Hip pain: both surgery and physio help young adults with FAI syndrome

Patients with femoroacetabular impingement (FAI) syndrome treated with arthroscopic hip surgery report greater improvements in symptoms at 12 months compared to patients treated conservatively with physiotherapy.

However the benefit on symptoms cannot be explained by any observed treatment effect on joint structure.

The Australian FASHIoN study comprised 99 patients with a mean age 33 years and FAI syndrome of either pincer, cam or mixed morphologic pattern randomised to either arthroscopic surgery or personalised hip therapy (PHT).

A comparison of the primary outcome – the delayed gadolinium-enhanced magnetic resonance imaging (MRI) of cartilage (dGEMRIC) score – found no significant difference in cartilage metabolism between the two treatment groups.

A number of secondary outcomes including pain and quality of life improved in both treatment groups but more so with surgery and with a statistically significant difference at 12 months.

The study, published in BMC Musculoskeletal Disorders, found radiographic measures of hip joint structural change were similar in both treatment groups.

“The results of semi-quantitative MRI analyses demonstrated worse cartilage and labral scores in the arthroscopic group at 12 months,” the study said.

Lead author Professor David Hunter told the limbic that their findings on symptoms were consistent with other studies such as the UK FASHIoN study.

“The initial motivation for this study is that there are other trials that have shown that there is a clinical benefit from the surgery but we know that there is a very large placebo effect associated with surgery.”

“The aim of the [current] study was to [also] look at the effects on structure and biomechanics.”

“So I think the main novelty of this particular trial is that surgery does not appear to be beneficial for structure at 12 months compared to physiotherapy – which I think was a little bit disappointing for the surgeons but that is what we found.”

“We don’t know why there is that discord between symptoms and structure. In an ideal world we might have seen some parallel there but at this point in time, structure is not helping to explain the symptom benefit.”

Professor Hunter, from the Institute of Bone and Joint Research at the University of Sydney, said many younger adults presenting with hip pain were often desperate for effective treatment.

“So at this point in time we know that physio helps and that surgery helps, and that at least at 12 months, there is some benefit on symptoms from surgery but we don’t know what the 3 and 5 year outcomes are likely to be at this time.”

“I think that data is going to be important because ultimately that’s what patients and their clinicians should be caring about – the long term clinical outcomes.”

The study said FAI syndrome was considered a primary contributor to the development of hip osteoarthritis.

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