Femoroacetabular impingement: surgery beats conservative management

  • Palmer AJR & al.
  • BMJ
  • 7 Feb 2019

  • curated by Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • For symptomatic femoroacetabular impingement (FAI), hip arthroscopy beats physiotherapy and activity adjustment for symptom improvement, according to FAIT results.
  • Not all patients gain benefit from surgery.

Why this matters

  • FAI may underlie half of cases of hip arthritis.
  • Treatment options remain a matter of debate because both can improve symptoms.
  • Surgery rates have increased.

Key results

  • Hip outcome score activities of daily living subscale:
    • Mean score with conservative treatment: 69.2 (95% CI, 65.2-73.3);
    • With surgery: 78.4 (95% CI, 74.4-82.3).
  • With adjustment, mean score with surgery was 10.0 points greater (P=.001).
  • That increase surpassed minimum of 9 points for clinical relevance.

Study design

  • Parallel, blinded, pragmatic, randomized controlled trial for femoroacetabular impingement treatment (FAIT).
  • 7 UK sites, 222 participants (112 surgery; 110 conservative management) aged 18-60 years.
  • Outcome: activity of daily living score at 8 months.
  • Funding: Arthritis Research UK; National Institute for Health Research.

Limitations

  • Patients with dysplasia, osteoarthritis excluded, although they can benefit from surgery.

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