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.
Key findings of the study include:
- Three further patients were excluded from the trial after randomization because they did not meet the eligibility criteria.
- Follow-up at the primary outcome assessment was 92% (N = 319; hip arthroscopy, n = 157; personalised hip therapy, n = 162).
- At 12 months, the mean International Hip Outcome Tool (iHOT-33) score had improved from 39.2 (standard deviation 20.9) points to 58.8 (standard deviation 27.2) points for participants in the hip arthroscopy group, and from 35.6 (standard deviation 18.2) points to 49.7 (standard deviation 25.5) points for participants in the personalized hip therapy group.
- In the primary analysis, the mean difference in International Hip Outcome Tool scores, adjusted for impingement type, sex, baseline International Hip Outcome Tool score, and center, was 6.8 (95% confidence interval 1.7 to 12.0) points in favor of hip arthroscopy.
- This estimate of treatment effect exceeded the minimum clinically important difference (6.1 points).
- Five (83%) of six serious adverse events in the hip arthroscopy group were related to treatment and one serious adverse event in the personalized hip therapy group was not.
- Thirty-eight (24%) personalized hip therapy patients chose to have hip arthroscopy between 1 and 3 years after randomization.
- Nineteen (12%) hip arthroscopy patients had a revision arthroscopy.
- Eleven (7%) personalized hip therapy patients and three (2%) hip arthroscopy patients had a hip replacement within 3 years.
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.
