Osteochondroplasty and Labral Repair for the Treatment of Young Adults With Femoroacetabular Impingement: A Randomized Controlled Trial

Abstract

Background: Femoroacetabular impingement (FAI) is a condition known to cause hip pain in young adults. Purpose: To evaluate the efficacy of the surgical correction of FAI via arthroscopic osteochondroplasty with or without labral repair compared with arthroscopic lavage of the hip joint with or without labral repair. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 220 male and female participants aged 18 to 50 years with nonarthritic FAI suitable for surgical treatment were recruited for the trial at 10 clinical centers in Canada, Finland, and Denmark between October 2012 and November 2017, of whom 214 were included in the final analysis. In the osteochondroplasty group, cam- and/or pincer-type lesions were resected using fluoroscopic guidance. In the lavage group, the joint was washed out with 3 L of normal saline. Surgeons were instructed to repair the labrum in both groups if it was mechanically unstable once probed, showing visible displacement or chondrolabral separation. The primary outcome was patient-reported pain (using the 100-point visual analog scale [VAS]) at 12 months. Secondary outcomes included hip function (Hip Outcome Score [HOS] and International Hip Outcome Tool), physical and mental health (12-Item Short Form Health Survey), and health utility (EuroQol–5 Dimensions) at 12 months as well as any reoperations and other hip-related adverse events at 24 months. Results: At 12 months, there was no difference in pain (VAS) between the groups (mean difference [MD], 0.11 [95% CI, –7.22 to 7.45]; P = .98). Also, 88.3% (189/214) of participants had a labral tear, of which 60.3% were repaired. For the secondary outcomes, there were no significant differences between treatment groups, with the exception of the HOS activities of daily living domain in which lavage showed significant improvement compared with osteochondroplasty (MD, –5.03 [95% CI, −10.40 to −0.03]; P = .049). By 24 months, there were significantly fewer reoperations reported in the osteochondroplasty group (8/105) than the lavage group (19/104) (odds ratio, 0.37 [95% CI, 0.15-0.89]; P = .026). The primary reasons for a reoperation included hip pain (15/27; 55.6%) and a reinjury of the labrum (11/27; 40.7%). Conclusion: Both the osteochondroplasty and the lavage groups with or without labral repair for FAI had significantly improved pain or function significantly at 1 year. By 2 years, the reoperation rate was significantly lower in the osteochondroplasty group. Registration: NCT01623843 ( ClinicalTrials.gov identifier)

Unintended consequences: quantifying the benefits, iatrogenic harms and downstream cascade costs of musculoskeletal MRI in UK primary care

“…There has been a shift away from conventional surgical approaches in favour of conservative therapy for many common conditions. Shoulder decompression, 19 20 rotator cuff repair, 21 shoulder labral repair, 22 osteochondroplasty for femoroacetabular impingement 23 and knee meniscectomy 24 are just some examples. Strict procedural criteria are enforced in some regions, while some high-volume spinal injections have been decommissioned.…”

Femoroacetabular impingement surgery leads to early pain relief but minimal functional gains past 6 months: experience from the FIRST trial

“…The datasets from the FIRST trial, comprising the 108 patients randomized to arthroscopic osteochondroplasty, were used for analysis [1]. Patients included in the FIRST trial were those with persistent symptoms and a minimum 6 months of non-operative treatment.…”

“…Given that the osteochondroplasty patients benefitted from significantly reduced re-operation rates at 24 months [1], evaluating the early outcomes for this cohort specifically was decided by them (i.e. 2 weeks to 12 months post-operatively).…”

“…In addition, results from our Femoroacetabular Impingement RandomiSed controlled Trial (FIRST) revealed significantly lower revision rates for osteochondroplasty versus lavage at 24 months. The FIRST trial was the first surgical randomized controlled trial (RCT) to evaluate the surgical and clinical outcomes of patients undergoing either arthroscopic osteochondroplasty or lavage of the hip joint, with or without labral repair [1].…”

Peritrochanteric space disorders: the future is now!

“…This exponential growth in procedure numbers has been facilitated by educational courses, societies dedicated to hip preservation and refined surgical equipment that has helped reduce surgical technical challenges [1]. Even though, the results of recent randomized controlled trials have validated the efficacy of hip arthroscopy for conditions that are commonly treated such as femoroacetabular impingement (FAI) [2][3][4] this field is not stagnating! Arthroscopic surgery's next challenge is tackling conditions in the peritrochanteric space (those not in the typical central compartment).…”