Nonoperative management of FAI syndrome may be effective for adolescent patients
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With successful and durable outcomes at 5 years, nonoperative management is an option for most adolescent patients with symptomatic femoroacetabular impingement syndrome, according to a pediatric sports medicine surgeon.
“Femoroacetabular impingement (FAI) syndrome is a common cause of adolescent hip pain. It has been a popular research topic, but most articles have focused on radiographic diagnosis, as well as surgical outcomes, and relatively few studies have been published looking at nonoperative outcomes,” Andrew Pennock, MD, said in his presentation at the Pediatric Orthopaedic Society of North America Annual Meeting.
Pennock and colleagues at Rady Children’s Hospital studied 5-year outcomes of a nonoperative management approach on 50 pediatric patients (67 hips) with symptomatic FAI syndrome. The protocol consisted of an initial phase of rest, physical therapy and activity modification. Patients who remained symptomatic were offered an intra-articular steroid injection or arthroscopic treatment. Patient-reported outcomes (PROs) included the modified Harris Hip Score (mHHS) and non-arthritic hip score (NAHS) at 1, 2 and 5 years, according to the study abstract.
Of the initial cohort of 100 patients (133 hips), 73% were managed nonoperatively for FAI. Mean mHHS and NAHS were 69.6 and 76.3, respectively, among the group. Of the 50 patients available at the final follow-up of 5 years, mean mHHS and NAHS were 89.6 and 88, respectively.
Pennock and colleagues found no differences in return to sport, regardless of treatment type or FAI type. Overall, 72% of patients were able to return to the same or similar level of sport. They also noted that the activity modification group and the scope group made “statistically significant improvement” in mHHS and NAHS at final follow-up.
“In conclusion, most adolescent patients treated nonoperatively have robust improvements in their PROs at 5 years,” Pennock said. “We do not see significant deterioration between 1 and 2 years and 5 years, and that is why a nonoperative approach continues to be my mainstay approach with these patients – at least initially,” he added.
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Pennock A, et al. Paper 109. Presented at: Pediatric Orthopaedic Society of North America Annual Meeting; May 12-15, 2021; Dallas (hybrid meeting).
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