Skip to main content
Top
Published in: Journal of Orthopaedic Surgery and Research 1/2022

01-12-2022 | Impingement Syndromes | Systematic review

Conservative therapy versus arthroscopic surgery of femoroacetabular impingement syndrome (FAI): a systematic review and meta-analysis

Authors: Yanlin Zhu, Peng Su, Tianhao Xu, Lei Zhang, Weili Fu

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2022

Login to get access

Abstract

Purpose

FAI (femoroacetabular impingement syndrome) is a common cause of hip pain, resulting in a decreased life quality. This study aims to compare the postoperative clinical outcome between arthroscopic surgery (AT) and conservative treatment (CT).

Method

The six studies were selected from PubMed, Embase and OVID database. The data were extracted and analyzed by RevMan5.3. Mean differences and 95% confidence intervals were calculated. RevMan5.3 was used to assess the risk of bias.

Result

Six observational studies were assessed. The methodological quality of the trials indicated five of six studies had a low risk of bias and one article had a high risk of bias. The differences were statistically significant between AT and CT for HOS (follow-up for 6 months), iHOT-33 (follow-up for 6 months) improvement, iHOT-33 (follow-up for 12 months) improvement, iHOT-33 (follow-up for 12 months), EQ-5D-5L index score (follow-up for 12 months) and AT showed higher benefits than CT. Meanwhile no statistically significant were found in iHOT-33 (follow-up for 6 months), EQ-5D-5L index score (follow-up for 6 months), EQ5D-VAS (follow-up for 6 months) and EQ5D-VAS (follow-up for 12 months).

Conclusion

AT and CT both can have clinical effects when facing FAI. In our meta-analysis, hip arthroscopy is statistically superior to conservative treatment in both long-term and short-term effects.
Literature
1.
go back to reference Langhout R, Weir A, Litjes W, Gozeling M, Stubbe JH, Kerkhoffs G, Tak I. Hip and groin injury is the most common non-time-loss injury in female amateur football. Knee Surg Sports Traumatol Arthrosc Off J ESSKA. 2019;27(10):3133–41.CrossRef Langhout R, Weir A, Litjes W, Gozeling M, Stubbe JH, Kerkhoffs G, Tak I. Hip and groin injury is the most common non-time-loss injury in female amateur football. Knee Surg Sports Traumatol Arthrosc Off J ESSKA. 2019;27(10):3133–41.CrossRef
2.
go back to reference Papalia R, Del Buono A, Franceschi F, Marinozzi A, Maffulli N, Denaro V. Femoroacetabular impingement syndrome management: arthroscopy or open surgery? Int Orthop. 2012;36(5):903–14.CrossRef Papalia R, Del Buono A, Franceschi F, Marinozzi A, Maffulli N, Denaro V. Femoroacetabular impingement syndrome management: arthroscopy or open surgery? Int Orthop. 2012;36(5):903–14.CrossRef
3.
go back to reference Ganz R, Gill TJ, Gautier E, Ganz K, Krügel N, Berlemann U. Surgical dislocation of the adult hip a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis. J Bone Joint Surg British. 2001;83(8):1119–24.CrossRef Ganz R, Gill TJ, Gautier E, Ganz K, Krügel N, Berlemann U. Surgical dislocation of the adult hip a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis. J Bone Joint Surg British. 2001;83(8):1119–24.CrossRef
4.
go back to reference Fioruzzi A, Acerbi A, Jannelli E, Ivone A, Fontana A. Interobserver and intraobserver reliability of a new radiological classification for femoroacetabular impingement syndrome. Musculoskelet Surg. 2020;104(3):279–84.CrossRef Fioruzzi A, Acerbi A, Jannelli E, Ivone A, Fontana A. Interobserver and intraobserver reliability of a new radiological classification for femoroacetabular impingement syndrome. Musculoskelet Surg. 2020;104(3):279–84.CrossRef
5.
go back to reference Griffin DR, Dickenson EJ, O’Donnell J, Agricola R, Awan T, Beck M, Clohisy JC, Dijkstra HP, Falvey E, Gimpel M, et al. The warwick agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. Br J Sports Med. 2016;50(19):1169–76.CrossRef Griffin DR, Dickenson EJ, O’Donnell J, Agricola R, Awan T, Beck M, Clohisy JC, Dijkstra HP, Falvey E, Gimpel M, et al. The warwick agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. Br J Sports Med. 2016;50(19):1169–76.CrossRef
6.
go back to reference Ganz R, Leunig M, Leunig-Ganz K, Harris WH. The etiology of osteoarthritis of the hip: an integrated mechanical concept. Clin Orthop Relat Res. 2008;466(2):264–72.CrossRef Ganz R, Leunig M, Leunig-Ganz K, Harris WH. The etiology of osteoarthritis of the hip: an integrated mechanical concept. Clin Orthop Relat Res. 2008;466(2):264–72.CrossRef
7.
go back to reference Agricola R, Heijboer MP, Bierma-Zeinstra SM, Verhaar JA, Weinans H, Waarsing JH. Cam impingement causes osteoarthritis of the hip: a nationwide prospective cohort study (CHECK). Ann Rheum Dis. 2013;72(6):918–23.CrossRef Agricola R, Heijboer MP, Bierma-Zeinstra SM, Verhaar JA, Weinans H, Waarsing JH. Cam impingement causes osteoarthritis of the hip: a nationwide prospective cohort study (CHECK). Ann Rheum Dis. 2013;72(6):918–23.CrossRef
8.
go back to reference Migliorini F, Maffulli N, Baroncini A, Eschweiler J, Tingart M, Betsch M. Revision surgery and progression to total hip arthroplasty after surgical correction of femoroacetabular impingement: a systematic review. Am J Sports Med. 2022;50(4):1146–56.CrossRef Migliorini F, Maffulli N, Baroncini A, Eschweiler J, Tingart M, Betsch M. Revision surgery and progression to total hip arthroplasty after surgical correction of femoroacetabular impingement: a systematic review. Am J Sports Med. 2022;50(4):1146–56.CrossRef
9.
go back to reference Ayeni OR, Wong I, Chien T, Musahl V, Kelly BT, Bhandari M. Surgical indications for arthroscopic management of femoroacetabular impingement. Arthrosc J Arthrosc Rel Surg Off Publ Arthrosc Assoc North Am Int Arthrosc Assoc. 2012;28(8):1170–9.CrossRef Ayeni OR, Wong I, Chien T, Musahl V, Kelly BT, Bhandari M. Surgical indications for arthroscopic management of femoroacetabular impingement. Arthrosc J Arthrosc Rel Surg Off Publ Arthrosc Assoc North Am Int Arthrosc Assoc. 2012;28(8):1170–9.CrossRef
10.
go back to reference Peters S, Laing A, Emerson C, Mutchler K, Joyce T, Thorborg K, Hölmich P, Reiman M. Surgical criteria for femoroacetabular impingement syndrome: a scoping review. Br J Sports Med. 2017;51(22):1605–10.CrossRef Peters S, Laing A, Emerson C, Mutchler K, Joyce T, Thorborg K, Hölmich P, Reiman M. Surgical criteria for femoroacetabular impingement syndrome: a scoping review. Br J Sports Med. 2017;51(22):1605–10.CrossRef
11.
go back to reference Jannelli E, Parafioriti A, Acerbi A, Ivone A, Fioruzzi A, Fontana A. Acetabular delamination: epidemiology, histological features, and treatment. Cartilage. 2019;10(3):314–20.CrossRef Jannelli E, Parafioriti A, Acerbi A, Ivone A, Fioruzzi A, Fontana A. Acetabular delamination: epidemiology, histological features, and treatment. Cartilage. 2019;10(3):314–20.CrossRef
12.
go back to reference Bardakos NV, Vasconcelos JC, Villar RN. Early outcome of hip arthroscopy for femoroacetabular impingement: the role of femoral osteoplasty in symptomatic improvement. J Bone Joint Surg British. 2008;90(12):1570–5.CrossRef Bardakos NV, Vasconcelos JC, Villar RN. Early outcome of hip arthroscopy for femoroacetabular impingement: the role of femoral osteoplasty in symptomatic improvement. J Bone Joint Surg British. 2008;90(12):1570–5.CrossRef
13.
go back to reference Amanatullah DF, Antkowiak T, Pillay K, Patel J, Refaat M, Toupadakis CA, Jamali AA. Femoroacetabular impingement: current concepts in diagnosis and treatment. Orthopedics. 2015;38(3):185–99.CrossRef Amanatullah DF, Antkowiak T, Pillay K, Patel J, Refaat M, Toupadakis CA, Jamali AA. Femoroacetabular impingement: current concepts in diagnosis and treatment. Orthopedics. 2015;38(3):185–99.CrossRef
14.
go back to reference de Girolamo L, Jannelli E, Fioruzzi A, Fontana A. Acetabular chondral lesions associated with femoroacetabular impingement treated by autologous matrix-induced chondrogenesis or microfracture: a comparative study at 8-year follow-up. Arthrosc: J Arthrosc & Rel Surg Off Publ Arthrosc Assoc North Am Int Arthrosc Assoc. 2018;34(11):3012–23.CrossRef de Girolamo L, Jannelli E, Fioruzzi A, Fontana A. Acetabular chondral lesions associated with femoroacetabular impingement treated by autologous matrix-induced chondrogenesis or microfracture: a comparative study at 8-year follow-up. Arthrosc: J Arthrosc & Rel Surg Off Publ Arthrosc Assoc North Am Int Arthrosc Assoc. 2018;34(11):3012–23.CrossRef
15.
go back to reference Scholes MJ, King MG, Crossley KM, Jones DM, Semciw AI, Mentiplay BF, Heerey JJ, Lawrenson PR, Coburn SL, Johnston RTR, et al. The validity, reliability, and responsiveness of the international hip outcome tool-33 (iHOT-33) in patients with hip and groin pain treated without surgery. Am J Sports Med. 2021;49(10):2677–88.CrossRef Scholes MJ, King MG, Crossley KM, Jones DM, Semciw AI, Mentiplay BF, Heerey JJ, Lawrenson PR, Coburn SL, Johnston RTR, et al. The validity, reliability, and responsiveness of the international hip outcome tool-33 (iHOT-33) in patients with hip and groin pain treated without surgery. Am J Sports Med. 2021;49(10):2677–88.CrossRef
16.
go back to reference Costa RMP, Cardinot TM, Mathias L, Leporace G, de Oliveira LP. Validation of the Brazilian version of the hip outcome score (HOS) questionnaire. Adv Rheumatol (London, England). 2018;58(1):4.CrossRef Costa RMP, Cardinot TM, Mathias L, Leporace G, de Oliveira LP. Validation of the Brazilian version of the hip outcome score (HOS) questionnaire. Adv Rheumatol (London, England). 2018;58(1):4.CrossRef
17.
go back to reference Hjermstad MJ, Fayers PM, Haugen DF, Caraceni A, Hanks GW, Loge JH, Fainsinger R, Aass N, Kaasa S. Studies comparing numerical rating scales, verbal rating scales, and visual analogue scales for assessment of pain intensity in adults: a systematic literature review. J Pain Symptom Manage. 2011;41(6):1073–93.CrossRef Hjermstad MJ, Fayers PM, Haugen DF, Caraceni A, Hanks GW, Loge JH, Fainsinger R, Aass N, Kaasa S. Studies comparing numerical rating scales, verbal rating scales, and visual analogue scales for assessment of pain intensity in adults: a systematic literature review. J Pain Symptom Manage. 2011;41(6):1073–93.CrossRef
18.
go back to reference Herdman M, Gudex C, Lloyd A, Janssen M, Kind P, Parkin D, Bonsel G, Badia X. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual life Res Int J Qual life Aspect Treatment, Care Rehabilit. 2011;20(10):1727–36.CrossRef Herdman M, Gudex C, Lloyd A, Janssen M, Kind P, Parkin D, Bonsel G, Badia X. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual life Res Int J Qual life Aspect Treatment, Care Rehabilit. 2011;20(10):1727–36.CrossRef
19.
go back to reference Realpe AX, Foster NE, Dickenson EJ, Jepson M, Griffin DR, Donovan JL. Patient experiences of receiving arthroscopic surgery or personalised hip therapy for femoroacetabular impingement in the context of the UK fashion study: a qualitative study. Trials. 2021;22(1):211.CrossRef Realpe AX, Foster NE, Dickenson EJ, Jepson M, Griffin DR, Donovan JL. Patient experiences of receiving arthroscopic surgery or personalised hip therapy for femoroacetabular impingement in the context of the UK fashion study: a qualitative study. Trials. 2021;22(1):211.CrossRef
20.
go back to reference Martin SD, Abraham PF, Varady NH, Nazal MR, Conaway W, Quinlan NJ, Alpaugh K. Hip arthroscopy versus physical therapy for the treatment of symptomatic acetabular labral tears in patients older than 40 years: a randomized controlled trial. Am J Sports Med. 2021;49(5):1199–208.CrossRef Martin SD, Abraham PF, Varady NH, Nazal MR, Conaway W, Quinlan NJ, Alpaugh K. Hip arthroscopy versus physical therapy for the treatment of symptomatic acetabular labral tears in patients older than 40 years: a randomized controlled trial. Am J Sports Med. 2021;49(5):1199–208.CrossRef
21.
go back to reference Hunter DJ, Eyles J, Murphy NJ, Spiers L, Burns A, Davidson E, Dickenson E, Fary C, Foster NE, Fripp J, et al. Multi-centre randomised controlled trial comparing arthroscopic hip surgery to physiotherapist-led care for femoroacetabular impingement (FAI) syndrome on hip cartilage metabolism: the Australian FASHIoN trial. BMC Musculoskelet Disord. 2021;22(1):697.CrossRef Hunter DJ, Eyles J, Murphy NJ, Spiers L, Burns A, Davidson E, Dickenson E, Fary C, Foster NE, Fripp J, et al. Multi-centre randomised controlled trial comparing arthroscopic hip surgery to physiotherapist-led care for femoroacetabular impingement (FAI) syndrome on hip cartilage metabolism: the Australian FASHIoN trial. BMC Musculoskelet Disord. 2021;22(1):697.CrossRef
22.
go back to reference Palmer AJR, Ayyar Gupta V, Fernquest S, Rombach I, Dutton SJ, Mansour R, Wood S, Khanduja V, Pollard TCB, McCaskie AW, et al. Arthroscopic hip surgery compared with physiotherapy and activity modification for the treatment of symptomatic femoroacetabular impingement: multicentre randomised controlled trial. BMJ (Clinic Res ed). 2019;364: l185.CrossRef Palmer AJR, Ayyar Gupta V, Fernquest S, Rombach I, Dutton SJ, Mansour R, Wood S, Khanduja V, Pollard TCB, McCaskie AW, et al. Arthroscopic hip surgery compared with physiotherapy and activity modification for the treatment of symptomatic femoroacetabular impingement: multicentre randomised controlled trial. BMJ (Clinic Res ed). 2019;364: l185.CrossRef
23.
go back to reference Mansell NS, Rhon DI, Meyer J, Slevin JM, Marchant BG. Arthroscopic surgery or physical therapy for patients with femoroacetabular impingement syndrome: a randomized controlled trial with 2-year follow-up. Am J Sports Med. 2018;46(6):1306–14.CrossRef Mansell NS, Rhon DI, Meyer J, Slevin JM, Marchant BG. Arthroscopic surgery or physical therapy for patients with femoroacetabular impingement syndrome: a randomized controlled trial with 2-year follow-up. Am J Sports Med. 2018;46(6):1306–14.CrossRef
24.
go back to reference Griffin DR, Dickenson EJ, Wall PDH, Achana F, Donovan JL, Griffin J, Hobson R, Hutchinson CE, Jepson M, Parsons NR, et al. Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome (UK FASHIoN): a multicentre randomised controlled trial. Lancet (London, England). 2018;391(10136):2225–35.CrossRef Griffin DR, Dickenson EJ, Wall PDH, Achana F, Donovan JL, Griffin J, Hobson R, Hutchinson CE, Jepson M, Parsons NR, et al. Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome (UK FASHIoN): a multicentre randomised controlled trial. Lancet (London, England). 2018;391(10136):2225–35.CrossRef
25.
go back to reference Lee-Robichaud H, Thomas K, Morgan J, Nelson RL. Lactulose versus polyethylene glycol for chronic constipation. Cochrane Database Syst Rev. 2010;7:cd007570. Lee-Robichaud H, Thomas K, Morgan J, Nelson RL. Lactulose versus polyethylene glycol for chronic constipation. Cochrane Database Syst Rev. 2010;7:cd007570.
26.
go back to reference Levy DM, Kuhns BD, Chahal J, Philippon MJ, Kelly BT, Nho SJ. Hip arthroscopy outcomes with respect to patient acceptable symptomatic state and minimal clinically important difference. Arthrosc J Arthrosc & Relat Surg Off Publ Arthrosc Assoc North Am Int Arthrosc Assoc. 2016;32(9):1877–86.CrossRef Levy DM, Kuhns BD, Chahal J, Philippon MJ, Kelly BT, Nho SJ. Hip arthroscopy outcomes with respect to patient acceptable symptomatic state and minimal clinically important difference. Arthrosc J Arthrosc & Relat Surg Off Publ Arthrosc Assoc North Am Int Arthrosc Assoc. 2016;32(9):1877–86.CrossRef
27.
go back to reference Trigg SD, Schroeder JD, Hulsopple C. Femoroacetabular impingement syndrome. Curr Sports Med Rep. 2020;19(9):360–6.CrossRef Trigg SD, Schroeder JD, Hulsopple C. Femoroacetabular impingement syndrome. Curr Sports Med Rep. 2020;19(9):360–6.CrossRef
28.
go back to reference Krych AJ, Thompson M, Knutson Z, Scoon J, Coleman SH. Arthroscopic labral repair versus selective labral debridement in female patients with femoroacetabular impingement: a prospective randomized study. Arthrosc J Arthrosc & Relat Surg Off Publ Arthrosc Assoc North Am Int Arthrosc Assoc. 2013;29(1):46–53.CrossRef Krych AJ, Thompson M, Knutson Z, Scoon J, Coleman SH. Arthroscopic labral repair versus selective labral debridement in female patients with femoroacetabular impingement: a prospective randomized study. Arthrosc J Arthrosc & Relat Surg Off Publ Arthrosc Assoc North Am Int Arthrosc Assoc. 2013;29(1):46–53.CrossRef
29.
go back to reference Bastos RM, de Carvalho Júnior JG, da Silva SAM, Campos SF, Rosa MV, de Moraes PB. Surgery is no more effective than conservative treatment for Femoroacetabular impingement syndrome: Systematic review and meta-analysis of randomized controlled trials. Clin Rehabil. 2021;35(3):332–41.CrossRef Bastos RM, de Carvalho Júnior JG, da Silva SAM, Campos SF, Rosa MV, de Moraes PB. Surgery is no more effective than conservative treatment for Femoroacetabular impingement syndrome: Systematic review and meta-analysis of randomized controlled trials. Clin Rehabil. 2021;35(3):332–41.CrossRef
30.
go back to reference Qiao HY, Zhang YH, Ren YM, Tian MQ. Arthroscopic versus open treatment for femoroacetabular impingement: A systematic review and meta-analyses. Medicine. 2020;99(47): e23364.CrossRef Qiao HY, Zhang YH, Ren YM, Tian MQ. Arthroscopic versus open treatment for femoroacetabular impingement: A systematic review and meta-analyses. Medicine. 2020;99(47): e23364.CrossRef
31.
go back to reference Schwabe MT, Clohisy JC, Cheng AL, Pascual-Garrido C, Harris-Hayes M, Hunt DM, Harris MD, Prather H, Nepple JJ. Short-term clinical outcomes of hip arthroscopy versus physical therapy in patients with femoroacetabular impingement: a systematic review and meta-analysis of randomized controlled trials. Orthop J Sports Med. 2020;8(11):2325967120968490.CrossRef Schwabe MT, Clohisy JC, Cheng AL, Pascual-Garrido C, Harris-Hayes M, Hunt DM, Harris MD, Prather H, Nepple JJ. Short-term clinical outcomes of hip arthroscopy versus physical therapy in patients with femoroacetabular impingement: a systematic review and meta-analysis of randomized controlled trials. Orthop J Sports Med. 2020;8(11):2325967120968490.CrossRef
32.
go back to reference Dwyer T, Whelan D, Shah PS, Ajrawat P, Hoit G, Chahal J. Operative versus nonoperative treatment of femoroacetabular impingement syndrome: a meta-analysis of short-term outcomes. Arthrosc J Arthrosc & Relat Surg Off Publ Arthrosc Assoc North Am Int Arthrosc Assoc. 2020;36(1):263–73.CrossRef Dwyer T, Whelan D, Shah PS, Ajrawat P, Hoit G, Chahal J. Operative versus nonoperative treatment of femoroacetabular impingement syndrome: a meta-analysis of short-term outcomes. Arthrosc J Arthrosc & Relat Surg Off Publ Arthrosc Assoc North Am Int Arthrosc Assoc. 2020;36(1):263–73.CrossRef
33.
go back to reference Kim CH, Moon JK, Yoon JY, Lee S, Kim WJ, Kim HS, Lee SJ, Yoon PW. Arthroscopy versus nonoperative treatment of symptomatic femoroacetabular impingement syndrome: A protocol for systematic review and meta-analysis. Medicine. 2020;99(49): e23247.CrossRef Kim CH, Moon JK, Yoon JY, Lee S, Kim WJ, Kim HS, Lee SJ, Yoon PW. Arthroscopy versus nonoperative treatment of symptomatic femoroacetabular impingement syndrome: A protocol for systematic review and meta-analysis. Medicine. 2020;99(49): e23247.CrossRef
Metadata
Title
Conservative therapy versus arthroscopic surgery of femoroacetabular impingement syndrome (FAI): a systematic review and meta-analysis
Authors
Yanlin Zhu
Peng Su
Tianhao Xu
Lei Zhang
Weili Fu
Publication date
01-12-2022
Publisher
BioMed Central
Published in
Journal of Orthopaedic Surgery and Research / Issue 1/2022
Electronic ISSN: 1749-799X
DOI
https://doi.org/10.1186/s13018-022-03187-1

Other articles of this Issue 1/2022

Journal of Orthopaedic Surgery and Research 1/2022 Go to the issue