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Most adolescent patients may be treated nonoperatively for FAI
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Most adolescent patients with femoroacetabular impingement may be treated nonoperatively and have significant improvements in outcome scores at the 2-year minimum follow-up, according to recently published results.
“Many patients present to my clinic with an MRI confirmed labral tear requesting arthroscopic surgery,” Andrew T. Pennock, MD, told Healio.com/Orthopedics. “There are many reasons for this including patients seeking a quick fix, patients having been told they need surgery by another provider, and patients feeling as though they have already failed a previous attempt at therapy and a brief period of rest. Our data has been an important tool for me demonstrating to these families that a commitment to non-operative care in this patient population not only works but can be successful in the majority of patients with femoroacetabular impingement [FAI]. As a result of this nonoperative protocol, we have experienced a dramatic reduction in the number of hip arthroscopy procedures performed at our institution.”
Pennock and colleagues identified 76 patients (99 hips) with prior hip surgery, groin-based pain, a positive impingement test and radiographic FAI syndrome and prospectively recruited them in a nonoperative FAI study. Investigators initiated protocol that included initial trial of rest, physical therapy and activity modification. An image-guided intra-articular steroid injection was offered to patients who remained symptomatic. Arthroscopic treatment was offered to patients with recurrent symptoms. At 12 and 24 months, outcomes were collected. Risk factors for the need of operative treatment and patient outcomes based on FAI type and treatment were determined with statistical analysis.
Results showed 65 hips were treated with physical therapy, rest and activity modification alone. Eleven hips that needed a steroid injection however, did not progress to surgery. Seventeen hips that needed arthroscopic management. The treatment groups all had similar improvements in the modified hip score and nonarthritic hip score. The modified Harris hip score had a mean improvement of 20.3 and nonarthritic hip score had a mean improvement of 13.2. Patients with hips with cam impingement and combined cam-pincer impingement were 4 times more likely to meet minimal clinically important difference in modified Harris hip score. These patients were also 4.4 times more likely to receive surgical interventions compared with patients with pincer deformities alone. Patients who participated in team sports were three times more likely to return to competitive sport activities compared with patients who were individual sports athletes. – by Monica Jaramillo
Disclosures: Pennock reports he is a board or committee member of the American Orthopaedic Society for Sports Medicine and Pediatric Orthopaedic Society of North America; has stock or stock options in Imagen and is a paid consultant for Orthopediatrics. Please see the full study for a list of all other authors’ relevant financial disclosures.
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