Management options for femoroacetabular impingement: a systematic review of symptom and structural outcomes

Abstract

Although evidence supports improvement in symptoms after surgery in FAI, no studies have compared surgical and non-surgical treatment. Therefore no conclusion regarding the relative efficacy of one approach over the other can be made. Surgery improves alpha angle but whether this alters the risk of development or progression of hip OA is unknown. This review highlights the lack of evidence for use of surgery in FAI. Given that hip geometry may be modified by non-surgical factors, clarifying the role of non-surgical approaches vs surgery for the management of FAI is warranted.

Is surgery effective in patients with femoroacetabular impingement syndrome?

“…The most recent systematic review (29 clinical studies, 1911 patients) found a statistically significant improvement across all PROMs following hip arthroscopy for FAIS,18 echoing the conclusions of previous systematic reviews 1617181920. Of those patients, 1.7% experienced complications.…”

“…All these systematic reviews relied on mostly low quality evidence from case series and cohort studies 1617181920. A Cochrane Review from 2014 confirmed that no randomised controlled trials comparing arthroscopic hip surgery with conservative management had been published 21…”

Hip arthroscopy for femoroacetabular impingement: use escalating beyond the evidence

“…While there is some evidence that hip arthroscopy results in short to medium term symptomatic improvement in FAI, 6 ‐ 8 these conclusions are based on examining patients only treated surgically, and no study has compared surgical with non‐surgical therapy. Although one systematic review concluded that symptom outcomes with hip arthroscopy were superior to non‐surgical management of FAI, 7 this conclusion may be misleading since the systematic review was largely based on case series with no head‐to‐head comparisons between surgical and non‐surgical groups.…”

“…Although surgical correction of hip bone shape provides a biologically plausible approach for reducing hip pain and slowing the incidence and progression of hip OA, the evidence supporting the use of hip arthroscopy in the management of FAI is limited 6 …”

Cumulative Effects of Occupational Loading as a Risk Factor for Hip Pain in UK Military Personnel - Study Protocol of a Case Control Study

“…FAI is recognized as a common cause of non-arthritic hip pain and is defined as a motion-related clinical disorder of the proximal femur and acetabulum that may result in pain and decreased function [6,7]. This impingement is caused by abnormal morphology of the femoral head/neck junction (cam impingement), acetabular rim (pincer impingement) or both [8].…”