Arthroscopic hip surgery compared with physiotherapy and activity modification for the treatment of symptomatic femoroacetabular impingement: multicentre randomised controlled trial.
Palmer AJR, Ayyar Gupta V, Fernquest S, et al. BMJ (Clinical research ed.) 2019 · PMID 30733197 · doi:10.1136/bmj.l185
- Question
- Is arthroscopic surgery more effective than physiotherapy plus activity modification for symptomatic FAI?
- Design
- Pragmatic, assessor-blinded, two-arm multicentre RCT across seven NHS sites in England.
- Patients
- Adults aged 18 to 60 with symptomatic FAI confirmed clinically and on imaging, excluding previous hip surgery, established osteoarthritis and hip dysplasia.
- Intervention
- Arthroscopic hip surgery to excise impinging bone, followed by routine postoperative care
- Comparison
- Individually tailored, goal-based physiotherapy programme with activity modification
- Primary outcome
- Hip Outcome Score activities of daily living (HOS-ADL) subscale at 8 months
- Key result
- Arthroscopy produced significantly better HOS-ADL scores at 8 months than physiotherapy and activity modification, with a difference around the prespecified minimum clinically important difference.
- Limitations
- Short primary follow-up and no blinding of participants; cartilage and long-term osteoarthritis outcomes were exploratory.
- Impact on practice
- Alongside UK FASHIoN, confirmed a short-term benefit of arthroscopy over non-operative care for FAI, strengthening the case for surgical referral when symptoms persist despite rehabilitation.