Arthroscopic surgery versus physiotherapy for femoroacetabular impingement: a meta-analysis study
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REVIEW ARTICLE
Arthroscopic surgery versus physiotherapy for femoroacetabular impingement: a meta‑analysis study Matthias Gatz1 · Arne Driessen1 · Jörg Eschweiler1 · Markus Tingart1 · Filippo Migliorini1 Received: 8 March 2020 / Accepted: 21 April 2020 © The Author(s) 2020
Abstract Introduction Femoroacetabular impingement (FAI) is thought to play an important role in the development of hip osteoarthritis. However, there is no consensus about the optimal treatment options, since non-operative therapy such as physiotherapy and surgical treatment such as arthroscopic hip surgery can both improve symptoms. Therefore, the aim of the present meta-analysis was to compare the outcomes between two different treatment regimes; physiotherapy versus arthroscopic treatment for FAI. Methods The present meta-analysis was carried out according to the PRISMA guidelines. In November 2019, the main online databases were accessed. All the randomized clinical trials (RCTs) comparing surgical arthroscopic treatment versus physiotherapy for FAI were considered for inclusion. Only articles reporting quantitative data under the outcomes of interest were included. For the all analysis, we used Review Manager Software. Data from 644 patients were analysed. Results Data from 644 patients were evaluated with a mean follow-up of 14.67 ± 8.3 months. The unpaired t test detected an optimal baseline comparability in terms of side, gender, years, duration of symptoms and BMI (p = 0.08–0.9). The VAS subscale of the score EQ-5D and the mean iHOT33 reported favourable values in the arthroscopic group (p = 0.03 and p 0.5 and I2 > 60% heterogeneity affected considerably the results. A fixed model effect was set in all the comparisons. In event of high heterogeneity, a random model effect was used. The confidence interval (CI) was set at 95% in all the comparisons. Values of p 2 mm (5) positive crossover sign (6) alpha angle > 50° (6) failed 6 weeks of conservative management
Inclusion criteria
Table 1 Demographic assessment of the included studies
24 ± 142
Conserva- 11 tive
57:43
61:39
Previous Right: symptoms left (%) duration (months) 41 ± 62
Procedures (n)
63
Arthroscopy
Intervention
42.9
40.9
Female (%)
29.4
30.3
32.9
27.7
Mean age Mean BMI
(1) Acetabuloplasty (2) labral repair/ debridement (3) femoroplasty
Surgical technique
(1) 12 sessions with a physical therapist (2) personalised impairmentbased treatment plan (3) joint mobilisations, mobilisation with motion, therapeutic exercise, soft tissue mobility, stretching and motor control exercises to address the identified impairments (4) additional home training
Rehabilitation program
European Journal of Orthopaedic Surgery & Traumatology
13
Type of deformity
Pincer (27) Cam (262) Mixed (59)
Journal
The Lancet
Author, year, (study title)
Griffin et al. 2018 [11] (UK FASHIoN)
Table 1 (continued)
13 Exclusion criteria
Mean follow-up (months)
(1) Osteoar- 12 (1) Age > 16 thritis (2) (2) hip pain congenital/ (3) alpha adolescent angle > 55° hip dis(4) late
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