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Abstract
Objective To report a 3-year follow-up from the FemoroAcetabular Impingement Trial, comparing arthroscopic surgery with physiotherapy in the management of femoroacetabular impingement (FAI) syndrome for the dual primary outcomes of radiographic hip osteoarthritis (OA) and patient-reported outcome measures of activities of daily living.
Methods Two-group parallel, assessor-blinded, pragmatic randomised controlled trial across seven sites. 222 participants aged 18–60 years with FAI syndrome confirmed clinically and radiologically were randomised (1:1) to receive arthroscopic hip surgery (n=112) or physiotherapy (n=110). Dual primary outcome measure was minimum joint space width (mJSW) on anteroposterior radiograph at 38 months post-randomisation and Hip Outcome Score ADL (HOS ADL) (higher score indicates superior outcomes). Secondary outcome measures were Scoring Hip Osteoarthritis with MRI (SHOMRI) (lower score indicates less pathology).
Results mJSW, HOS ADL and MRI data were available for 45%, 77% and 62% of participants at 38 months, respectively. No significant difference in mJSW was seen between groups at 38 months. HOS ADL was higher in the arthroscopy group (mean (SD) 84.2 (17.4)) compared with the physiotherapy group (74.2 (21.9)), difference 8.9 (95% CI 7.0, 10.8)). SHOMRI score total at 38 months was lower in the arthroscopy group (mean (SD) 9.22 (11.43)) compared with the physiotherapy group (22.76 (15.26)), differences (95% CIs) −15.94 (–18.69, –13.19).
Conclusions No difference was seen between groups on radiographic measures of OA progression. Patients with FAI syndrome treated surgically may experience superior pain and function outcomes, and less MRI-measured cartilage damage compared with physiotherapy.
Trial registration number NCT01893034.
- Hip
Data availability statement
Data are available upon reasonable request. Anonymised patient level data can be made available on reasonable request after approval from the trial management committee and after signing a data access agreement. Proposals should be directed to the corresponding author. Consent was not obtained for data sharing but the presented data is anonymised and the risk of identification is low.
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Data availability statement
Data are available upon reasonable request. Anonymised patient level data can be made available on reasonable request after approval from the trial management committee and after signing a data access agreement. Proposals should be directed to the corresponding author. Consent was not obtained for data sharing but the presented data is anonymised and the risk of identification is low.
Footnotes
X @AJRPalmer, @SJFernquest, @DrPaulDijkstra
Collaborators FAIT Study Group: Sion Glyn-Jones (Oxford University Hospitals NHS Foundation Trust), Tony Andrade, Tom Pollard (Royal Berkshire NHS Foundation Trust), Chris Paliobeis (Wye Valley NHS Trust), Vikas Khanduja (Cambridge University Hospitals NHS Foundation Trust), Adekoyejo Odutola (Weston Area Health NHS Trust), David Hollinghurst, Mike Rigby, Adam Brooks (Great Western Hospitals NHS Foundation Trust), Jon Conroy (Harrogate and District NHS Foundation Trust), Ayyar Gupta V.
Contributors AP and SG-J designed the study and the protocol was developed with AGV, IR, SD, SW, TP, AWM, KLB, TA, AJC and DJB. IR and SD performed the statistical analyses. AP, AGV, SF, MR, SW, VK, TP, TA and SG-J recruited patients and acquired data. AP, AGV, SF, IR and SG-J drafted the manuscript. All authors revised manuscript drafts, approved the final manuscript and contributed intellectually important content. SG-J attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted. SG-J is the guarantor of the paper and takes responsibility for the integrity of the work from inception to published article.
Funding Arthritis Research UK and the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC).
Competing interests All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare support from Arthritis Research UK and NIHR Oxford Biomedical Research Centre for the submitted work. There was independence between the researchers and funders. Unrelated to the submitted work, VK received support from Stryker and Smith and Nephew for educational consultancy, TA received support from Stryker, Smith and Nephew, and Zimmer Biomet for lectures, and SG-J received research grants and fees for lectures from Zimmer Biomet, Corin, and ConMed, and research grants from Neurotechnics, Johnson and Johnson, and Siemens.
Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.
Provenance and peer review Not commissioned; externally peer reviewed.
Author note Oversight committees: Trial Steering Committee: Mr Oliver Pearce (Consultant Orthopaedic Surgeon, Milton Keynes University Hospital NHS Foundation Trust), Mr Timothy Theologis (Consultant Orthopaedic Surgeon, Oxford University Hospitals NHS Foundation Trust), Mr Sunil Auplish (Consultant Orthopaedic Surgeon, Barking, Havering and Redbridge University Hospitals NHS Trust). Data Monitoring Committee: Dr Karen Smith (Principal Statistician, NIHR Research Design Services, University of Leicester), Mr Muthu Ganapathi (Consultant Orthopaedic Surgeon, NHS Wales University Health Board). Mr Peter Lovell (Lay Representative).
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