This multicentre, randomised controlled trial (RCT) published in the Lancet has found that hip arthroscopy provided a better level of function at 12 month follow-up when compared to a tailored rehabilitation programme.1
Femoroacetabular impingement syndrome (FAIS) is a potential cause of hip pain in young adults and is increasingly being diagnosed in football players. Impingement is associated with abnormalities involving the femoral neck, the acetabulum or both, and may lead to damage to both the articular cartilage and acetabular labrum. Hip arthroscopy acts by re-shaping the hip with a goal of preventing impingement and relieving symptoms. Non-operative management of FAIS typically involves exercise physiotherapy, education, analgesia and guided injections.
This multicentre RCT involved a total of 348 participants followed up for 12 months. Based on the results of this study hip arthroscopy appears to lead to better patient functioning at 12 month follow-up when compared with conservative hip therapy. The rehabilitation in this study involved a multimodal rehabilitation programme involving physiotherapy treatments, analgesics and injection therapy. Quality of life related to hip functioning was measured using the international Hip Outcome Tool. This patient-reported tool records symptoms and functional limitations, sports and recreational physical activities, job-related concerns, and social, emotional and lifestyle concerns. The higher scores recorded in this study following hip arthroscopy do come at some cost, with an increased financial cost associated with arthroscopy and higher risk of adverse events. It is also unclear whether the greater patient-reported improvements from arthroscopy are maintained in the longer-term.
High quality studies relating to the surgical treatment of common football conditions are lacking. This study does show that surgical treatment of FAI, at least in the short-medium term, may be associated with improved outcomes. This may in turn improve the probability of a successful return to play and prolong a player’s career. It is important to acknowledge that this study did not involve a dedicated cohort of football players – and as a result the studies generalisability to this unique group cannot be assumed. The rehabilitation programme used in this study, while comprehensive, may also not be as intensive or as effective as those seen in a professional environment where there may be more resources available.
1. Griffin DR, Dickenson EJ, Wall PDH, et al. Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome (UK FASHIoN): a multicentre randomised controlled trial. Lancet 2018; 391:2225-35.