Patient experiences of receiving arthroscopic surgery or personalised hip therapy for femoroacetabular impingement in the context of the UK fashion study: a qualitative study

A. X. Realpe*, Nadine E Foster, E. J. Dickenson, M. Jepson, D. R. Griffin, J. L. Donovan

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

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Abstract

Background
UK FASHIoN was a multicentre randomised controlled trial comparing hip arthroscopic surgery (HA) with personalised hip therapy (PHT, physiotherapist-led conservative care), for patients with hip pain attributed to femoroacetabular impingement (FAI) syndrome. Our aim was to describe the treatment and trial participation experiences of patients, to contextualise the trial results and offer further information to assist treatment decision-making in FAI.

Methods
We conducted in-depth semi-structured telephone interviews with a purposive sample of trial participants from each of the trial arms. They were interviewed after they received treatment and completed their first year of trial participation. Thematic analysis and constant comparison analytical approaches were used to identify themes of patient treatment experiences during the trial.

Results
Forty trial participants were interviewed in this qualitative study. Their baseline characteristics were similar to those in the main trial sample. On average, their hip-related quality of life (iHOT-33 scores) at 12 months follow-up were lower than average for all trial participants, indicating poorer hip-related quality of life as a consequence of theoretical sampling. Patient experiences occurred in five patient groups: those who felt their symptoms improved with hip arthroscopy, or with personal hip therapy, patients who felt their hip symptoms did not change with PHT but did not want HA, patients who decided to change from PHT to HA and a group who experienced serious complications after HA. Interviewees mostly described a trouble-free, enriching and altruistic trial participation experience, although most participants expected more clinical follow-up at the end of the trial.

Conclusion
Both HA and PHT were experienced as beneficial by participants in the trial. Treatment success appeared to depend partly on patients’ prior own expectations as well as their outcomes, and future research is needed to explore this further. Findings from this study can be combined with the primary results to inform future FAI patients.

Trial registration
Arthroscopic surgery for hip impingement versus best conventional care (ISRCTN64081839). 28/02/2014.
Original languageEnglish
Article number211
Number of pages11
JournalTrials
Volume22
Issue number1
DOIs
Publication statusPublished - 16 Mar 2021

Bibliographical note

Funding Information:
NF and JLD are NIHR Senior Investigators, NF was funded through an NIHR Research Professorship (NIHR-RP-011-015. The study had been funded by the Health Technology Assessment Programme (HTA) of the National Institute of Health Research; this is a division of the department of health. Grant numbers 10/41/02 and 13/103/02.

Funding Information:
DRG reports grants from the National Institute of Health Research (NIHR) during the conduct of the study and personal fees from Stryker UK, outside the submitted work; he is also a board member of the International Society of Hip Arthroscopy and is a consultant surgeon who routinely performs hip arthroscopy. JLD and NEF report grants from the NIHR Health Technology Assessment Programme during the conduct of this study. All other authors declare no competing interests.

Publisher Copyright:
© 2021, The Author(s).

Keywords

  • Femoroacetabular impingement
  • Hip arthroscopy
  • Hip physiotherapy
  • Orthopaedic patient experiences
  • Qualitative study

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