Protocol for the Femoroacetabular Impingement Trial (FAIT)

Abstract

AimsFemoroacetabular Junction Impingement (FAI) describes abnormalities in the shape of the femoral head–neck junction, or abnormalities in the orientation of the acetabulum. In the short term, FAI can give rise to pain and disability, and in the long-term it significantly increases the risk of developing osteoarthritis. The Femoroacetabular Impingement Trial (FAIT) aims to determine whether operative or non-operative intervention is more effective at improving symptoms and preventing the development and progression of osteoarthritis. MethodsFAIT is a multicentre superiority parallel two-arm randomised controlled trial comparing physiotherapy and activity modification with arthroscopic surgery for the treatment of symptomatic FAI. Patients aged 18 to 60 with clinical and radiological evidence of FAI are eligible. Principal exclusion criteria include previous surgery to the index hip, established osteoarthritis (Kellgren–Lawrence ≥ 2), hip dysplasia (centre-edge angle < 20°), and completion of a physiotherapy programme targeting FAI within the previous 12 months. Recruitment will take place over 24 months and 120 patients will be randomised in a 1:1 ratio and followed up for three years. The two primary outcome measures are change in hip outcome score eight months post-randomisation (approximately six-months post-intervention initiation) and change in radiographic minimum joint space width 38 months post-randomisation. ClinicalTrials.gov: NCT01893034.Cite this article: Bone Joint Res 2014;3:321–7.

Arthroscopic hip surgery compared with physiotherapy and activity modification for the treatment of symptomatic femoroacetabular impingement: multicentre randomised controlled trial

“…The Femoroacetabular Impingement Trial (FAIT) compared arthroscopic hip surgery with physiotherapy and activity modification in patients referred to secondary or tertiary care with symptomatic FAI 12. Here we report the primary endpoint of patient reported outcomes at eight months post-randomisation.…”

Past and projected temporal trends in arthroscopic hip surgery in England between 2002 and 2013

“…18 Randomised controlled trials are required to compare the efficacy of arthroscopic hip surgery with non-operative interventions, 19 and such studies are currently recruiting patients. 20 The adoption of hip arthroscopy in the UK has not been described. It is not universally funded by Clinical Commissioning Groups, which may give rise to geographical variation in practice.…”

Preoperative physical examination and imaging of femoroacetabular impingement prior to hip arthroscopy—a systematic review

“…Further, there have been theoretical propositions that early surgical intervention may in fact be more efficacious and prevent the development of future arthritis [ 23 ]. Research is currently underway to determine the type and duration of non-operative treatment that is most beneficial [ 24 , 25 ].…”

“…With respect to diagnosis of FAI, FADIR testing was the most reported clinical examination which is known to be highly sensitive (0.99) for FAI/labral pathology though less specific [ 13 , 14 ]. FABER and impingement sign were used less often which may reflect a relatively decreased sensitivity and specificity [ 14 , 25 ]. Interestingly, diagnostic injection was a highly underreported component of preoperative assessment (used in 7% of patients) despite a positive response being reported as 90% accurate for detecting intra-articular pathology [ 24 ].…”