Conservative therapy versus arthroscopic surgery of femoroacetabular impingement syndrome (FAI): a systematic review and meta-analysis

Abstract

Purpose FAI (femoroacetabular impingement syndrome) is a common cause of hip pain, resulting in a decreased life quality. This study aims to compare the postoperative clinical outcome between arthroscopic surgery (AT) and conservative treatment (CT). Method The six studies were selected from PubMed, Embase and OVID database. The data were extracted and analyzed by RevMan5.3. Mean differences and 95% confidence intervals were calculated. RevMan5.3 was used to assess the risk of bias. Result Six observational studies were assessed. The methodological quality of the trials indicated five of six studies had a low risk of bias and one article had a high risk of bias. The differences were statistically significant between AT and CT for HOS (follow-up for 6 months), iHOT-33 (follow-up for 6 months) improvement, iHOT-33 (follow-up for 12 months) improvement, iHOT-33 (follow-up for 12 months), EQ-5D-5L index score (follow-up for 12 months) and AT showed higher benefits than CT. Meanwhile no statistically significant were found in iHOT-33 (follow-up for 6 months), EQ-5D-5L index score (follow-up for 6 months), EQ5D-VAS (follow-up for 6 months) and EQ5D-VAS (follow-up for 12 months). Conclusion AT and CT both can have clinical effects when facing FAI. In our meta-analysis, hip arthroscopy is statistically superior to conservative treatment in both long-term and short-term effects.

Efficacy and safety of arthroscopy in femoroacetabular impingement syndrome: A systematic review and meta-analysis

“…The results of the AMSTAR-2 assessment are shown in Supplementary Table 1 [21][22][23][24][25][26][27] . Further alteration of the standards was observed with respect to duplicate data extraction, lack of discussion or interpretation of the results according to the risk of bias of the articles, and lack of discussion of the in uence of individual article funding or con ict of interest on the overall results.…”

“…The meta-analysis by Zhu et al 21 , the one with the highest number of studies, also included six RCTs concluding in favor of the statistical superiority of arthroscopy; however, one of the included studies is a duplicate of the UK FASHioN trial. Furthermore, it did not include the analysis of clinical superiority in the main variables of these RCTs, did not grade the evidence according to GRADE, and did not discuss the impact of different moderating or demographic variables on the main results of the meta-analysis 21 . This metaanalysis concluded that "arthroscopy treatment is more recommended for patients who need improvement in a shorter period of time" but did not consider the time lag from randomization between groups, which was almost three months.…”

“…In addition, the quality of the evidence and the strength of the recommendations were low or very low for the e cacy variables assessed by the GRADE system. The meta-analysis by Zhu et al 21 , the one with the highest number of studies, also included six RCTs concluding in favor of the statistical superiority of arthroscopy; however, one of the included studies is a duplicate of the UK FASHioN trial. Furthermore, it did not include the analysis of clinical superiority in the main variables of these RCTs, did not grade the evidence according to GRADE, and did not discuss the impact of different moderating or demographic variables on the main results of the meta-analysis 21 .…”