Is surgery effective in patients with femoroacetabular impingement syndrome?

• Published in: BMJ (Online) Vol. 365; p. l1359
• Main Authors: Richardson, Ruth SF, Lothe, Karen, Sturridge, Seb
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 18.04.2019
• Subjects: Anti-inflammatory agents; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Arthralgia - etiology; Arthralgia - therapy; Arthroscopy; Cartilage diseases; Clinical trials; Disease Progression; Femoracetabular Impingement - complications; Femoracetabular Impingement - therapy; Hip; Hip Joint - surgery; Humans; Inflammation; Joint surgery; Nonsteroidal anti-inflammatory drugs; Osteoarthritis; Pain; Pain Management - methods; Pain Management - standards; Patients; Practice Guidelines as Topic; Statistical analysis; Surgery; Systematic review; Treatment Outcome; Young adults; United Kingdom > UK
• ISSN: 0959-8138; 1756-1833
• DOI: 10.1136/bmj.l1359

Study Size Conclusions Uncertainty Griffin D, et al13 UK FASHIoN multicentre RCT comparing hip arthroscopy and best conservative care for FAIS June 2018 348 Patients across 23 UK centres with 27 treating surgeons Primary outcome measurement iHOT-33 (a 100 point hip related quality of life measurement) showed improvement in both the surgical and physiotherapy arms; however, the treatment effect was greater in those having hip arthroscopy (adjusted mean difference of 6.8 points 95% confidence interval 1.7 to 12.0, P=0.0093). [...]it cannot conclude whether one approach is superior to the other. Studies with long term follow-up are required to investigate further Minkara A et al18 Systematic review and meta-analysis of outcomes following arthroscopy for FAIS January 2018 29 Clinical studies (1911 patients) 5.5% Risk of re-operation, (95% confidence interval 3.6-7.5), of which 77% had hip replacement 1.7% complication risk (95% confidence interval 0.9-2.5). The wide variation in findings of progression to osteoarthritis indicates uncertainty on the issue Wall P et al21Cochrane review of surgery for FAIS 2014 No research studies identified which met the inclusion criteria No research studies of sufficient quality have been completed to provide an estimate of whether surgery benefits patients with FAIS At the time of this publication in 2014, there were no randomised controlled trials looking at the efficacy of surgery for FAIS RCT: randomised controlled trial Short term outcomes The most recent systematic review (29 clinical studies, 1911 patients) found a statistically significant improvement across all PROMs following hip arthroscopy for FAIS,18 echoing the conclusions of previous systematic reviews.1617181920 Of those patients, 1.7% experienced complications.