Arthroscopic surgery versus physiotherapy for femoroacetabular impingement: a meta-analysis study.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2020;8(22):7 Eur J Orthop Surg Traumatol. 2020 Oct;30(7): 1151-1162.What this means for my practice?
The results of this meta-analysis suggest that arthroscopic surgery can improve function and quality of life for patients with femoroacetabular impingement when compared to physiotherapy. However, this meta-analysis had only 3 studies included which can bias the findings and the short follow-up periods where long-term outcomes need to be evaluated.
Study Summary
A total of 3 randomized controlled trials with 644 patients with femoroacetabular impingement (FAI) were included in this meta-analysis comparing arthroscopic hip surgery to physiotherapy treatment. The outcomes of interest included the EuroQoL-5D (EQ-5D) Visual Analogue Scale (VAS), the Hip Outcome Score (HOS) subscale of Activities of Daily Living, International Hip Outcome Tool (iHOT-33) scores, the Hip Outcome Score (HOS) Sports subscale, and the risk of a future total hip arthroplasty (THA). All pooled outcomes were assessed at a mean follow-up of 14.67 (SD 8.3) months, and iHOT33 scores was also measured at both 6 and 12 months follow-up. The pooled results demonstrated that EQ-5D VAS (p=0.03), HOS-ADL (p<0.0001), HOS-Sports (p=0.0003), and iHOT 33 scores were all statistically significantly in favour of the arthroscopic surgery group compared to the control at the mean of 14.67 months follow-up. Furthermore, iHOT33 scores were statistically significantly in favour of the arthroscopic group at 12 months (p=0.0002) follow-up, but not at 6 months (p=0.70). The risk of THA was not statistically significantly different between the two treatments (p=0.72).
Why was this study needed now?
Femoroacetabular impingement (FAI) can damage the joints, thus causing pain and decreasing daily activities. Furthermore, FAI has been predicted to be responsible for approximately 1 in 2 cases of hip osteoarthritis. Management includes traditional physiotherapy as well as arthroscopic surgery. However, a lack of consensus remains on whether surgery proves more efficacious compared to traditional physiotherapy especially since surgery is associated with increased risk of complications.
What was the principal research question?
In patients with femoroacetabular impingement (FAI), how does physiotherapy compare to arthroscopic treatment with respect to functional and pain outcomes and progression to osteoarthritis?
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