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What Patients with Femoroacetabular Impingement Need Most

Posted on: 10/17/2012
Sometimes in life, there are more answers than there are questions. Orthopedic surgeons certainly face their share of unknowns with many different kinds of problems. Take the treatment of femoroacetabular impingement (FAI) for example. Best practice and guidelines for clinical practice based on high-quality evidence just aren't available for this condition. As this recent review shows, a more consistent approach to research and study of FAI is needed.

Femoroacetabular impingement (FAI) occurs in the hip joint. Impingement refers to some portion of the soft tissue around the hip socket getting pinched or compressed. Femoroacetabular tells us the impingement is occurring where the femur (thigh bone) meets the acetabulum (hip socket). There are several different types of impingement. They differ slightly depending on what gets pinched and where the impingement occurs.

Once the diagnosis has been made and all the test results are available, a course of action is determined. This may be conservative (nonoperative) care with antiinflammatories and physical therapy. In some cases, surgery is recommended right away. Early diagnosis and surgical correction may be able to restore normal hip motion.

Delaying surgery is possible for other patients but the long-term effect(s) of putting surgery off have not been determined. There is concern for the development of osteoarthritis without treatment or with delayed treatment. The current data related to hip deformity and osteoarthritis is the specific focus of this review study. The authors point out that whether someone with FAI will develop osteoarthritis, how soon, and how severe remain some of the unknowns with this condition.

Taking a look at the studies done so far, they were unable to add much new to the surgeon's understanding of the diagnosis, treatment, and outcomes for FAI. Why is that? You might think with all the latest developments in technology, it would be possible to document and follow everything that is going on with these patients. And, in theory, that is true. But the key is in data collection.

For studies to generate useful information, it is necessary for everyone to collect and report on the same types of data. This is called standardization of data collection. For example, patients can vary tremendously in the type and severity of hip impingement. Patients can be professional athletes or stay-at-home parents so the goals and hoped for results may be different from one patient to another and one group to another.

The way surgeons measure disease severity isn't always the same. The type of surgery performed and the way surgery is performed (open versus arthroscopic) can vary. Even the way the surgery is described differs in published studies. Finally, documentation and reporting of complications are not similar enough from study-to-study to combine the results toward any useful conclusions or recommendations.

What can be done to correct this problem? What we need is a universal, consistent, and standard way to collect, process, and analyze data in order to shape treatment and provide successful outcomes. The studies must use reliable tools to measure pain and level of activity as appropriate outcome measures for patients with femoroacetabular impingement (FAI).

With long-term data reporting, it will be possible to see the natural history (what happens over time) with FAI, determine who is getting the best results and why, and thus guide treatment decisions. This type of approach could make it possible for surgeons to predict which patients will do best with conservative (nonoperative) care or surgery. If surgery is deemed best, then the same process can aid in determining what approach is best: an open procedure or an arthroscopic approach?

In summary, based on currently published studies of femoroacetabular impingement (FAI), there is a clear need for long-term data collection that is standardized across all studies. Only then will the goal be met to provide best practice and thus best outcomes for the treatment of all patients with FAI.

References:
Ernest L. Sink, MD, and Young-Jo Kim, MD, PhD. Femoroacetabular Impingement: Current Clinical Evidence. In Journal of Pediatric Orthopaedics. September. Vol. 32. No. 2. Supplement. Pp. S166-S171.

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