Rationale

The concept of FAI was introduced by Ganz and associates in 2003 as a cause for osteoarthritis of the hip.³ The classic types of FAI include cam deformity, and pincer and mixed impingement.³ The treatment of FAI includes nonsurgical (personalized hip therapy) and surgical methods. Personalized hip therapy provides muscle control, strength around the hip, and movement patterns, which can lead to the avoidance of hip impingement.⁶ The surgical management has been described through both open⁷–⁹ and arthroscopic procedures,¹⁰–¹² which allows resection of the bony impingement, treatment of the labral tears, and management of articular chondral lesions. Hip arthroscopy has equal or better outcomes compared to open surgical techniques and is associated with a lower incidence of major complications.¹³ In a systematic review comparing the results of open surgical dislocation, mini‐open technique, and hip arthroscopy, the authors found a higher incidence of complications with open surgical dislocation primarily because of trochanteric osteotomy related issues. The mini‐open procedure had a significantly higher incidence of iatrogenic injury of the lateral femoral cutaneous nerve.¹³

Clinical comment

Both hip arthroscopy and personalized hip therapy are successful methods in the management of FAI; however, hip arthroscopy can result in greater improvements of patients’ symptoms in the short term.

Available literature and quality of the evidence

• Level I: 1 study (hip arthroscopy versus physical therapy).
  
• Level IV: 1 meta‐analysis of level III and IV evidence.

Findings

Griffin et al. compared the clinical effectiveness of hip arthroscopy versus the best conservative care for patients with FAI in a multicenter trial (UK FASHIoN study) conducted in 23 hospitals in the UK.⁶ The study was an assessor‐blinded randomized controlled trial (RCT) that included 348 patients with symptomatic FAI with no radiographic evidence of osteoarthritis. Patients were allocated to receive either hip arthroscopy or personalized hip therapy (an individualized, supervised, and progressive physiotherapist‐led program of conservative care). Their primary outcome was the patient‐reported International Hip Outcome Tool (IHOT‐33) 12 months after randomization. Both groups showed an improvement of the average IHOT‐33; however, the mean difference in IHOT‐33 scores was 6.8 (95% confidence interval [CI]: 1.7–12.0) in favor of hip arthroscopy (p = 0.0093). The UK FASHIoN study is the first RCT that shows that hip arthroscopy is effective in the treatment of FAI. This study published in 2018 reported only 12 months clinical outcome after randomization and longer‐term follow‐up is still needed. In a recent meta‐analysis of 1981 hips assessing the outcome of hip arthroscopy for FAI (level IV), the reported risk of reoperation was 5.5%, while the risk of clinical complications was 1.7%. These complications included heterotopic ossification, transient neuropraxia, adhesions, stiffness, wound infection, skin necrosis, and nondisplaced femoral head‐neck fracture.¹⁴

Resolution of clinical scenario

Related posts:

Hip Resurfacing Reverse Total Shoulder Arthroplasty Proximal Tibia Fractures Lumbar Radiculopathy Ankle Ligament Injuries Spinal Infections

Stay updated, free articles. Join our Telegram channel

Join