority randomised controlled trial comparing physiotherapist-led management to hip arthroscopy for FAI. FAI participants were recruited from participating orthopaedic surgeons clinics, and randomly allocated to receive either physiotherapist-led conservative care or surgery. The surgical intervention was arthroscopic FAI surgery. The physiotherapist-led conservative management was an individualised physiotherapy program, named Personalised Hip Therapy (PHT). The primary outcome measure was change in dGEMRIC score between baseline and 12 months. Secondary outcomes included a range of patient-reported outcomes and structural measures relevant to FAI pathoanatomy and hip osteoarthritis development. Interventions were compared by intention-to-treat analysis.ResultsNinety-nine participants were recruited, of mean age 33 years and 58% male. Primary outcome data were available for 53 participants (27 in surgical group, 26 in PHT). The adjusted group difference in change at 12 months in dGEMRIC was -59 ms (95%CI − 137.9 to - 19.6) (p = 0.14) favouring PHT. Hip-related quality of life (iHOT-33) showed improvements in both groups with the adjusted between-group difference at 12 months showing a statistically and clinically important improvement in arthroscopy of 14 units (95% CI 5.6 to 23.9) (p = 0.003).ConclusionThe primary outcome of dGEMRIC showed no statistically significant difference between PHT and arthroscopic hip surgery at 12 months of follow-up. Patients treated with surgery reported greater benefits in symptoms at 12 months compared to PHT, but these benefits are not explained by better hip cartilage metabolism.Trial registration detailsAustralia New Zealand Clinical Trials Registry reference: ACTRN12615001177549. Trial registered 2/11/2015.
Highlights
Arthroscopic surgery for femoroacetabular impingement syndrome (FAI) is known to lead to selfreported symptom improvement
Primary outcome data were available for 53 participants (27 in surgical group, 26 in Personalised Hip Therapy (PHT))
Hip-related quality of life showed improvements in both groups with the adjusted between-group difference at 12 months showing a statistically and clinically important improvement in arthroscopy of 14 units (p = 0.003)
Summary
Arthroscopic surgery for femoroacetabular impingement syndrome (FAI) is known to lead to selfreported symptom improvement. Femoroacetabular impingement (FAI) syndrome is a motion-related clinical disorder of the hip with a triad of symptoms, clinical signs, and imaging findings [1] It is a highly prevalent cause of hip pain in active young adults [2] and considered to be a primary contributor to the development of hip osteoarthritis (OA) [3]. The repetitive abutment of the proximal femur against the acetabular rim, applying shear forces to the acetabular labrum and/or cartilage, is believed to lead to hip OA [4,5,6] Both because of the symptoms associated with FAI and the purported linkages prognostically to hip OA, there is increasing interest in treating the syndrome. Several randomised controlled trials have recently been conducted comparing interventions for FAI [9,10,11,12,13]
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