Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome (UK FASHIoN): a multicentre randomised controlled trial

Damian R. Griffin; Edward J. Dickenson; Peter D.H. Wall; Felix Achana; Jenny L. Donovan; James Griffin; Rachel Hobson; Charles E. Hutchinson; Marcus Jepson; Nick R. Parsons; Stavros Petrou; Alba Realpe; Joanna Smith; Nadine E. Foster; the FASHIoN Study Group

doi:10.1016/S0140-6736(18)31202-9

Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome (UK FASHIoN): a multicentre randomised controlled trial

Damian R. Griffin^*, Edward J. Dickenson, Peter D.H. Wall, Felix Achana, Jenny L. Donovan, James Griffin, Rachel Hobson, Charles E. Hutchinson, Marcus Jepson, Nick R. Parsons, Stavros Petrou, Alba Realpe, Joanna Smith, Nadine E. Foster, the FASHIoN Study Group

^*Corresponding author for this work

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Abstract

Background
Femoroacetabular impingement (FAI) syndrome is a cause of hip pain in young adults. It is believed to be due to abnormal contact between the ball and socket of the hip, caused by hip shape abnormalities. Hip arthroscopy (HA), which aims to reshape the hip, is a popular treatment strategy. We conducted a randomised controlled trial (RCT) to compare the clinical and cost-effectiveness of HA versus best conservative care.

Methods
We conducted a pragmatic, multi-centre, two arm, assessor-blinded, RCT in patients with FAI syndrome presenting to 23 UK NHS hospitals. Participants were randomly allocated (1:1) to HA or Personalised Hip Therapy (PHT), an individualised, supervised and progressive physiotherapist-led programme of conservative care. Stratification by impingement type and recruiting centre was used during randomisation, which was administered through a central telephone service by research staff at each hospital. The primary outcome measure was the patient-reported International Hip Outcome Tool (iHOT-33) 12 months after randomisation. The trial was registered with ISRCTN 64081839 and is closed to recruitment.

Findings
We recruited 348 participants between 20/07/2012 and 15/07/2016: 171 were allocated HA and 177 PHT. Follow-up at the primary outcome assessment was 92%. After 12 months, mean iHOT-33 scores had improved; HA from 39 to 59 and PHT from 36 to 50. In the primary ‘intention to treat’ analysis, the mean difference in iHOT-33 scores, adjusted for impingement type, gender, baseline iHOT-33 score and centre, was 6.8 (95%CI 1.7-12.0) in favour of HA (p=0.009). This estimate of effect exceeds the minimally clinically important difference. One participant allocated to HA (0.7%) had a deep hip infection after surgery. In the cost effectiveness analysis PHT dominated HA.

Interpretation
Hip arthroscopy for patients with FAI syndrome provides a clinically significant benefit compared to best conservative care.

Original language	English
Pages (from-to)	2225-2235
Number of pages	11
Journal	Lancet
Volume	391
Issue number	10136
Early online date	1 Jun 2018
DOIs	https://doi.org/10.1016/S0140-6736(18)31202-9
Publication status	Published - 8 Jun 2018

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Centre for Surgical Research

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Griffin, D. R., Dickenson, E. J., Wall, P. D. H., Achana, F., Donovan, J. L., Griffin, J., Hobson, R., Hutchinson, C. E., Jepson, M., Parsons, N. R., Petrou, S., Realpe, A., Smith, J., Foster, N. E., & the FASHIoN Study Group (2018). Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome (UK FASHIoN): a multicentre randomised controlled trial. Lancet, 391(10136), 2225-2235. https://doi.org/10.1016/S0140-6736(18)31202-9

@article{8a05c8d4023042e8b1615db624d96d87,

title = "Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome (UK FASHIoN): a multicentre randomised controlled trial",

abstract = "BackgroundFemoroacetabular impingement (FAI) syndrome is a cause of hip pain in young adults. It is believed to be due to abnormal contact between the ball and socket of the hip, caused by hip shape abnormalities. Hip arthroscopy (HA), which aims to reshape the hip, is a popular treatment strategy. We conducted a randomised controlled trial (RCT) to compare the clinical and cost-effectiveness of HA versus best conservative care.MethodsWe conducted a pragmatic, multi-centre, two arm, assessor-blinded, RCT in patients with FAI syndrome presenting to 23 UK NHS hospitals. Participants were randomly allocated (1:1) to HA or Personalised Hip Therapy (PHT), an individualised, supervised and progressive physiotherapist-led programme of conservative care. Stratification by impingement type and recruiting centre was used during randomisation, which was administered through a central telephone service by research staff at each hospital. The primary outcome measure was the patient-reported International Hip Outcome Tool (iHOT-33) 12 months after randomisation. The trial was registered with ISRCTN 64081839 and is closed to recruitment.FindingsWe recruited 348 participants between 20/07/2012 and 15/07/2016: 171 were allocated HA and 177 PHT. Follow-up at the primary outcome assessment was 92%. After 12 months, mean iHOT-33 scores had improved; HA from 39 to 59 and PHT from 36 to 50. In the primary {\textquoteleft}intention to treat{\textquoteright} analysis, the mean difference in iHOT-33 scores, adjusted for impingement type, gender, baseline iHOT-33 score and centre, was 6.8 (95%CI 1.7-12.0) in favour of HA (p=0.009). This estimate of effect exceeds the minimally clinically important difference. One participant allocated to HA (0.7%) had a deep hip infection after surgery. In the cost effectiveness analysis PHT dominated HA. InterpretationHip arthroscopy for patients with FAI syndrome provides a clinically significant benefit compared to best conservative care. ",

author = "Griffin, {Damian R.} and Dickenson, {Edward J.} and Wall, {Peter D.H.} and Felix Achana and Donovan, {Jenny L.} and James Griffin and Rachel Hobson and Hutchinson, {Charles E.} and Marcus Jepson and Parsons, {Nick R.} and Stavros Petrou and Alba Realpe and Joanna Smith and Foster, {Nadine E.} and {the FASHIoN Study Group} and Siobhan Stevens and Elke Gemperle-Mannion and Jaclyn Brown and Marc Philippon and Martin Beck and John O'Donnell and David Robinson and Ivor Hughes and David Hunter and Kim Bennell and Bache, {Christopher Edward} and Callum McBryde and Angelos Politis and Marcus Bankes and Marc George and Gavin Bartlett and Mark Norton and Tim Board and Aslam Mohammed and Asim Rajpura and Michael Cronin and Wael Dandachli and Johan Witt and Stephen Eastaugh-Waring and Max Fehily and Darren Fern and Richard Field and Paul Latimer and Matthew Wilson and Mark Williams and Emma Jones and Daniel Wright and David Cooke and Peter Morrison and Kirsten Harris and Helen Murray",

year = "2018",

month = jun,

day = "8",

doi = "10.1016/S0140-6736(18)31202-9",

language = "English",

volume = "391",

pages = "2225--2235",

journal = "Lancet",

issn = "0140-6736",

publisher = "Lancet Publishing Group",

number = "10136",

}

Griffin, DR, Dickenson, EJ, Wall, PDH, Achana, F, Donovan, JL, Griffin, J, Hobson, R, Hutchinson, CE, Jepson, M, Parsons, NR, Petrou, S, Realpe, A, Smith, J, Foster, NE & the FASHIoN Study Group 2018, 'Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome (UK FASHIoN): a multicentre randomised controlled trial', Lancet, vol. 391, no. 10136, pp. 2225-2235. https://doi.org/10.1016/S0140-6736(18)31202-9

Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome (UK FASHIoN): a multicentre randomised controlled trial. / Griffin, Damian R.; Dickenson, Edward J.; Wall, Peter D.H. et al.
In: Lancet, Vol. 391, No. 10136, 08.06.2018, p. 2225-2235.

Research output: Contribution to journal › Article (Academic Journal) › peer-review

TY - JOUR

T1 - Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome (UK FASHIoN)

T2 - a multicentre randomised controlled trial

AU - Griffin, Damian R.

AU - Dickenson, Edward J.

AU - Wall, Peter D.H.

AU - Achana, Felix

AU - Donovan, Jenny L.

AU - Griffin, James

AU - Hobson, Rachel

AU - Hutchinson, Charles E.

AU - Jepson, Marcus

AU - Parsons, Nick R.

AU - Petrou, Stavros

AU - Realpe, Alba

AU - Smith, Joanna

AU - Foster, Nadine E.

AU - the FASHIoN Study Group

AU - Stevens, Siobhan

AU - Gemperle-Mannion, Elke

AU - Brown, Jaclyn

AU - Philippon, Marc

AU - Beck, Martin

AU - O'Donnell, John

AU - Robinson, David

AU - Hughes, Ivor

AU - Hunter, David

AU - Bennell, Kim

AU - Bache, Christopher Edward

AU - McBryde, Callum

AU - Politis, Angelos

AU - Bankes, Marcus

AU - George, Marc

AU - Bartlett, Gavin

AU - Norton, Mark

AU - Board, Tim

AU - Mohammed, Aslam

AU - Rajpura, Asim

AU - Cronin, Michael

AU - Dandachli, Wael

AU - Witt, Johan

AU - Eastaugh-Waring, Stephen

AU - Fehily, Max

AU - Fern, Darren

AU - Field, Richard

AU - Latimer, Paul

AU - Wilson, Matthew

AU - Williams, Mark

AU - Jones, Emma

AU - Wright, Daniel

AU - Cooke, David

AU - Morrison, Peter

AU - Harris, Kirsten

AU - Murray, Helen

PY - 2018/6/8

Y1 - 2018/6/8

N2 - BackgroundFemoroacetabular impingement (FAI) syndrome is a cause of hip pain in young adults. It is believed to be due to abnormal contact between the ball and socket of the hip, caused by hip shape abnormalities. Hip arthroscopy (HA), which aims to reshape the hip, is a popular treatment strategy. We conducted a randomised controlled trial (RCT) to compare the clinical and cost-effectiveness of HA versus best conservative care.MethodsWe conducted a pragmatic, multi-centre, two arm, assessor-blinded, RCT in patients with FAI syndrome presenting to 23 UK NHS hospitals. Participants were randomly allocated (1:1) to HA or Personalised Hip Therapy (PHT), an individualised, supervised and progressive physiotherapist-led programme of conservative care. Stratification by impingement type and recruiting centre was used during randomisation, which was administered through a central telephone service by research staff at each hospital. The primary outcome measure was the patient-reported International Hip Outcome Tool (iHOT-33) 12 months after randomisation. The trial was registered with ISRCTN 64081839 and is closed to recruitment.FindingsWe recruited 348 participants between 20/07/2012 and 15/07/2016: 171 were allocated HA and 177 PHT. Follow-up at the primary outcome assessment was 92%. After 12 months, mean iHOT-33 scores had improved; HA from 39 to 59 and PHT from 36 to 50. In the primary ‘intention to treat’ analysis, the mean difference in iHOT-33 scores, adjusted for impingement type, gender, baseline iHOT-33 score and centre, was 6.8 (95%CI 1.7-12.0) in favour of HA (p=0.009). This estimate of effect exceeds the minimally clinically important difference. One participant allocated to HA (0.7%) had a deep hip infection after surgery. In the cost effectiveness analysis PHT dominated HA. InterpretationHip arthroscopy for patients with FAI syndrome provides a clinically significant benefit compared to best conservative care.

AB - BackgroundFemoroacetabular impingement (FAI) syndrome is a cause of hip pain in young adults. It is believed to be due to abnormal contact between the ball and socket of the hip, caused by hip shape abnormalities. Hip arthroscopy (HA), which aims to reshape the hip, is a popular treatment strategy. We conducted a randomised controlled trial (RCT) to compare the clinical and cost-effectiveness of HA versus best conservative care.MethodsWe conducted a pragmatic, multi-centre, two arm, assessor-blinded, RCT in patients with FAI syndrome presenting to 23 UK NHS hospitals. Participants were randomly allocated (1:1) to HA or Personalised Hip Therapy (PHT), an individualised, supervised and progressive physiotherapist-led programme of conservative care. Stratification by impingement type and recruiting centre was used during randomisation, which was administered through a central telephone service by research staff at each hospital. The primary outcome measure was the patient-reported International Hip Outcome Tool (iHOT-33) 12 months after randomisation. The trial was registered with ISRCTN 64081839 and is closed to recruitment.FindingsWe recruited 348 participants between 20/07/2012 and 15/07/2016: 171 were allocated HA and 177 PHT. Follow-up at the primary outcome assessment was 92%. After 12 months, mean iHOT-33 scores had improved; HA from 39 to 59 and PHT from 36 to 50. In the primary ‘intention to treat’ analysis, the mean difference in iHOT-33 scores, adjusted for impingement type, gender, baseline iHOT-33 score and centre, was 6.8 (95%CI 1.7-12.0) in favour of HA (p=0.009). This estimate of effect exceeds the minimally clinically important difference. One participant allocated to HA (0.7%) had a deep hip infection after surgery. In the cost effectiveness analysis PHT dominated HA. InterpretationHip arthroscopy for patients with FAI syndrome provides a clinically significant benefit compared to best conservative care.

UR - http://www.scopus.com/inward/record.url?scp=85047747424&partnerID=8YFLogxK

U2 - 10.1016/S0140-6736(18)31202-9

DO - 10.1016/S0140-6736(18)31202-9

M3 - Article (Academic Journal)

C2 - 29893223

AN - SCOPUS:85047747424

SN - 0140-6736

VL - 391

SP - 2225

EP - 2235

JO - Lancet

JF - Lancet

IS - 10136

ER -

Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome (UK FASHIoN): a multicentre randomised controlled trial

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Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome (UK FASHIoN): a multicentre randomised controlled trial

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