Summary

Preliminary findings indicate a 9.3% conversion to arthroscopy rate within 2 years in cases where patients had previously chosen not to undergo surgery for FAI.

Abstract

Introduction

In randomised control trials comparing arthroscopy versus conservative care for femoroacetabular impingement (FAI), crossover favouring surgery is commonly observed.1–3 No study has quantified the outcomes of patients considered good candidates for surgical intervention but who did not undertake it. The aim of this preliminary study was to examine outcomes of patients who were not treated arthroscopically for FAI.

Methods

Patients diagnosed with FAI between November 2015 and December 2019 (n=246) and who chose not to undergo surgery were reviewed. Osteoarthritis, dysplasia, and previous arthroscopy were excluded. Patients with mild symptoms where surgery was not deemed necessary were also excluded. Patients were contacted a minimum of 2 years following diagnosis. The primary outcome was subsequent hip arthroscopy. In the absence of surgery, patients were asked to detail any intra-articular injections they may have received, and their current physical activity (PA) involvement. PA was categorised as fully engaged in pre-injury PA, modified involvement, which included either reducing the time/intensity of the same activity or switching to another activity, or cessation of habitual PA. Results were reported descriptively.

Results

47 patients (58 FAI cases) were identified for inclusion and 74% (n=43) of cases were followed up at an average of 30.8 ± 5.8 months. 86% of cases were male and the average age at follow up was 33.6 ± 8 years. Of the followed-up cases, 4 had undergone arthroscopy (9.3%). Where surgery was not conducted (n=39), 5 cases (12.8%) had received corticosteroid injections. Of those 39, 5 (12.8%) had ceased habitual physical activity engagement and 12 (30.8%) had changed/modified their PA. 22 FAI cases were still involved in Full PA (56.4%), but 5 reported continued hip pain during PA.

Discussion

Preliminary findings indicate a 9.3% conversion to surgery rate within 2 years. Only 43.6% of patients were participating in pre-injury level of physical activity without pain.

1. Griffin DR, Dickensen EJ, Hobson R, et al. Hip arthroscopy compared to best conservative care for the treatment of femoroacetabular impingement syndrome: a randomised controlled trial (UK FASHIoN). Osteoarthr Cartil. 2018;26(10136):S24-S25.

2. Mansell NS, Rhon DI, Meyer J, Slevin JM, Marchant BG. Arthroscopic surgery or physical therapy for patients with femoroacetabular impingement syndrome: a randomized controlled trial with 2-year follow-up. Am J Sports Med. 2018;46(6):1306-1314.

3. Palmer AJR, Gupta VA, Fernquest S, et al. Arthroscopic hip surgery compared with physiotherapy and activity modification for the treatment of symptomatic femoroacetabular impingement: multicentre randomised controlled trial. bmj. 2019;364:l185.