Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome (UK FASHIoN): a multicentre randomised controlled trial.
Griffin DR, Dickenson EJ, Wall PDH, et al. Lancet (London, England) 2018 · PMID 29893223 · doi:10.1016/s0140-6736(18)31202-9
- Question
- In patients with femoroacetabular impingement (FAI) syndrome, does hip arthroscopy give better hip-related quality of life than a structured programme of physiotherapist-led conservative care?
- Design
- Pragmatic multicentre RCT across 23 NHS hospitals, with assessors blinded to allocation where possible.
- Patients
- Adults (16 and over) with FAI syndrome, defined by symptoms, clinical signs and cam or pincer morphology on imaging, who were considered suitable for arthroscopy.
- Intervention
- Arthroscopic hip surgery (cam and/or pincer resection, labral treatment) followed by rehabilitation
- Comparison
- Personalised Hip Therapy (PHT): protocolised, physiotherapist-led conservative care
- Primary outcome
- iHOT-33 score at 12 months
- Key result
- Both groups improved, but hip arthroscopy gave significantly better iHOT-33 scores at 12 months than Personalised Hip Therapy, a difference judged to be clinically meaningful.
- Limitations
- Surgery and physiotherapy could not be blinded to patients, and follow-up was only 12 months, so effects on later osteoarthritis are unknown.
- Impact on practice
- Provided the first high-quality evidence that arthroscopy is superior to conservative care for FAI syndrome in the short term, supporting its use in carefully selected patients after shared decision-making; Personalised Hip Therapy became the reference conservative package.