User login
LIVERPOOL, ENGLAND – Hip arthroscopic surgery produced better long-term results than did personalized hip physiotherapy for femoroacetabular impingement syndrome in a randomized trial conduced across multiple U.K. centers.
At 12 months, respective International Hip Outcome Tool-33 (iHOT-33) scores were 58.8 and 49.7, a difference of 9.1 points before and 6.8 points after adjustment for potential confounding factors (P = .0093).
“This trial shows that hip arthroscopic surgery and personalized hip therapy both improved hip-related quality of life for patients with FAI [femoroacetabular impingement] syndrome, but that the surgery did indeed produce a greater improvement at our primary time point of 12 months,” she added. Dr. Foster is professor of musculoskeletal health in primary care at Keele University, Newcastle-under-Lyme, England, one of the 23 centers involved in the FASHIoN study in England, Wales, and Scotland.
“FAI is a very common cause of hip and groin pain in young adults, and it’s associated with the development of hip osteoarthritis,” Dr. Foster noted.
There are three types of FAI – pincer, cam, and combined. The pincer type of FAI is where there is “prominence or overcoverage of the rim of the acetabulum,” and the cam type is where there is a “bony prominence of the femoral head-neck junction,” she explained at the meeting sponsored by the Osteoarthritis Research Society International.
The link to OA comes when the femur and acetabulum prematurely connect, usually during activity, causing damage to the labrum and articular cartilage in the long term. Thus, treating FAI is important, not just for relieving patient’s pain and joint stiffness.
Hip arthroscopic surgery has become an established way of treating FAI syndrome – more than 2,400 operations were performed in 2013 in the United Kingdom alone, Dr. Foster observed. The aim of surgery is to try to reshape the hip joint to prevent impingement, and resect, repair, or reconstruct any intra-articular damage that may be present.
“Physiotherapy aims to improve hip muscle control and strength, and to correct the abnormal movement patterns that we see in these patients,” Dr. Foster said. “Through that, we hope to prevent the premature contact that occurs in FAI syndrome and thereby improve symptoms, allowing patients to return to activities and prevent recurrence.”
Working with physiotherapists, physicians, and surgeons, Dr. Foster and her associates have previously developed a “best conservative care” intervention that they call personalized hip therapy (PHT), which involves the delivery and supervision of an individualized exercise program by experienced physiotherapists over a 3- to 6-month period, and which patients repeat at home (PM R. 2013 May;5[5]:418-26).
The aim of the UK FASHIoN trial was to compare the clinical and cost-effectiveness of hip arthroscopy and PHT for FAI syndrome, as there was no robust clinical trial evidence to demonstrate a benefit of one over the other.
A total of 351 adults with hip and groin pain were randomized to either arthroscopic surgery (n = 173) or PHT (n = 178). The mean age of participants was 35 years, with no significant differences between the two treatment groups in terms of baseline demographics or type or duration of hip impingement.
While surgery was better in terms of patient outcomes, the study didn’t demonstrate its cost-effectiveness within the first 12 months, Dr. Foster observed. Cost-effectiveness, together with various other quality-of-life measurements, was a secondary endpoint of the study.
“Longer-term outcomes are required to establish whether improvement is sustained, and whether surgery is cost-effective at the longer time points for our health service,” she said.
Responding to a question about whether any of the patients in the study had radiographic evidence of osteoarthritis, Dr. Foster said that such patients had been excluded from the study.
“One of the hopes of the trial’s team is that, with the long-term follow-up, we might be able to get data at 5 and 10 years on things like hip osteoarthritis in these patients,” she said.
The study was funded by the National Institute for Health Research. Dr. Foster had no financial relationships or commercial interests to disclose.
SOURCE: Griffin DR et al. Osteoarthritis Cartilage. 2018:26(1):S24-25. Abstract 28
LIVERPOOL, ENGLAND – Hip arthroscopic surgery produced better long-term results than did personalized hip physiotherapy for femoroacetabular impingement syndrome in a randomized trial conduced across multiple U.K. centers.
At 12 months, respective International Hip Outcome Tool-33 (iHOT-33) scores were 58.8 and 49.7, a difference of 9.1 points before and 6.8 points after adjustment for potential confounding factors (P = .0093).
“This trial shows that hip arthroscopic surgery and personalized hip therapy both improved hip-related quality of life for patients with FAI [femoroacetabular impingement] syndrome, but that the surgery did indeed produce a greater improvement at our primary time point of 12 months,” she added. Dr. Foster is professor of musculoskeletal health in primary care at Keele University, Newcastle-under-Lyme, England, one of the 23 centers involved in the FASHIoN study in England, Wales, and Scotland.
“FAI is a very common cause of hip and groin pain in young adults, and it’s associated with the development of hip osteoarthritis,” Dr. Foster noted.
There are three types of FAI – pincer, cam, and combined. The pincer type of FAI is where there is “prominence or overcoverage of the rim of the acetabulum,” and the cam type is where there is a “bony prominence of the femoral head-neck junction,” she explained at the meeting sponsored by the Osteoarthritis Research Society International.
The link to OA comes when the femur and acetabulum prematurely connect, usually during activity, causing damage to the labrum and articular cartilage in the long term. Thus, treating FAI is important, not just for relieving patient’s pain and joint stiffness.
Hip arthroscopic surgery has become an established way of treating FAI syndrome – more than 2,400 operations were performed in 2013 in the United Kingdom alone, Dr. Foster observed. The aim of surgery is to try to reshape the hip joint to prevent impingement, and resect, repair, or reconstruct any intra-articular damage that may be present.
“Physiotherapy aims to improve hip muscle control and strength, and to correct the abnormal movement patterns that we see in these patients,” Dr. Foster said. “Through that, we hope to prevent the premature contact that occurs in FAI syndrome and thereby improve symptoms, allowing patients to return to activities and prevent recurrence.”
Working with physiotherapists, physicians, and surgeons, Dr. Foster and her associates have previously developed a “best conservative care” intervention that they call personalized hip therapy (PHT), which involves the delivery and supervision of an individualized exercise program by experienced physiotherapists over a 3- to 6-month period, and which patients repeat at home (PM R. 2013 May;5[5]:418-26).
The aim of the UK FASHIoN trial was to compare the clinical and cost-effectiveness of hip arthroscopy and PHT for FAI syndrome, as there was no robust clinical trial evidence to demonstrate a benefit of one over the other.
A total of 351 adults with hip and groin pain were randomized to either arthroscopic surgery (n = 173) or PHT (n = 178). The mean age of participants was 35 years, with no significant differences between the two treatment groups in terms of baseline demographics or type or duration of hip impingement.
While surgery was better in terms of patient outcomes, the study didn’t demonstrate its cost-effectiveness within the first 12 months, Dr. Foster observed. Cost-effectiveness, together with various other quality-of-life measurements, was a secondary endpoint of the study.
“Longer-term outcomes are required to establish whether improvement is sustained, and whether surgery is cost-effective at the longer time points for our health service,” she said.
Responding to a question about whether any of the patients in the study had radiographic evidence of osteoarthritis, Dr. Foster said that such patients had been excluded from the study.
“One of the hopes of the trial’s team is that, with the long-term follow-up, we might be able to get data at 5 and 10 years on things like hip osteoarthritis in these patients,” she said.
The study was funded by the National Institute for Health Research. Dr. Foster had no financial relationships or commercial interests to disclose.
SOURCE: Griffin DR et al. Osteoarthritis Cartilage. 2018:26(1):S24-25. Abstract 28
LIVERPOOL, ENGLAND – Hip arthroscopic surgery produced better long-term results than did personalized hip physiotherapy for femoroacetabular impingement syndrome in a randomized trial conduced across multiple U.K. centers.
At 12 months, respective International Hip Outcome Tool-33 (iHOT-33) scores were 58.8 and 49.7, a difference of 9.1 points before and 6.8 points after adjustment for potential confounding factors (P = .0093).
“This trial shows that hip arthroscopic surgery and personalized hip therapy both improved hip-related quality of life for patients with FAI [femoroacetabular impingement] syndrome, but that the surgery did indeed produce a greater improvement at our primary time point of 12 months,” she added. Dr. Foster is professor of musculoskeletal health in primary care at Keele University, Newcastle-under-Lyme, England, one of the 23 centers involved in the FASHIoN study in England, Wales, and Scotland.
“FAI is a very common cause of hip and groin pain in young adults, and it’s associated with the development of hip osteoarthritis,” Dr. Foster noted.
There are three types of FAI – pincer, cam, and combined. The pincer type of FAI is where there is “prominence or overcoverage of the rim of the acetabulum,” and the cam type is where there is a “bony prominence of the femoral head-neck junction,” she explained at the meeting sponsored by the Osteoarthritis Research Society International.
The link to OA comes when the femur and acetabulum prematurely connect, usually during activity, causing damage to the labrum and articular cartilage in the long term. Thus, treating FAI is important, not just for relieving patient’s pain and joint stiffness.
Hip arthroscopic surgery has become an established way of treating FAI syndrome – more than 2,400 operations were performed in 2013 in the United Kingdom alone, Dr. Foster observed. The aim of surgery is to try to reshape the hip joint to prevent impingement, and resect, repair, or reconstruct any intra-articular damage that may be present.
“Physiotherapy aims to improve hip muscle control and strength, and to correct the abnormal movement patterns that we see in these patients,” Dr. Foster said. “Through that, we hope to prevent the premature contact that occurs in FAI syndrome and thereby improve symptoms, allowing patients to return to activities and prevent recurrence.”
Working with physiotherapists, physicians, and surgeons, Dr. Foster and her associates have previously developed a “best conservative care” intervention that they call personalized hip therapy (PHT), which involves the delivery and supervision of an individualized exercise program by experienced physiotherapists over a 3- to 6-month period, and which patients repeat at home (PM R. 2013 May;5[5]:418-26).
The aim of the UK FASHIoN trial was to compare the clinical and cost-effectiveness of hip arthroscopy and PHT for FAI syndrome, as there was no robust clinical trial evidence to demonstrate a benefit of one over the other.
A total of 351 adults with hip and groin pain were randomized to either arthroscopic surgery (n = 173) or PHT (n = 178). The mean age of participants was 35 years, with no significant differences between the two treatment groups in terms of baseline demographics or type or duration of hip impingement.
While surgery was better in terms of patient outcomes, the study didn’t demonstrate its cost-effectiveness within the first 12 months, Dr. Foster observed. Cost-effectiveness, together with various other quality-of-life measurements, was a secondary endpoint of the study.
“Longer-term outcomes are required to establish whether improvement is sustained, and whether surgery is cost-effective at the longer time points for our health service,” she said.
Responding to a question about whether any of the patients in the study had radiographic evidence of osteoarthritis, Dr. Foster said that such patients had been excluded from the study.
“One of the hopes of the trial’s team is that, with the long-term follow-up, we might be able to get data at 5 and 10 years on things like hip osteoarthritis in these patients,” she said.
The study was funded by the National Institute for Health Research. Dr. Foster had no financial relationships or commercial interests to disclose.
SOURCE: Griffin DR et al. Osteoarthritis Cartilage. 2018:26(1):S24-25. Abstract 28
REPORTING FROM OARSI 2018
Key clinical point: Hip arthroscopy produced better results at 12 months than did the best conservative care.
Major finding: iHOT-33 scores at 12 months were 58.3 for surgery and 49.7 for personalized hip therapy (P = .0093)
Study details: Multicenter, randomized controlled UK FASHIoN trial of 351 adults with hip and groin pain.
Disclosures: The study was funded by the National Institute for Health Research. Dr. Foster had nothing to disclose.
Source: Griffin DR et al. Osteoarthritis Cartilage. 2018:26(1):S24-25. Abstract 28.