Hip arthroscopy, physical therapy may improve femoroacetabular impingement syndrome
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Published results showed patients with femoroacetabular impingement had statistically and clinically significant short-term improvements in hip pain, function and quality of life when treated with either hip arthroscopy or physical therapy.
In a systematic database search, researchers identified three randomized controlled trials in which patients with femoroacetabular impingement syndrome received treatment with either hip arthroscopy or physical therapy. Researchers evaluated the international hip outcome tool–33 (iHot–33) score between 6 and 8 months after the interventions, and computed the pooled mean difference in iHOT-33 scores within and between the treatment arms using a random effects model.
Results showed significant increases in iHOT–33 from baseline to follow-up for both hip arthroscopy and physical therapy. Compared with physical therapy, researchers found significantly higher iHOT–33 scores at follow-up among patients who received hip arthroscopy.
“The superiority of hip arthroscopy as compared to physical therapy was statistically proven, but the clinical relevance of these findings remains unclear as the difference between the effects of hip arthroscopy and physical therapy may not be clinically detected by patients,” the authors wrote. “One of the main future research challenges is to identify which patients could best benefit from each of these interventions.”
Perspective
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Jacob Shapira, MD
Since the introduction of femoroacetabular impingement syndrome in 2003, surgical management of the aberrant bony anatomy and the related soft tissue damage has become the gold standard. The pre- and postoperative rehabilitation programs are considered an integral part of the surgical management and imperative to optimizing the treatment outcomes. The favorable outcomes shown following the management of femoroacetabular impingement syndrome are the result of ongoing research that constantly strives to break the familiar boundaries of common practice. An example is the push for a paradigm shift to managing the mechanical manifestations of femoroacetabular impingement syndrome with physical therapy.
The presented article conducted a meta-analysis on the effectiveness of physical therapy in patients with femoroacetabular impingement syndrome, exclusively relying on randomized controlled studies. However, variations in treatment protocols, high crossover rate and limited follow-up time among the included articles may limit the generalizability of their results. Nevertheless, as one of the enrolled studies quotes, “It is error only, and not truth, that shrinks from inquiry,’’ and the important insights provided by this study should not be overlooked.
Physical therapy is an important treatment modality that can improve the well-being of some patients with femoroacetabular impingement syndrome. However, despite the challenges in synthesis of data from multiple studies, the authors succeeded in demonstrating superior functional improvement with hip arthroscopy compared to physical therapy for femoroacetabular impingement syndrome.
References:
Casartelli NC, et al. Arthritis Care Res (Hoboken). 2020;doi:10.1002/acr.24234.
Domb BG, et al. Sports Health. 2016;doi:10.1177/1941738116647920.
Faucett SC, et al. Am J Sports Med. 2018;doi:10.1177/0363546518777483.
Ganz R, et al. Clin Orthop Relat Res. 2003;doi:10.1097/01.blo.0000096804.78689.c2.
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