Hip arthroscopy and physiotherapy both improve QoL in femoroacetabular impingement

UK: Findings from a trial found that in patients with femoroacetabular impingement syndrome, both hip arthroscopy, and personalized hip therapy improve hip-related quality of life but at 12 months hip arthroscopy led to greater improvements. UK FASHIoN (full trial of arthroscopic surgery for hip impingement compared with non-operative care) findings appear in the journal Health Technology Assessment. 

"The study does not show the cost-effectiveness of hip arthroscopy versus personalized hip therapy within the first 12 months," Damian R Griffin, Warwick Medical School, University of Warwick, Coventry, UK, and colleagues wrote in their study. "And, further follow-up of the trial will divulge whether or not the benefits of hip arthroscopy are maintained and if it is cost-effective in the long term."

Femoroacetabular impingement syndrome is an important cause of hip pain among young adults. Its treatment options include arthroscopic hip surgery or physiotherapist-led conservative care. Considering this, Dr. Griffin and the team aimed to compare the clinical effectiveness and cost-effectiveness of hip arthroscopy with the best conservative care in a pragmatic, multicentre, randomized controlled trial (UK FASHIoN) that was carried out at 23 NHS hospitals.

The study included people with femoroacetabular impingement, aged ≥ 16 years old, who had hip pain with radiographic features of cam or pincer morphology (but no osteoarthritis) and were believed to be likely to benefit from hip arthroscopy. They were randomly assigned in the ratio of 1:1 to receive hip arthroscopy followed by postoperative physiotherapy (n=171), or personalized hip therapy (i.e. an individualized physiotherapist-led program of conservative care; n=177). Stratification of the randomization was done by impingement type and recruiting center using a central telephone randomization service. Outcome assessment and analysis were masked. 

Hip-related quality of life, measured by the patient-reported International Hip Outcome Tool (iHOT-33) 12 months after randomisation was the primary outcome and analysed by intention to treat. 

To conclude, both Hip arthroscopy and personalized hip therapy improved hip-related quality of life for femoroacetabular impingement syndrome patients. However, hip arthroscopy led to a greater improvement in quality of life than personalized hip therapy, and this difference was clinically significant at 12 months.

Reference:

Griffin DR, Dickenson EJ, Achana F, Griffin J, Smith J, Wall PD, Realpe A, Parsons N, Hobson R, Fry J, Jepson M, Petrou S, Hutchinson C, Foster N, Donovan J. Arthroscopic hip surgery compared with personalised hip therapy in people over 16 years old with femoroacetabular impingement syndrome: UK FASHIoN RCT. Health Technol Assess. 2022 Feb;26(16):1-236. doi: 10.3310/FXII0508. PMID: 35229713.