Surgery may be best option for hip impingement syndrome

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– Hip arthroscopic surgery produced better long-term results than did personalized hip physiotherapy for femoroacetabular impingement syndrome in a randomized trial conduced across multiple U.K. centers.

At 12 months, respective International Hip Outcome Tool-33 (iHOT-33) scores were 58.8 and 49.7, a difference of 9.1 points before and 6.8 points after adjustment for potential confounding factors (P = .0093).

Dr. Nadine Foster of Keele University, Newcastle-under-Lyme, England Sara Freeman/MDedge News
Dr. Nadine Foster
“This difference was clinically important,” study investigator Nadine Foster, DPhil, said at the World Congress on Osteoarthritis. The iHOT-33 is a patient-reported outcome measure that rates quality of life on a 0-100 scale, with 0 indicating no impairment and 100 the worst impairment. A difference of 6.1 is considered clinically significant.

“This trial shows that hip arthroscopic surgery and personalized hip therapy both improved hip-related quality of life for patients with FAI [femoroacetabular impingement] syndrome, but that the surgery did indeed produce a greater improvement at our primary time point of 12 months,” she added. Dr. Foster is professor of musculoskeletal health in primary care at Keele University, Newcastle-under-Lyme, England, one of the 23 centers involved in the FASHIoN study in England, Wales, and Scotland.

“FAI is a very common cause of hip and groin pain in young adults, and it’s associated with the development of hip osteoarthritis,” Dr. Foster noted.

There are three types of FAI – pincer, cam, and combined. The pincer type of FAI is where there is “prominence or overcoverage of the rim of the acetabulum,” and the cam type is where there is a “bony prominence of the femoral head-neck junction,” she explained at the meeting sponsored by the Osteoarthritis Research Society International.

The link to OA comes when the femur and acetabulum prematurely connect, usually during activity, causing damage to the labrum and articular cartilage in the long term. Thus, treating FAI is important, not just for relieving patient’s pain and joint stiffness.

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