Abstract:Objective
Femoroacetabular impingement (FAI) is a condition that has been increasingly recognized as a source of hip pain and a possible risk factor to early development of hip osteoarthritis (OA). To our knowledge, the use of HA in the treatment of femoroacetabular FAI has been investigated only by two studies, both using a high molecular weight HA. The aim of this study was to evaluate the efficacy of two weekly injections of an hexadecylamide derivative of HA (HYADD4-G, HYMOVIS, Fidia Farmaceut… Show more
“… 23 reported significant improvements in pain scoring (SMD –3.12, 95% CI –4.09 to –2.14, P = .002) at the latest follow-up. This was also the case in the study by Ometti et al., 25 who demonstrated significant improvements in pain following HA (SMD –2.71, 95% CI –3.59 to –1.83, P ≤ .001) at final follow-up. Fig 4 A forest plot showing changes from pretreatment to postfunction treatment using hyaluronic acid (HA).…”
Section: Resultssupporting
confidence: 74%
“…Eighteen studies met the inclusion criteria for this review; each was published between 2014 and 2020 from countries which included the United States, Chile, Italy, South Korea, Germany, and Spain. Three studies used PRP 20 , 21 , 22 in conjunction with surgery, 3 used HA as a primary treatment, 23 , 24 , 25 and 12 applied different methods of cell therapies as an adjuvant to surgery for cartilage defects 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 ( Table 1 ). Thirteen studies were prospective 20 , 21 , 22 , 23 , 24 , 25 , 26 , 31 , 32 , 35 , 36 , 37 and 5 were retrospective 27 , 28 , 29 , 30 , 33 with 7 of the studies including a control group.…”
Section: Resultsmentioning
confidence: 99%
“…Three studies used PRP 20 , 21 , 22 in conjunction with surgery, 3 used HA as a primary treatment, 23 , 24 , 25 and 12 applied different methods of cell therapies as an adjuvant to surgery for cartilage defects 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 ( Table 1 ). Thirteen studies were prospective 20 , 21 , 22 , 23 , 24 , 25 , 26 , 31 , 32 , 35 , 36 , 37 and 5 were retrospective 27 , 28 , 29 , 30 , 33 with 7 of the studies including a control group. 20 , 21 , 22 , 27 , 29 , 30 , 34 Randomization of patients allocated to treatment or control groups occurred in 3 of these studies.…”
Section: Resultsmentioning
confidence: 99%
“… 24 2016 Prospective randomized cross over study LOE III No HA Steroid 30 24-51 11/19 12/6/12 Function HOOS 12 wk Ometti et al. 25 2020 Prospective case series LOE IV No HA derivative 19 (21 hips) 36-56 5/14 14/3/4 Pain Function VAS, HHS, Lequesne index, TALS 1 y Cell-based Therapies Flickert et al. 28 2014 Retrospective case series LOE IV No MACT 6 25-45 5/1 5/0/0 1 traumatic cause Function mHHS, NAHS, SF-36 1 y Mancini & Fontana 33 2014 Retrospective cohort study LOE IV No AMIC MACI 57 19-50 25/32 37/29/9 Function mHHS 5 y Fontana & de Girolamo 29 2015 Retrospective case-control LOE IV Yes AMIC Mf 147 18-55 91/56 …”
Section: Resultsmentioning
confidence: 99%
“…Ten studies were rated as weak using the EPHPP tool 23 , 24 , 25 , 26 , 28 , 31 , 32 , 35 , 36 , 37 and 5 were rated as moderate. 27 , 29 , 30 , 33 , 34 The main areas where studies were rated as weak on the EPHPP tool was for confounders and blinding ( Appendix Tables 1-3 , available at www.arthroscopyjournal.org ).…”
“… 23 reported significant improvements in pain scoring (SMD –3.12, 95% CI –4.09 to –2.14, P = .002) at the latest follow-up. This was also the case in the study by Ometti et al., 25 who demonstrated significant improvements in pain following HA (SMD –2.71, 95% CI –3.59 to –1.83, P ≤ .001) at final follow-up. Fig 4 A forest plot showing changes from pretreatment to postfunction treatment using hyaluronic acid (HA).…”
Section: Resultssupporting
confidence: 74%
“…Eighteen studies met the inclusion criteria for this review; each was published between 2014 and 2020 from countries which included the United States, Chile, Italy, South Korea, Germany, and Spain. Three studies used PRP 20 , 21 , 22 in conjunction with surgery, 3 used HA as a primary treatment, 23 , 24 , 25 and 12 applied different methods of cell therapies as an adjuvant to surgery for cartilage defects 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 ( Table 1 ). Thirteen studies were prospective 20 , 21 , 22 , 23 , 24 , 25 , 26 , 31 , 32 , 35 , 36 , 37 and 5 were retrospective 27 , 28 , 29 , 30 , 33 with 7 of the studies including a control group.…”
Section: Resultsmentioning
confidence: 99%
“…Three studies used PRP 20 , 21 , 22 in conjunction with surgery, 3 used HA as a primary treatment, 23 , 24 , 25 and 12 applied different methods of cell therapies as an adjuvant to surgery for cartilage defects 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 ( Table 1 ). Thirteen studies were prospective 20 , 21 , 22 , 23 , 24 , 25 , 26 , 31 , 32 , 35 , 36 , 37 and 5 were retrospective 27 , 28 , 29 , 30 , 33 with 7 of the studies including a control group. 20 , 21 , 22 , 27 , 29 , 30 , 34 Randomization of patients allocated to treatment or control groups occurred in 3 of these studies.…”
Section: Resultsmentioning
confidence: 99%
“… 24 2016 Prospective randomized cross over study LOE III No HA Steroid 30 24-51 11/19 12/6/12 Function HOOS 12 wk Ometti et al. 25 2020 Prospective case series LOE IV No HA derivative 19 (21 hips) 36-56 5/14 14/3/4 Pain Function VAS, HHS, Lequesne index, TALS 1 y Cell-based Therapies Flickert et al. 28 2014 Retrospective case series LOE IV No MACT 6 25-45 5/1 5/0/0 1 traumatic cause Function mHHS, NAHS, SF-36 1 y Mancini & Fontana 33 2014 Retrospective cohort study LOE IV No AMIC MACI 57 19-50 25/32 37/29/9 Function mHHS 5 y Fontana & de Girolamo 29 2015 Retrospective case-control LOE IV Yes AMIC Mf 147 18-55 91/56 …”
Section: Resultsmentioning
confidence: 99%
“…Ten studies were rated as weak using the EPHPP tool 23 , 24 , 25 , 26 , 28 , 31 , 32 , 35 , 36 , 37 and 5 were rated as moderate. 27 , 29 , 30 , 33 , 34 The main areas where studies were rated as weak on the EPHPP tool was for confounders and blinding ( Appendix Tables 1-3 , available at www.arthroscopyjournal.org ).…”
Purpose
The purpose of this scoping review was to assess the outcomes of all the non-operative modalities of management for femoroacetabular impingement (FAI) and concomitant osteoarthritis (OA) Tönnis Grade 2 or more.
Methods
A systematic search of PubMed was performed from inception to December 1st 2021 for literature on outcomes of non-operative management strategies for young adults with symptomatic FAI using the PRISMA Extension for Scoping Reviews guidelines. Cohorts investigating FAI and concomitant hip OA Tönnis Grade 2 or more were considered eligible. Studies not written in English or German, below level 4 evidence, and reviews were excluded. A secondary analysis for FAI without OA stratification was conducted after the initial screening to allow identification of available non-operative interventions.
Results
No study reported outcomes separately for non-operative management of FAI with Tönnis Grade 2 OA or more and as such, did not fulfil the inclusion criteria.
A secondary analysis included 24 studies that reported on outcomes for non-operative interventions for FAI irrespective of the degree of degeneration. Three studies investigated the efficacy of hyaluronic acid injection, 5 reports investigated corticosteroid injections, 2 studies evaluated the outcomes of hip bracing and 16 studies included a physiotherapy programme. Associations between the aforementioned interventions were analysed.
There is level I evidence supporting the efficacy of activity modification and hip-specific physiotherapy for FAI and mild OA. Core-strengthening exercises are prevalent amongst successful regimens in the literature. Contradictory evidence questions the efficacy of hip bracing even for short-term outcomes. Corticosteroid injections have mostly failed in intention-to treat analyses but may be valuable in delaying the need for surgery; further studies are warranted. Reports on outcomes following hyaluronic acid injections are contradictory.
Conclusion
No evidence exists on outcomes following non-operative management of FAI with concomitant Tönnis Grade 2 or more OA of the hip. Further studies are required and should explore the non-operative interventions that were employed for FAI and milder OA. There is strong evidence for a hip-specific physiotherapy program including activity modification and core strengthening exercises. Adjunct interventions such as corticosteroid injections and NSAID consumption may be valuable in delaying the need for surgery.
Level of evidence
Level IV.
Purpose To evaluate studies utilizing orthobiologics in the management of femoroacetabular impingement syndrome (FAIS) to (1) assess the indications for usage, and (2) analyze patient-reported outcome measures (PROM) following treatment. It was hypothesized that orthobiologics would (1) be utilized for symptomatic FAIS in the setting of labral or chondral pathology, and (2) improve PROM at most recent follow-up. Methods The Pubmed, Ovid Medline, Cochrane, and Web of Science databases were searched for clinical studies evaluating orthobiologics [hyaluronic acid (HA), platelet-rich plasma (PRP), or cell-based therapy (CBT) for treatment of FAIS. Exclusion criteria included orthobiologics used in conjunction with cartilage transfer or scaffolding procedures and a primary indication other than FAIS. Data collection included patient demographics, indications, and baseline and most recent PROM.Results Eleven studies (one level I, four level II, four level III, and two level IV evidence) met inclusion criteria, consisting of 440 patients with mean ages ranging from 32.8 to 47 years. All 11 studies demonstrated an improvement in PROM from baseline to most-recent follow-up. Four studies administered PRP either intraoperatively or the day after surgery as an adjunct to labral repair. CBT was used intraoperatively in the setting of acetabular chondral lesions (three studies) and labral repair (one study). When comparing to a control group at most recent follow-up, three PRP cohorts demonstrated similar PROM (n.s.), while one PRP group exhibited worse visual analog pain scores (2.5 vs. 3.4, p = 0.005) and modified Harris Hip Scores (mHHS) (82.6 vs. 78.7, p = 0.049). The four CBT studies reported favorable results compared to a control group, with a significantly higher mHHS at most recent follow-up or mean improvement from baseline in Hip Outcome Score-Activities of Daily Living (p < 0.05). Three studies reported on HA, which was utilized exclusively in the nonoperative setting. Conclusions Intraoperative PRP and CBT have been commonly reported in the setting of hip arthroscopy for labral repairs and acetabular chondral lesions, respectively. The CBT cohorts demonstrated more favorable PROM at most recent follow-up when compared to a control group, though these results should be interpreted with caution due to heterogeneity of orthobiologic preparations. Level of evidence IV.
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