A Physical Therapy Program Versus Surgery for Femoroacetabular Impingement: Randomized Clinical Trial
Condition: Femoroacetabular Impingement
MeSH terms: Femoracetabular Impingement
Study type: Interventional

Summary: 
      The purpose of this study is to compare the outcomes for patients that receive two different
      treatments used for FAI (Femoroacetabular Impingement). The programs are 1) a 6-week
      supervised physical therapy program and 2) arthroscopic surgery. Enrollment is limited to
      patients that have already been determined surgical candidates. The study is following
      patients for a 2-year period.
    

Detailed description: 
      This study plans to enroll a total of 60 Tricare beneficiaries primarily from the Madigan
      Healthcare System with a diagnosis of FAI that are surgical candidates and have already
      failed at least six weeks of conservative treatment.

      This is a randomized controlled study comparing outcomes for the standard treatment for FAI
      and/or acetabular labral pathology (arthroscopy with or without labral repair) versus
      physical therapy. For subjects in the arthroscopy group, the surgery will be performed by the
      Orthopedic Surgical Service at Madigan Army Medical Center.

      Subjects randomized to the physical therapy group will follow a treatment plan implemented by
      a physical therapist within the Madigan Army Healthcare System.

      After consent, subjects will be randomized into one of two arms (Group I = hip arthroscopy,
      Group II = physical therapy). Group I will undergo hip arthroscopy with or without labral
      repair. Group II will follow a FAI-based physical therapy program x 12 sessions (6 weeks).

      The arthroscopy group will complete outcome measures at time of consent and following surgery
      at 6 months, 1 year and 2 year time periods. Subjects in this group will follow a
      standardized post-operative rehabilitation protocol.

      The physical therapy group will complete outcomes measures at time of consent and at 6 month,
      1 year and 2 year time periods following the initial physical therapy evaluation. Subjects in
      this group will complete 6 weeks of an impairment-based physical therapy program.

      In addition to the outcome measures taken, healthcare utilization and associated costs for
      hip-related care during this 2-year period will also calculated for comparison between the 2
      groups.
    

Intervention name(s): Arthroscopic Surgery; Physical Therapy
Intervention type(s): Procedure; Procedure
Intervention description(s): The hip arthroscopy will consist of acetabular rim trimming, labral repair or debridement and femoroplasty, all as indicated based on the surgeon's clinical judgment with input from pre-operative imaging, exam findings and intra-operative findings.; Subjects will participate in two 45-minute sessions for six weeks (total of 12 sessions). The physical therapy treatment plan will be based on individual impairments identified during the initial evaluation, and include manual therapy to the hip, lumbar spine, and pelvis, as well as therapeutic exercise all tailored to individual patient impairments.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: FAI; femoroacetabular impingement; hip pain; hip arthroscopy; physical therapy