Clinical Outcomes of an Initial 3-month Trial of Conservative Treatment for Femoroacetabular Impingement

Abstract

Background:Femoroacetabular impingement (FAI) can be managed either conservatively or by a surgical correction of the deformity causing impingement. However, there is insufficient evidence to justify an immediate surgical treatment in all symptomatic patients, and the role of a nonoperative treatment is unclear. This study evaluates the role of conservative treatment for FAI.Materials and Methods:87 patients (102 hips) diagnosed as FAI between January 2011 and May 2012 were included in this retrospective study. All patients underwent an initial 3-month conservative treatment followed by arthroscopic hip surgery if symptoms did not improve. Clinical outcome scores (modified Harris Hip Score, nonarthritic hip score, and Western Ontario and McMaster Universities Arthritis Index) were evaluated at baseline and at the end of followup, and scores were compared between the nonsurgical and surgical groups.Results:The final analysis included 83 patients (55 men, 28 women; 97 hips) because four patients were lost to followup. The average age was 45.1 years and 14 patients had bilateral symptomatic FAI. After an initial conservative treatment averaging 27.5 months (range 24–36 months), 53 hips (54.6%) could perform normal daily activities. The nonsurgical group had significant improvements in all clinical scores at the end of followup (P < 0.001). Forty four hips (45.4%) were unresponsive to conservative treatment and underwent arthroscopic hip surgery with subsequent significant improvements in clinical scores (P < 0.001). At the end of followup, there were no significant differences in clinical scores between the two groups.Conclusion:An initial trial of conservative treatment of sufficient length should be considered for FAI patients before surgical intervention.

Arthroscopic versus open treatment for femoroacetabular impingement

“…Surgical treatment is indicated in cases when conservative treatment brings only temporary relief. [ 6 – 9 ]…”

Arthroscopy versus nonoperative treatment of symptomatic femoroacetabular impingement syndrome

“…Of the 5 included studies, [ 4 , 7 , 9 , 10 , 25 ] 3 studies [ 4 , 7 , 9 ] were RCTs, one [ 10 ] was a prospective cohort study, and the other one [ 25 ] was a retrospective cohort study. A total of 838 patients were included in the studies selected: 382 patients underwent arthroscopic treatment, and 456 patients were treated by nonsurgical intervention.…”

“…The mean ages among the study samples ranged from 15.3 to 45.1 years, and the mean follow-up durations ranged from 8 to 26.8 months. Three [ 9 , 10 , 25 ] of the 5 studies reported 2-year follow-up results. The details are shown in Table 1 .…”

“…Notably, all of the included non-randomized cohort studies revealed no statistical differences in pre-intervention patient-reported outcomes (PROs). [ 10 , 25 ]…”

“…The mean MINORS score for methodological quality assessment was 20.8/24 (range, 18–23) (Table 1 ). With consideration of the 8 main evaluation variables, 1 study [ 25 ] received a point deduction for its retrospective study design, and 4 studies [ 7 , 9 , 10 , 25 ] received point deductions because they lacked blinded evaluation of endpoints. Three studies [ 4 , 7 , 10 ] received point deductions because at least 5% of the initially included patients were lost to follow-up.…”