Surgical criteria for femoroacetabular impingement syndrome: a scoping review

Abstract

BackgroundThe purpose of this review was to analyse and report criteria used for open and arthroscopic surgical treatment of femoroacetabular impingement syndrome (FAIS).MethodsA librarian-assisted computer search of Medline, CINAHL and Embase for studies related to criterion for FAIS surgery was used in this study. Inclusion criteria included studies with the primary purpose of surgery or surgical outcomes for treatment of FAIS with and without labral tear, and reporting criteria for FAIS surgery.ResultsDiagnostic imaging was a criterion for surgery in 92% of the included studies, with alpha angle the most frequently reported (68% of studies) criterion. Reporting of symptoms was a criterion for surgery in 75%, and special tests a criterion in 70% of studies. Range-of-motion limitations were only a required criterion in 30%, only 12% of studies required intra-articular injection and 44% of studies described previously failed treatment (non-surgical or physiotherapist-led rehabilitation) as a criterion for surgery. Only 56% of included studies utilised the combination of symptoms, clinical signs and diagnostic imaging combined for diagnosis of FAIS as suggested by the Warwick Agreement on FAIS meeting.ConclusionDiagnostic imaging evidence of FAIS was the most commonly reported criterion for surgery. Only 56% of included studies utilised the combination of symptoms, clinical signs and diagnostic imaging for diagnosis of FAIS as suggested by the Warwick Agreement on FAIS meeting, and only 44% of studies had failed non-surgical treatment (and 18% a failed trial of physiotherapy) as a criterion for surgery.

Femoroacetabular impingement surgery allows 74% of athletes to return to the same competitive level of sports participation but their level of performance remains unreported: a systematic review with meta-analysis

“…Athletes typically choose surgery for pain relief and RTS PRE 5. Our results suggest that current studies are at moderate to high risk of bias and inadequately report surgical outcomes.…”

“…Patients with FAI syndrome and intra-articular pathology, including acetabular labral tears and cartilage pathology, have reported groin pain, reduced quality of life and functional limitations in most aspects of daily living, including sport-related activity 2–4. Surgery, particularly arthroscopic hip surgery (including bony debridement ± labral reconstruction), has been increasingly offered to these patients in an attempt to control pain and improve function 5. However, whether such surgery permits successful return to sport (RTS) is unclear.…”

What treatment options exist for patients with femoroacetabular impingement syndrome but without surgical indication?

“…These criteria include the presence of symptoms, clinical signs and imaging findings. In contrast, indications for hip surgery in patients with a diagnosis of FAI syndrome are vague 3. Besides the level of hip joint damage, which might favour the surgical option for patients with early stages of chondral lesion and severe morphologies, the failure of non-surgical management is frequently considered the most important indication for hip surgery (figure 1, solid line) 4.…”

“…Non-surgical management for patients with FAI syndrome should probably include a combination of conservative care, that is, education, activity and lifestyle modification, physiotherapy-led rehabilitation, and if also required, the use of oral analgesics 1. However, the failure of non-surgical management as an indication for hip surgery has been poorly reported in previous studies 3. It is not clear whether non-surgical treatments were attempted before directing patients to surgery.…”

Imaging for hip-related groin pain: don’t be hip-notised by the findings

“…However, there is no strong evidence of improved clinical outcomes with arthroscopic interventions. Although imaging findings are only diagnostic for FAI syndrome when they exist together with clinical signs and symptoms , imaging remains the main criterion for FAI surgery 2. Most patients (71%) are willing to undergo surgery based solely on their physician’s recommendation 3.…”