Nonoperative Management of Femoroacetabular Impingement: Clinical Outcomes at 5-years – A Prospective Study 2021 POSNA Annual Meeting – Best Clinical Award Paper

Abstract

Purpose: Our purpose is to present 5-year outcomes data utilizing a nonoperative protocol on a consecutive series of patients with FAI syndrome.

Methods: Between 2013 and 2016, patients were prospectively recruited in a nonoperative FAI study. The protocol consisted of an initial trial of rest, physical therapy, and activity modification. Patients who remained symptomatic were offered an intraarticular steroid injection. Patients with recurrent symptoms were offered arthroscopic treatment. Patient-reported outcomes, including the modified Harris Hip Score (mHHS) and Nonarthritic Hip Score (NAHS), were collected 1-, 2-, and 5-years after enrollment. We present the 5-year data. Statistical analysis was performed to determine outcomes based on FAI type and treatment.

Results: One hundred thirty-three hips in 100 patients were enrolled. Sixty-seven hips in 50 patients were available for 5-year follow-up. At enrollment, the mean mHHS and NAHS were 69.6±13.1 and 76.3±14.7, respectively. In total, 73% of the cohort was managed nonoperatively. Of the 11 patients requiring surgery, six (55%) converted to surgery within 1 year of enrollment, four (36%) converted to surgery between 1 and 2 years, and one patient converted to surgery between 2 and 5 years. At final follow-up, the mean mHHS and NAHS were 89.6±10.7 and 88.0±12.1, respectively. At 1-year follow-up, only the activity modification group made a significant increase in mHHS and NAHS (p<0.03). By 2-year follow-up, all three treatment groups had made statistically significant improvements in mHHS and NAHS (p<0.05). By 5-year follow-up, the activity modification group and the scope group had maintained their statistically significant improvement in mHHS and NAHS (p<0.03). There was no significant difference in mHHS or NAHS between treatment groups at 5-year follow-up (p>0.4) (Table 1) and no difference in proportion of hips meeting the MCID for mHHS based on treatment course (p=0.961). There was no difference in mHHS or NAHS between FAI types at any time point (p>0.06) (Table 2) or in the proportion of hips that met MCID among FAI types (p=0.511). Seventy-two percent of patients returned to the same or similar sport/activity level, and there was no difference in the proportion of patients that returned to sports/activities among treatment type (p=0.095) or FAI type (p=0.273).

Conclusions: Nonoperative management of FAI syndrome is effective in a majority of adolescent patients with robust improvements in patient-reported outcomes persisting at 5-year follow-up.

Significance: Nonoperative management can be successful for a large portion of adolescent patients with symptomatic FAI syndrome with durable outcomes at 5-year follow-up.