Femoroacetabular impingement, or F**-A-I, is a condition known to cause hip pain in young adults. Open surgical hip dislocation was initially the gold-standard treatment for FAI. But arthroscopic surgery is becoming increasingly common. Unfortunately, few high-level trials have evaluated the efficacy of surgical correction for FAI. To address that gap, researchers conducted a randomized controlled trial comparing osteochondroplasty to lavage with or without labral repair for the treatment of F-A-**I. The lower reoperation rate observed among patients undergoing osteochondroplasty supports arthroscopic surgery as an effective treatment option for young adults with hip impingement.
The study recruited 220 male and female patients aged 18 to 50 years with non-arthritic F**-A-**I who were deemed suitable for surgical treatment. Patients were randomized to one of two groups. In the osteochondroplasty group, impingement lesions were resected using fluoroscopic guidance. In the lavage group, the hip joint was washed with 3 liters of normal saline. Surgeons performed labrum [SSW9] [SN10] repair on any patient in either group if the labrum appeared mechanically unstable when probed.
At 12 months, there was no difference between the groups with respect to pain, which was reported by patients using a visual analogue scale.
Similarly, no significant differences were observed in terms of health utility, physical and mental health, or general hip function at 12 months. Patients in the lavage group, however, did show significant improvements in the daily living domain of the Hip Outcome Score.
While hip pain and function are among the most relevant outcomes for patients undergoing surgery for hip impingement, a lower reoperation rate is important to consider. In the current study, the reoperation rate at 24 months was significantly lower for patients in the osteochondroplasty group than for those in the lavage group.
The findings suggest that osteochondroplasty was a more effective treatment than lavage 2 years after surgery.
Importantly, pain scores were not obtained for 27% of patients at 12 months, although the study still met the sample size calculation for statistical power. And it’s unclear whether or how labrum repair may have affected the rate of reoperation.
Still, the findings support surgery as an effective treatment option for patients with hip impingement, and could help inform clinicians and patients when deciding the best course of care.