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.O que é que isto significa para a minha prática?
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.
Resumo do estudo
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).
Porque é que este estudo era necessário agora?
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.
Qual era a principal questão de investigação?
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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