Femoroacetabular impingement surgery leads to early pain relief but minimal functional gains past 6 months: experience from the FIRST trial

Abstract

Purpose To understand the early outcomes after hip arthroscopy and better define the trajectory of improvement in a prospective cohort of patients who have undergone hip arthroscopic osteochondroplasty for femoroacetabular impingement (FAI) syndrome. Methods Data were analyzed from the Femoroacetabular Impingement RandomiSed controlled Trial (FIRST) on the 108 study patients who underwent osteochondroplasty, with or without labral repair. Study outcomes included patient-reported pain (using a 100-point Visual Analogue Scale (VAS)), hip function (using the Hip Outcome Score (HOS) and International Hip Outcome Tool (iHOT-12)), and health-related quality of life (using the EuroQol 5 Dimensions (EQ-5D)) measured at baseline, 2 weeks, 3 months, 6 months, and 12 months post-operatively. Results There was a decrease in mean post-operative pain VAS scores from baseline. The first 2 weeks post-operative yielded the greatest reduction in pain with a mean (SD) VAS score of 37.8 (23.4), with score stabilization between 6 months (26.9 (26.9)) and 12 months (25.3 (27.6)). Mean HOS (activities of daily living) scores improved from baseline (59.7 (16.2)) starting at 6 weeks post-operative (64.1 (19.1)). The HOS (Sports) showed no improvement from baseline (41.2 (20.4)) until 3 months (49.1 (27.9)), and continued to improve at 6 months (64.1 (28.7)) and 12 months (68.6 (30.5)). The iHOT-12 scores showed functional improvement from baseline (31.3 (18.8)), as early as 6 weeks (44.9 (22.4)) up to and including 12 months (67.1 (29.7)). EQ-5D index scores showed modest steady improvement from 6 weeks to 12 months post-operative, while the EQ-5D VAS component similarly showed modest and steady improvements from 3 months onward. Conclusion Results from this study highlight that hip arthroscopic osteochondroplasty with or without labral repair for FAI leads to early pain relief. While all scores improved from baseline, functional gains appear to plateau from 6 months onwards. These data can be used to inform decision-making about timelines for rehabilitation and return to sport, a knowledge gap in the current FAI literature. Level of evidence II. Keywords FAI syndrome • Hip osteochondroplasty • Early functional outcomes • Trajectory of improvement Abbreviations FAI Femoroacetabular impingement FIRST Femoroacetabular Impingement Ran-domiSed controlled Trial RCT Randomized controlled trial VAS Visual analogue scale HOS-ADL Hip outcome score-activities of daily living HOS-Sports Hip outcome score-sports subscale iHOT-12 International hip outcome tool-12 MCID Minimum clinically important difference EQ-5D Euro-Qol 5 dimensions

Patients Require Less Time to Complete Preoperative Patient-Reported Outcomes Measurement Information System (PROMIS) Than Legacy Patient-Reported Outcome Measures

“…12,13 It is well established within the literature that hip arthroscopy is an effective treatment for femoroacetabular impingement syndrome (FAIS) and leads to improvement in PROs over time. [14][15][16][17][18][19][20][21] A series of legacy PROs often are used to evaluate patient functional status and pain but are not without limitations. PROs often are administered in the physician's office before appointments, which can delay care and lead to inefficiencies.…”

The Influence of Compensatory Pelvic Tilt on Patient‐reported Outcome Measurements in FAI Patients Who Received Arthroscopic Treatment

“…Patients in this study reported significant changes in their usual activities following surgery, as demonstrated by their EQ‐5D scores. This health‐related quality of life scale was also applied in recent studies to assess improvements 23–25 . Patients who reported being satisfied postoperatively showed significant changes in postoperative EQ‐5D usual activities and higher means in each EQ‐5D term and the EQ‐5D‐VAS assessment compared to unsatisfied patients.…”

“…This health-related quality of life scale was also applied in recent studies to assess improvements. [23][24][25] Patients who reported being satisfied postoperatively showed significant changes in postoperative EQ-5D usual activities and higher means in each EQ-5D term and the EQ-5D-VAS assessment compared to unsatisfied patients. The results illustrated that patients' health conditions were directly related to their functional status and satisfaction with surgery, representing an evidence-based suggestion for assessments of staged postoperative rehabilitation.…”

Bilateral hip arthroscopy for treating femoroacetabular impingement: a systematic review

“…The mean time between surgeries found in this review was 7.1 ± 4.0 months; however, studies indicated that the contralateral procedure can vary from 2 weeks to up to 3 months after the index surgery or when the first hip has completely recovered [14, 23, 30, 31]. This would allow for the development of physical capability for proper rehabilitation of the second hip [4]. Thus, the ideal duration between surgeries will vary on a case‐by‐case basis.…”