ARTHROSCOPIC SURGERY OR PHYSICAL THERAPY FOR PATIENTS WITH FEMOROACETABULAR IMPINGEMENT SYNDROME: A RANDOMIZED CONTROLLED TRIAL WITH 2-YEAR FOLLOW-UP

Review written by Dr Fiona Wilson info

BACKGROUND & OBJECTIVE

There has been a substantial increase in arthroscopic hip surgery in recent years. There has been a similar increase in the diagnosis of femoroacetabular impingement syndrome (FAIS), and this type of surgery is the treatment of choice in many settings, despite the absence of robust evidence to support its use over conservative interventions. There is a paucity of studies comparing surgical versus non-surgical management of FAIS. Therefore, the objective of this study was to compare two-year outcomes between patients with FAIS randomised to either arthroscopic surgery or a supervised physical therapy programme.

METHODS

The outcomes of interest were self-reported disability, costs and return to work status between the two groups. 80 participants were recruited for the study, most of whom were active military members. All had already been referred for surgery. All patients attended a self-management class prior to randomisation where they were provided with education (current evidence for surgical and non-operative management) as well as advice on how to manage symptoms (activity modification, exercises and pain management). If after this ‘self-management’ programme they were unsatisfied, they could opt to enrol to the study. Those allocated to surgery also had post-op physiotherapy. Those in the physiotherapy group completed a 12-week programme twice a week consisting of manual therapy, motor control exercises and mobility exercises.

The primary outcome measure was the Hip Outcome Score (HOS) and the secondary was the International Hip Outcome Tool (iHOT-33). Outcomes were assessed at baseline, 6 months, one year and two years.

RESULTS

Statistically significant improvements were seen in both groups in the HOS and iHOT-33. There was no statistically significant mean difference between groups at any time point. General satisfaction rating between the two groups was also the same. Of the participants

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