Osteochondroplasty and Labral Repair for the Treatment of Young Adults With Femoroacetabular Impingement: A Randomized Controlled Trial
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OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2021;9(4):11 Am J Sports Med. 2021 Jan;49(1):25-34.What this means for my practice?
The results of this study suggest that osteochondroplasty and lavage, both with and without labral repair, result in similar pain, function, and quality of life outcomes at 1-year follow-up in patients with femoroacetabular impingement syndrome. However, a statistically significantly lower rate of reoperation was observed in the osteochondroplasty group, suggesting that it is the more robust treatment. This study was limited by the severe loss to follow up over the 12 month clinical follow up period, as well as the discrepancies between groups in the number of patients who had a labral repair that required re-operation (87.5% vs. 52.6% for the osteochondroplasty and lavage groups, respectively), which may indicate an effect on labrum treatment on the incidence of reoperation. Future long-term follow up studies are of interest to assess the potential degenerative effects over time in both treatments.
Study Summary
Two hundred and twenty patients with femoroacetabular impingement (FAI) were randomized to receive surgical correction via arthroscopic osteochondroplasty (n=110) or arthroscopic lavage (n=110), with or without labral repair. The primary outcome of interest was pain score on a Visual Analog Scale (VAS) at 12 months. Secondary outcomes of interest included hip function as measured by the Hip Outcomes Score (HOS) and International Hip Outcome Tool (iHOT-12), quality of life as measured by the Short Form 12 (SF-12) physical and mental component scores, and health utility as measured by the Euro-QoL 5-Dimensions (EQ-5D) index and VAS score, which were all measured at 12 months. Additionally, re-operation rate at 24 months and the incidence of adverse events were recorded. Results of the study found no statistical significant differences between the two groups in the change from baseline in VAS pain scores (p=0.976), HOS sport scores (p=0.075), iHOT-12 score (p=0.353), EQ-5D index score (p=0.314), or EQ-5D VAS scores (p=0.808) at 12 months. Moreover, no statistical significant differences in SF-12 physical component scores (p=0.452) and mental component scores (p=0.887) were observed between the two groups. The incidence of operatively-treated hip-related complications was statistically significantly higher in the lavage group compared to the osteochondroplasty group (p=0.026), yet no differences were observed in the total incidence of hip-related complications (p=0.246). The incidence of re-operation was statistically significantly higher in the lavage group compared to the osteochondroplasty group at 24 months (p=0.026). The change from baseline in HOS ADL scores were statistically significantly greater in the lavage group at 12 months (p=0.049).
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