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. 2023 Jun;31(6):2103-2122.
doi: 10.1007/s00167-022-07274-y. Epub 2022 Dec 9.

No evidence exists on outcomes of non-operative management in patients with femoroacetabular impingement and concomitant Tönnis Grade 2 or more hip osteoarthritis: a scoping review

Octavian Andronic  1   2   3 , Leica Sarah Claydon-Mueller  4 , Rachael Cubberley  4 , Daniel Karczewski  5 , Victor Lu  6 , Vikas Khanduja  4   7
Affiliations

No evidence exists on outcomes of non-operative management in patients with femoroacetabular impingement and concomitant Tönnis Grade 2 or more hip osteoarthritis: a scoping review

Octavian Andronic et al. Knee Surg Sports Traumatol Arthrosc. 2023 Jun.

Abstract

Purpose: The purpose of this scoping review was to assess the outcomes of all the non-operative modalities of management for femoroacetabular impingement (FAI) and concomitant osteoarthritis (OA) Tönnis Grade 2 or more.

Methods: A systematic search of PubMed was performed from inception to December 1st 2021 for literature on outcomes of non-operative management strategies for young adults with symptomatic FAI using the PRISMA Extension for Scoping Reviews guidelines. Cohorts investigating FAI and concomitant hip OA Tönnis Grade 2 or more were considered eligible. Studies not written in English or German, below level 4 evidence, and reviews were excluded. A secondary analysis for FAI without OA stratification was conducted after the initial screening to allow identification of available non-operative interventions.

Results: No study reported outcomes separately for non-operative management of FAI with Tönnis Grade 2 OA or more and as such, did not fulfil the inclusion criteria. A secondary analysis included 24 studies that reported on outcomes for non-operative interventions for FAI irrespective of the degree of degeneration. Three studies investigated the efficacy of hyaluronic acid injection, 5 reports investigated corticosteroid injections, 2 studies evaluated the outcomes of hip bracing and 16 studies included a physiotherapy programme. Associations between the aforementioned interventions were analysed. There is level I evidence supporting the efficacy of activity modification and hip-specific physiotherapy for FAI and mild OA. Core-strengthening exercises are prevalent amongst successful regimens in the literature. Contradictory evidence questions the efficacy of hip bracing even for short-term outcomes. Corticosteroid injections have mostly failed in intention-to treat analyses but may be valuable in delaying the need for surgery; further studies are warranted. Reports on outcomes following hyaluronic acid injections are contradictory.

Conclusion: No evidence exists on outcomes following non-operative management of FAI with concomitant Tönnis Grade 2 or more OA of the hip. Further studies are required and should explore the non-operative interventions that were employed for FAI and milder OA. There is strong evidence for a hip-specific physiotherapy program including activity modification and core strengthening exercises. Adjunct interventions such as corticosteroid injections and NSAID consumption may be valuable in delaying the need for surgery.

Level of evidence: Level IV.

Keywords: FAI; Femoroacetabular impingement; Hip osteoarthritis; Hip preservation; Non-operative; Outcomes.

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Conflict of interest statement

None to declare.

Figures

Fig. 1
Fig. 1
Flowchart of the scoping review
See this image and copyright information in PMC

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References

    1. Abate M, Scuccimarra T, Vanni D, Pantalone A, Salini V. Femoroacetabular impingement: is hyaluronic acid effective? Knee Surg Sports Traumatol Arthrosc. 2014;22:889–892. - PubMed
    1. Addai D, Zarkos J, Pettit M, Sunil Kumar KH, Khanduja V. Outcomes following surgical management of femoroacetabular impingement: a systematic review and meta-analysis of different surgical techniques. Bone Joint Res. 2021;10:574–590. - PMC - PubMed
    1. Andronic O, Claydon-Mueller LS, Cubberley R, Karczewski D, Sunil-Kumar KH, Khanduja V. Inconclusive and contradictory evidence for outcomes after hip arthroscopy in patients with Femoroacetabular impingement and osteoarthritis of Tönnis grade 2 or greater: a systematic review. Arthroscopy. 2022;38(7):2307–2318.e1. - PubMed
    1. Andronic O, Claydon L, Cubberley R, Sunil-Kumar KH, Khanduja V. Outcomes of hip arthroscopy in patients with femoroacetabular impingement and concomitant tönnis grade ii osteoarthritis or greater: protocol for a systematic review. Int J Surg Protoc. 2021;25:1–6. - PMC - PubMed
    1. Andronic O, Nakano N, Daivajna S, Board TN, Khanduja V. Non-arthroplasty iliopsoas impingement in athletes: a narrative literature review. Hip Int. 2019;29(5):460–467. - PubMed

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