Two-year outcomes after arthroscopic surgery compared to physical therapy for femoracetabular impingement: A protocol for a randomized clinical trial

Abstract

BackgroundAs the prevalence of hip pathology in the younger athletic population rises, the medical community continues to investigate effective intervention options. Femoracetabular impingement is the morphologically abnormal articulation of the femoral head against the acetabulum, and often implicated in pre-arthritic hip conditions of musculoskeletal nature. Arthroscopic surgical decompression and non-surgical rehabilitation programs focused on strengthening and stability are common interventions. However, they have never been directly compared in clinical trials.The primary purpose of this study will be to assess the difference in outcomes between these 2 commonly utilized interventions for femoracetabular impingement.MethodsThe study will be a single site, non-inferiority, randomized controlled trial comparing two different treatment approaches (surgical and nonsurgical) for FAI. The enrollment goal is for a total of 80 subjects with a diagnosis of Femoracetabular impingement that are surgical candidates and have failed 6 weeks of conservative treatment. This will be a convenience sample of consecutive patients that are Tricare beneficiaries and seeking care at Madigan Army Medical Center. Patients that meet the criteria will be screened, provide written consent before enrollment, and then randomized into one of two arms (Group I = hip arthroscopy, Group II = physical therapy). Group I will undergo hip arthroscopy with or without labral repair. Group II will follow an impairment based physical therapy program consisting of 2 sessions per week for 6 weeks. The primary outcome will be the Hip Outcome Score and secondary measures will include the International Hip Outcome Tool and the Global Rating of Change. Measures will be taken at baseline, 6 months, 1 and 2 years. Hip-related healthcare utilization between both groups will also be assessed at the end of 2 years.DiscussionThe current evidence to support both surgical and conservative interventions for femoroacetabular impingement is based on low-level research. To date, none of these interventions have been directly compared in a randomized clinical trial. Clinical trials are needed to help establish the value of these interventions in the management of femoracetabular impingement and to help define appropriate clinical pathways.Trial registrationNCT01993615 30 October 2013.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-016-0914-1) contains supplementary material, which is available to authorized users.

Operative Versus Nonoperative Treatment of Femoroacetabular Impingement Syndrome: A Meta-analysis of Short-Term Outcomes

“…Postoperative rehabilitation was begun within 7 days; patients attended physical therapy for the first 7 weeks and then performed a detailed series of exercises 3 to 5 times per week. 43 Rehabilitation was typically completed within 6 months after surgery.…”

“…In the study conducted by Mansell et al, 43 a supervised physical therapy program comprising two 45-minute sessions twice per week for 6 weeks was provided. A personalized treatment plan was developed based on physical assessment; therapy included stretching, motor control exercises, and mobility exercises that were provided in detail in a series of handouts.…”

“…A personalized treatment plan was developed based on physical assessment; therapy included stretching, motor control exercises, and mobility exercises that were provided in detail in a series of handouts. 43 After the 6-week program, a home exercise program was used.…”

Femoroacetabular Impingement: Anatomy and Pathogenesis

“…Arthroscopy is the most common surgical procedure for FAI involving acetabuloplasty, labral repair/debridement, and/or femoroplasty [5].…”

Prologue to a Scope

“…Because the apparent efficacy of surgery for alleviating symptomatic FAI and labral tears has been demonstrated in many noncomparative studies, 1,3,5,9,11,14 patients and surgeons usually expect the option to proceed to surgery if the nonsurgical treatment does not seem to be working. 2,20 One such trial that compared arthroscopic and nonsurgical treatment of FAI, done in a military setting by Mansell and colleagues, 12,13 appeared in AJSM last year and garnered considerable reader attention. 7,19 Mansell et al 13 reported no difference between the 2 alternatives in their intention-to-treat analysis.…”