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

Research output: Contribution to journalArticle

  • 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
Original languageEnglish
Pages (from-to)2225-2235
Number of pages11
JournalLancet
Volume391
Issue number10136
Early online date1 Jun 2018
DOIs
DateAccepted/In press - 18 May 2018
DateE-pub ahead of print - 1 Jun 2018
DatePublished (current) - 8 Jun 2018

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.

    Structured keywords

  • Centre for Surgical Research

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    Rights statement: This is the final published version of the article (version of record). It first appeared online via Elsevier at https://www.sciencedirect.com/science/article/pii/S0140673618312029 . Please refer to any applicable terms of use of the publisher.

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