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AAOS, AANA and AOSSM oppose ‘no coverage’ guidance for FAI surgery

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In a joint statement, three orthopedic physician groups opposed a recommendation by the Oregon Health Evidence Review Commission, or HERC, to not cover femoroacetabular impingement surgery due to lack of evidence for its efficacy.

“We oppose the proposed determination put forth by the HERC because we do not believe this decision is consistent with evidence showing that surgery is a cost-effective treatment for the management of [femoroacetabular impingement] FAI Syndrome,” American Association of Orthopaedic Surgeons (AAOS) president Joshua J. Jacobs, MD, stated in an AAOS press release. “Surgical treatment of FAI for symptomatic patients with ongoing disability issues can provide long-lasting symptom relief and allows these patients to return to work or other desired activities, reducing FAI’s economic burden on society.”

Jacobs was joined by J.W. Thomas Byrd, MD, president of the Arthroscopy Association of North America (AANA), and Jo A. Hannafin, MD, PhD, president of the American Orthopaedic Society for Sports Medicine (AOSSM), in opposing the HERC recommendation.

 

Joshua J. Jacobs

As part of Oregon’s Action Plan for Health, the Oregon HERC conducted an evidence review of FAI surgery, which included comparing treatment outcomes and studying the surgery’s safety.

As written in the recommendation, “There is no evidence that the diagnosis of FAI can be obtained from clinical exam. One clinical test, the impingement sign, had a positive and negative predictive value of 86% and 79% in one study where the prevalence of FAI was 50%; however, in another study, the interobserver reliability of the impingement sign was only moderate.”

There were no randomized controlled trials available that compared FAI with other surgical interventions or conservative treatment, the HERC said in its recommendation. But the commission noted that one retrospective study compared FAI with no surgery and four retrospective studies compared FAI with other surgical interventions. In its guidance, the Oregon HERC concluded that after FAI surgery the risk of reoperation that did not involve conversion to total hip arthroplasty was 4% to 9%, the risk of heterotopic ossification was 2% to 6% and neurological complications may occur in 22% of patients.

To read HERC’s full recommendation on FAI, click here.

Reference:
http://www.oregon.gov/oha/OHPR/pages/herc/coverage-guidance.aspx

Disclosure: Jacobs is a paid consultant for Medtronic Sofamor Danek, Nuvasive and Zimmer and retains stock options for Implant Protection.