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Randomized Controlled Trial
. 2019 Feb 7:364:l185.
doi: 10.1136/bmj.l185.

Arthroscopic hip surgery compared with physiotherapy and activity modification for the treatment of symptomatic femoroacetabular impingement: multicentre randomised controlled trial

Antony J R Palmer  1 , Vandana Ayyar Gupta  2 , Scott Fernquest  2 , Ines Rombach  3 , Susan J Dutton  3 , Ramy Mansour  4 , Simon Wood  4 , Vikas Khanduja  5 , Tom C B Pollard  6 , Andrew W McCaskie  7 , Karen L Barker  2 , Tony J M D Andrade  6 , Andrew J Carr  2 , David J Beard  2   8 , Sion Glyn-Jones  2 ; FAIT Study Group
Affiliations
Randomized Controlled Trial

Arthroscopic hip surgery compared with physiotherapy and activity modification for the treatment of symptomatic femoroacetabular impingement: multicentre randomised controlled trial

Antony J R Palmer et al. BMJ. .

Erratum in

  • Correction for vol. 372, p.
    [No authors listed] [No authors listed] BMJ. 2021 Jan 18;372:m3715. doi: 10.1136/bmj.m3715. BMJ. 2021. PMID: 33461966 Free PMC article.

Abstract

Objective: To compare arthroscopic hip surgery with physiotherapy and activity modification for improving patient reported outcome measures in patients with symptomatic femoroacetabular impingement (FAI).

Design: Two group parallel, assessor blinded, pragmatic randomised controlled trial.

Setting: Secondary and tertiary care centres across seven NHS England sites.

Participants: 222 participants aged 18 to 60 years with symptomatic FAI confirmed clinically and with imaging (radiography or magnetic resonance imaging) were randomised (1:1) to receive arthroscopic hip surgery (n=112) or a programme of physiotherapy and activity modification (n=110). Exclusion criteria included previous surgery, completion of a physiotherapy programme targeting FAI within the preceding 12 months, established osteoarthritis (Kellgren-Lawrence grade ≥2), and hip dysplasia (centre-edge angle <20 degrees).

Interventions: Participants in the physiotherapy group received a goal based programme tailored to individual patient needs, with emphasis on improving core stability and movement control. A maximum of eight physiotherapy sessions were delivered over five months. Participants in the arthroscopic surgery group received surgery to excise the bone that impinged during hip movements, followed by routine postoperative care.

Main outcome measures: The primary outcome measure was the hip outcome score activities of daily living subscale (HOS ADL) at eight months post-randomisation, with a minimum clinically important difference between groups of 9 points. Secondary outcome measures included additional patient reported outcome measures and clinical assessment.

Results: At eight months post-randomisation, data were available for 100 patients in the arthroscopic hip surgery group (89%) and 88 patients in the physiotherapy programme group (80%). Mean HOS ADL was 78.4 (95% confidence interval 74.4 to 82.3) for patients randomised to arthroscopic hip surgery and 69.2 (65.2 to 73.3) for patients randomised to the physiotherapy programme. After adjusting for baseline HOS ADL, age, sex, and study site, the mean HOS ADL was 10.0 points higher (6.4 to 13.6) in the arthroscopic hip surgery group compared with the physiotherapy programme group (P<0.001)). No serious adverse events were reported in either group.

Conclusions: Patients with symptomatic FAI referred to secondary or tertiary care achieve superior outcomes with arthroscopic hip surgery than with physiotherapy and activity modification.

Trial registration: ClinicalTrials.gov NCT01893034.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: support from Arthritis Research UK and NIHR Oxford Biomedical Research Centre for the submitted work. The researchers and funders were independent. AJRP received funding from the Royal College of Surgeons of England and Dunhill Medical Trust. Unrelated to the submitted work, VK received support from Stryker and Smith and Nephew for educational consultancy, AA received support from Stryker, Smith and Nephew, and Zimmer Biomet for lectures, and SGJ received research grants and fees for lectures from Zimmer Biomet, Corin, and ConMed, and research grants from Neurotechnics, Johnson and Johnson, and Siemens.

Figures

Fig 1
Fig 1
Anteroposterior radiographs showing (A) normal morphology, (B) cam morphology, and (C) pincer morphology. Dashes represent abnormal morphology that predisposes to femoroacetabular impingement, and which is excised with a burr during arthroscopic surgery to prevent impingement
Fig 2
Fig 2
Right hip coronal magnetic resonance image of trial participant randomised to surgery: (A) Baseline image showing cam morphology (arrow). (B) Six months after hip arthroscopy with restoration of the normal concavity at the femoral head-neck junction by burring away the cam lesion (arrow). This procedure prevents abutment of the femoral head-neck junction against the acetabular rim during a functional range of movement
Fig 3
Fig 3
CONSORT diagram
Fig 4
Fig 4
Hip outcome score on activities of daily living subscale (HOS ADL) at baseline and eight months post-randomisation (modified intention to treat). Dots represent extreme outliers
See this image and copyright information in PMC

Comment in

References

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