Arthroscopic hip surgery compared with personalised hip therapy in people over 16 years old with femoroacetabular impingement syndrome: UK FASHIoN RCT

• Published in: Health technology assessment (Winchester, England) England), 2022-02, Vol.26 (16), p.1-236
• Main Authors: Griffin, Damian R, Dickenson, Edward J, Achana, Felix, Griffin, James, Smith, Joanna, Wall, Peter Dh, Realpe, Alba, Parsons, Nick, Hobson, Rachel, Fry, Jeremy, Jepson, Marcus, Petrou, Stavros, Hutchinson, Charles, Foster, Nadine, Donovan, Jenny
• Format: Article
• Language: English
• Subjects: Adolescent; Arthroscopy; Cost-Benefit Analysis; Femoracetabular Impingement - surgery; femoroacetabular impingement; hip arthroscopy; Humans; Pain; physiotherapy; Quality of Life; United Kingdom; Young Adult
• ISSN: 1366-5278; 2046-4924
• DOI: 10.3310/FXII0508

Femoroacetabular impingement syndrome is an important cause of hip pain in young adults. It can be treated by arthroscopic hip surgery or with physiotherapist-led conservative care. To compare the clinical effectiveness and cost-effectiveness of hip arthroscopy with best conservative care. The UK FASHIoN (full trial of arthroscopic surgery for hip impingement compared with non-operative care) trial was a pragmatic, multicentre, randomised controlled trial that was carried out at 23 NHS hospitals. Participants were included if they had femoroacetabular impingement, were aged ≥ 16 years old, had hip pain with radiographic features of cam or pincer morphology (but no osteoarthritis) and were believed to be likely to benefit from hip arthroscopy. Participants were randomly allocated (1 : 1) to receive hip arthroscopy followed by postoperative physiotherapy, or personalised hip therapy (i.e. an individualised physiotherapist-led programme of conservative care). Randomisation was stratified by impingement type and recruiting centre using a central telephone randomisation service. Outcome assessment and analysis were masked. The primary outcome was hip-related quality of life, measured by the patient-reported International Hip Outcome Tool (iHOT-33) 12 months after randomisation, and analysed by intention to treat. Between July 2012 and July 2016, 648 eligible patients were identified and 348 participants were recruited. In total, 171 participants were allocated to receive hip arthroscopy and 177 participants were allocated to receive personalised hip therapy. Three further patients were excluded from the trial after randomisation because they did not meet the eligibility criteria. Follow-up at the primary outcome assessment was 92% (  = 319; hip arthroscopy,  = 157; personalised hip therapy,  = 162). At 12 months, mean International Hip Outcome Tool (iHOT-33) score had improved from 39.2 (standard deviation 20.9) points to 58.8 (standard deviation 27.2) points for participants in the hip arthroscopy group, and from 35.6 (standard deviation 18.2) points to 49.7 (standard deviation 25.5) points for participants in personalised hip therapy group. In the primary analysis, the mean difference in International Hip Outcome Tool scores, adjusted for impingement type, sex, baseline International Hip Outcome Tool score and centre, was 6.8 (95% confidence interval 1.7 to 12.0) points in favour of hip arthroscopy (  = 0.0093). This estimate of treatment effect exceeded the