Arthroscopic hip surgery vs. physiotherapy in FAI
This study found that hip arthroscopy was superior to physiotherapy and activity modification in patients with symptomatic femoroacetabular impingement (FAI) referred to secondary or tertiary care centers.
This was determined by the hip outcome score activities of daily living subscale (HOS-ADL), which was on average 10 points higher in the arthroscopy group.
However, the authors warn that not all patients benefit from surgery, and this decision should be thoroughly discussed with patients, as the benefit of arthroscopy seems to decrease with age.
FAI is a condition which predisposes the hip to premature joint degeneration and affects about 20% of the general population. However, only 25% of cases develop pain. Despite contradictory evidence regarding its efficacy, the number of arthroscopic procedures for treating FAI has been rising.
A total of 222 patients with symptomatic FAI aged 18 to 60 years were recruited and randomly allocated (1:1) to receive hip arthroscopy or a physiotherapy/ activity modification program with a maximum of 8 sessions over 5 months. The primary outcome measure was the hip outcome score activities of daily living subscale 8 months after randomization.
Overall, 51% of participants in the hip arthroscopy group and 32% of participants in the physiotherapy group reported an improvement in HOS-ADL of at least 9 points (clinically important change).
The authors warn, however, that these results represent the reality of patients in secondary and tertiary care, and that given the potential surgical complications and the improvement obtained the physiotherapy program, physiotherapy should constitute the first-line treatment option.
Expert opinion by José Pedro Correia
This study provides useful advice in terms of managing patient expectations regarding the predictable outcomes of FAI and in terms of establishing who may benefit more from surgery. But, as stated by the authors themselves, further research is required to clarify this. For example, it would have been beneficial to include a sham surgery group, since it has provided similar patient-reported outcomes in other joints.
In this sample of secondary and tertiary care patients, arthroscopy proved more effective in various outcome measures. Nevertheless, the clinical improvement produced by the physiotherapy program still led the authors to recommend physiotherapy as a first-line intervention.
> From: Palmer et al., BMJ 364 (2019) I185 (Epub ahead of print). All rights reserved to BMJ Publishing Group Ltd. Click here for the online summary.