Reviewed by Tyler Tice, PT, DPT, OCS, ATC
Introduction
Surgery for FAIS has increased over the past 10 years. It is important to understand the long term effects of surgery versus nonoperative management to reduce financial impacts on patients and insurance. This study aims to compare the 2-year outcomes of patients who underwent arthroscopic surgery or supervised PT and its implications on disability, costs, and return-to-work status.
Methods
This study consisted of 80 patients seeking care at Madigan Army Medical Center between the ages of 18-60 years. All patients were required to attend informational session about recent evidence of FAIS management prior to randomization. The PT group had 2 sessions per week for 12 weeks, and the surgical group was provided the most appropriate surgery according to the orthopedic surgeon. Data was collected at 6 months, 1 year, and 2 years using the Hip Outcome Score (HOS), the International Hip Outcome Tool (iHOT-33), and the Global Rating of Change (GRC).
Results
Out of 80 patients 66 patients (38 from surgical group, 28 from rehab group) underwent surgery. There was no significant difference between the groups at 2-year follow-up on the HOS or iHOT-33. There was a significant improvement from baseline to 1 and 2 years on the HOS ADL subscale in the PT group. No significant difference was found between the surgery group and nonoperative group at 2 years on the HOS ADL and sport subscales or iHOT-33. Following hip-related care, about half of those on active duty returned to work with no significant difference between the groups.
Discussion
The study found no significant difference in outcomes between the two groups at 2 years and the mean perception of both groups showed no improvement. The results of this study is skewed due to the amount of crossover from the PT group into surgery, making type II errors more likely.
Conclusion
Regardless of treatment randomized or ultimately chosen by the patient, the results were similar within both groups. No meaningful change was perceived but there were patients in each group that showed improvements. Future studies should analyze the factors contributing to cross-over effect and successes between each type of surgery for FAIS.
Reference
Mansell, N.S., Meyer, J., Slevin, J.M., & Marchant, B.G. (2018). Arthroscopic Surgery or Physical Therapy for Patients With Femoroacetabular Impingement Syndrome: A Randomized Control Trial with 2-year Follow-up. The American Journal of Sports Medicine, 46(6), 1306-1314. DOI: 10.1177/0363546517751912