S. Rawal1, S. Alothman2, P. Vogrin3, H. Cecelia3, S. Vollbrecht3, M. Jones3
1University of Saint Mary, Physical Therapy, Leavenworth, United States, 2Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia, 3University of Saint Mary, Leavenworth, United States
Background: Femoroacetabular impingement syndrome (FAIS) refers to an arthrokinematic discrepancy in hip movement in which the femoral head and acetabulum have increased contact, which can cause pain, induce osteoarthritis, and reduce quality of life. Between 2005 and 2013, surgical procedures for the treatment of FAIS increased by 465% in North America and until recent years, research comparing conservative management and surgical treatment has been limited.
Purpose: This systematic review aims to describe optimal management methods for FAIS, comparing physical therapy to arthroscopic surgery.
Methods: Cinahl, Ebsco, Medline, PubMed, Sport Discus, and Cochrane Review databases were searched. Four randomized control trials published within the last 10 years met the inclusion criteria of a 7/10 PEDro score, diagnosis of FAIS across all subjects, and the comparison of arthroscopy to physical therapy. Studies were excluded if a labral pathology or chronic arthritic hip pain was the main impairment. The total number of subjects included is this review is 481.
Results: Each randomized control trial directly compared physical therapy interventions to arthroscopic surgery. Physical therapy interventions included patient education, pain relief, core stabilization, movement control, hip mobilizations, gait retraining, hip strengthening, and hip mobility exercises. Arthroscopic surgery interventions included acetabuloplasty, femoroplasty, osteoplasty, labral repair, and debridement. Different outcome measures were utilized, with International Hip Outcome Tool (iHOT-33), Hip Outcome Score for Activities of Daily Living (HOS ADL), and Hip Outcome Score for Sport (HOS Sport) being the most common. In 2 of the 4 studies, iHOT-33 scores improved in both the surgical and conservative groups with no clinically significant difference between groups. One study found a significant difference between groups in the HOS ADL scale in favor of physical therapy. Long term results in three of the studies concluded that physical therapy and surgery with postoperative physical therapy yielded improvements in outcome measures.
Conclusion(s): Our research has determined that both conservative physical therapy and hip arthroscopy are successful interventions in the treatment of FAIS and restoring hip related quality of life. Further research is indicated to continue investigating optimal treatment for this condition.
Implications: This systematic review will serve as a guide for physical therapists who are treating patients experiencing FAIS and as a resource for evidence-based management of this condition. It is clinically relevant for physical therapists to understand when to refer patients for surgery when conservative management yields diminishing returns.
Funding, acknowledgements: There is no funding to disclose for this study.
Keywords: Femoroacetabular impingement syndrome, physical therapy, arthroscopic surgery
Topic: Musculoskeletal
Did this work require ethics approval? No
Institution: n/a
Committee: n/a
Reason: n/a
All authors, affiliations and abstracts have been published as submitted.
