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Hip Osteochondroplasty May Benefit The Non-Ideal Patient With Femoroacetabular Impingement: Analysis From The Embedded Prospective Cohort Of The First Trial


Mahmoud Almasri, MD, FRCSC
UNITED STATES

Hip Osteochondroplasty May Benefit The Non-Ideal Patient With Femoroacetabular Impingement: Analysis From The Embedded Prospective Cohort Of The First Trial

Mahmoud Almasri, MD, FRCSC, UNITED STATES Nicole Simunovic, MSc, CANADA Diane Heels-Ansdell, MSc, CANADA Olufemi R. Ayeni, MD, PhD, MSc, FRCSC, CANADA FIRST Investigators, MD, CANADA

McMaster University, Hamilton, Ontario, CANADA

2021 Congress   Abstract Presentation   6 minutes   Not yet rated

 

Anatomic Location

Hip / Groin / Thigh

Diagnosis / Condition

Impingement

Treatment / Technique

Arthroscopy

Anatomic Structure

Bones Labrum

Sports Medicine

Epidemiology

Labrum

Labrum Treatment

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Summary: The benefits of the osteochondroplasty procedure shown in the FIRST trial, appear to also apply to patients commonly seen in regular practice.

Background

Randomized controlled trials (RCTs) typically have specific eligibility criteria that lead to the recruitment of optimized or ideal patient populations for the interventions under study. The Femoroacetabular Impingement RandomiSed controlled Trial (FIRST) demonstrated the efficacy of arthroscopic osteochondroplasty when compared to arthroscopic lavage in the treatment of femoroacetabular impingement (FAI) in ideal patients at 2 years. During the FIRST trial, we concurrently ran an embedded prospective cohort study that enrolled patients who either did not meet the full trial eligibility criteria or who refused to participate in the RCT and therefore were treated with arthroscopic osteochondroplasty as per standard of care. We present the results of this embedded cohort study to determine if arthroscopic osteochondroplasty demonstrated effectiveness (i.e., the intervention was also beneficial to a non-ideal, pragmatic FAI patient population).

Methods

All cohort patients were not randomized and were followed prospectively with a follow-up assessment protocol identical to that in the FIRST trial. The primary outcome was hip pain using a 100-point Visual Analogue Scale (VAS). Secondary outcomes included hip function (Hip Outcome Score, HOS; International Hip Outcome Tool, iHOT-12), health utility (EQ-5D), and health-related quality of life (SF-12 mental and physical component summary scores, MCS and PCS) at 12 months as well as operatively and non-operatively treated hip complications at 24 months. We performed multiple linear regressions to compare these outcomes between 3 groups of patients: 1) those randomized to lavage in the FIRST trial, 2) those randomized to osteochondroplasty in the FIRST trial, and 3) those who received osteochondroplasty as part of the cohort study. Regression model covariates included: impingement sub-type, age, sex, severity of baseline impingement, presence of comorbidities at baseline, temporary pain relief from diagnostic hip injection prior to surgery, body mass index (BMI), and baseline score for all questionnaire outcomes.

Results

Similar to the results of the FIRST trial, all groups had improvements in VAS pain scores from baseline to 12 months, and experienced similar improvements in hip function (HOS, iHOT-12), health utility (EQ-5D), and health-related quality of life (SF-12 MCS and PCS), with no significant differences between groups. From the logistic regression model adjusting for age, there were significantly more re-operations in the lavage trial group compared to those in the embedded cohort (i.e. ‘non-ideal’ patients who received osteochondroplasty) (adjusted odds ratio, OR 3.08; 95% confidence interval, CI 1.23 to 7.73; p = 0.016). There were significantly more non-operatively treated complications in the lavage trial group and in the osteochondroplasty trial group when compared to those in the embedded cohort (adjusted OR 3.81; 95% CI 1.19 to 12.17; p = 0.024 and adjusted OR 4.55; 95% CI 1.43 to 14.42; p = 0.010, respectively). These results were consistent across the adjusted and unadjusted analyses.

Conclusion

Hip arthroscopic osteochondroplasty leads to improvement in hip pain, function, and health-related quality of life at 12 months across both RCT (ideal) and cohort (non-ideal) patients. Those receiving osteochondroplasty as part of the pragmatic cohort had significantly fewer re-operations and other complications when compared to RCT patients randomized to either arthroscopic lavage or osteochondroplasty. The benefits of the osteochondroplasty procedure shown in the FIRST trial, appear to also apply to patients commonly seen in regular practice.

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