Effectiveness of Hip Arthroscopy on Treatment of Femoroacetabular Impingement Syndrome: A Meta-Analysis of Randomized Controlled Trials

Objective To appraise the highest available evidence provided by randomized controlled trials (RCTs) on the effectiveness of hip arthroscopy versus physical therapy in patients with femoroacetabular impingement syndrome (FAIS). Methods Four databases (Medline, Embase, Web of Science, and Scopus) were systematically searched until October 1, 2019. Eligible studies were RCTs in which patients with FAIS underwent hip arthroscopy or physical therapy. The study outcome was the International Hip Outcome Tool, 33 Items (iHOT-33) score, a measure of hip pain, function, and quality of life, assessed at baseline and at the follow-up closer to 12 months after randomization. The pooled mean difference in iHOT-33 scores within and between the treatment arms was computed using a random effects model. The minimum clinically important difference in the iHOT-33 scores was set at 10 points. Results Three RCTs evaluating iHOT-33 scores between 6 and 8 months after the interventions were included. Significant increases in iHOT-33 scores were observed from baseline to follow-up for both hip arthroscopy (22.3 points [95% confidence interval (95% CI) 17.3-27.4]) and physical therapy (13.0 points [95% CI 9.5-16.4]). Hip arthroscopy demonstrated significantly higher iHOT-33 scores at follow-up compared with physical therapy (10.9 points [95% CI 4.7-17.0]). Conclusion Both hip arthroscopy and physical therapy resulted in statistically and clinically significant short-term improvements in hip pain, function, and quality of life in patients with FAIS. Hip arthroscopy was statistically superior to physical therapy in improving the outcome at follow-up even if improvement may not be detected by patients.