TY - JOUR
T1 - Osteochondroplasty and Labral Repair for the Treatment of Young Adults With Femoroacetabular Impingement
T2 - A Randomized Controlled Trial
AU - Femoroacetabular Impingement Randomized Controlled Trial (FIRST) Investigators
AU - Ayeni, Olufemi R.
AU - Karlsson, Jon
AU - Heels-Ansdell, Diane
AU - Thabane, Lehana
AU - Musahl, Volker
AU - Simunovic, Nicole
AU - Duong, Andrew
AU - Bhandari, Mohit
AU - Bedi, Asheesh
AU - Jarvinen, Teppo
AU - Naudie, Douglas
AU - Seppanen, Matti
AU - Slobogean, Gerard
AU - Skelly, Matthew
AU - Shanmugaraj, Ajay
AU - Crouch, Sarah
AU - Sprague, Sheila
AU - Buckingham, Lisa
AU - Ramsay, Tim
AU - Lee, John
AU - Kousa, Petteri
AU - Carsen, Sasha
AU - Choudur, Hema
AU - Sim, Yan
AU - Johnston, Kelly
AU - Ayeni, Olufemi R.
AU - Wong, Ivan
AU - Murphy, Ryland
AU - Sparavalo, Sara
AU - Whelan, Daniel
AU - Khan, Ryan
AU - Wood, Gavin C. A.
AU - Howells, Fiona
AU - Sihvonen, Raine
AU - Raivio, Marko
PY - 2021/1
Y1 - 2021/1
N2 - Background:Femoroacetabular impingement (FAI) is a condition known to cause hip pain in young adults.Purpose:To evaluate the efficacy of the surgical correction of FAI via arthroscopic osteochondroplasty with or without labral repair compared with arthroscopic lavage of the hip joint with or without labral repair.Study Design:Randomized controlled trial; Level of evidence, 1.Methods:A total of 220 male and female participants aged 18 to 50 years with nonarthritic FAI suitable for surgical treatment were recruited for the trial at 10 clinical centers in Canada, Finland, and Denmark between October 2012 and November 2017, of whom 214 were included in the final analysis. In the osteochondroplasty group, cam- and/or pincer-type lesions were resected using fluoroscopic guidance. In the lavage group, the joint was washed out with 3 L of normal saline. Surgeons were instructed to repair the labrum in both groups if it was mechanically unstable once probed, showing visible displacement or chondrolabral separation. The primary outcome was patient-reported pain (using the 100-point visual analog scale [VAS]) at 12 months. Secondary outcomes included hip function (Hip Outcome Score [HOS] and International Hip Outcome Tool), physical and mental health (12-Item Short Form Health Survey), and health utility (EuroQol-5 Dimensions) at 12 months as well as any reoperations and other hip-related adverse events at 24 months.Results:At 12 months, there was no difference in pain (VAS) between the groups (mean difference [MD], 0.11 [95% CI, -7.22 to 7.45]; P = .98). Also, 88.3% (189/214) of participants had a labral tear, of which 60.3% were repaired. For the secondary outcomes, there were no significant differences between treatment groups, with the exception of the HOS activities of daily living domain in which lavage showed significant improvement compared with osteochondroplasty (MD, -5.03 [95% CI, -10.40 to -0.03]; P = .049). By 24 months, there were significantly fewer reoperations reported in the osteochondroplasty group (8/105) than the lavage group (19/104) (odds ratio, 0.37 [95% CI, 0.15-0.89]; P = .026). The primary reasons for a reoperation included hip pain (15/27; 55.6%) and a reinjury of the labrum (11/27; 40.7%).Conclusion:Both the osteochondroplasty and the lavage groups with or without labral repair for FAI had significantly improved pain or function significantly at 1 year. By 2 years, the reoperation rate was significantly lower in the osteochondroplasty group.Registration:NCT01623843 ( identifier)
AB - Background:Femoroacetabular impingement (FAI) is a condition known to cause hip pain in young adults.Purpose:To evaluate the efficacy of the surgical correction of FAI via arthroscopic osteochondroplasty with or without labral repair compared with arthroscopic lavage of the hip joint with or without labral repair.Study Design:Randomized controlled trial; Level of evidence, 1.Methods:A total of 220 male and female participants aged 18 to 50 years with nonarthritic FAI suitable for surgical treatment were recruited for the trial at 10 clinical centers in Canada, Finland, and Denmark between October 2012 and November 2017, of whom 214 were included in the final analysis. In the osteochondroplasty group, cam- and/or pincer-type lesions were resected using fluoroscopic guidance. In the lavage group, the joint was washed out with 3 L of normal saline. Surgeons were instructed to repair the labrum in both groups if it was mechanically unstable once probed, showing visible displacement or chondrolabral separation. The primary outcome was patient-reported pain (using the 100-point visual analog scale [VAS]) at 12 months. Secondary outcomes included hip function (Hip Outcome Score [HOS] and International Hip Outcome Tool), physical and mental health (12-Item Short Form Health Survey), and health utility (EuroQol-5 Dimensions) at 12 months as well as any reoperations and other hip-related adverse events at 24 months.Results:At 12 months, there was no difference in pain (VAS) between the groups (mean difference [MD], 0.11 [95% CI, -7.22 to 7.45]; P = .98). Also, 88.3% (189/214) of participants had a labral tear, of which 60.3% were repaired. For the secondary outcomes, there were no significant differences between treatment groups, with the exception of the HOS activities of daily living domain in which lavage showed significant improvement compared with osteochondroplasty (MD, -5.03 [95% CI, -10.40 to -0.03]; P = .049). By 24 months, there were significantly fewer reoperations reported in the osteochondroplasty group (8/105) than the lavage group (19/104) (odds ratio, 0.37 [95% CI, 0.15-0.89]; P = .026). The primary reasons for a reoperation included hip pain (15/27; 55.6%) and a reinjury of the labrum (11/27; 40.7%).Conclusion:Both the osteochondroplasty and the lavage groups with or without labral repair for FAI had significantly improved pain or function significantly at 1 year. By 2 years, the reoperation rate was significantly lower in the osteochondroplasty group.Registration:NCT01623843 ( identifier)
KW - osteochondroplasty
KW - lavage
KW - femoroacetabular impingement
KW - randomized controlled trial
U2 - 10.1177/0363546520952804
DO - 10.1177/0363546520952804
M3 - Article
SN - 0363-5465
VL - 49
SP - 25
EP - 34
JO - The American Journal of Sports Medicine
JF - The American Journal of Sports Medicine
IS - 1
ER -
