Hip
FIRST
Femoroacetabular Impingement RandomiSed controlled Trial (FIRST): A Multi-Centre Randomized Controlled Trial Comparing Arthroscopic Lavage and Arthroscopic Osteochondroplasty on Patient Important Outcomes and Quality of Life in the Treatment of Young Adult (18-50) Femoroacetabular Impingement
Several cross-sectional studies have estimated that the prevalence of femoroacetabular impingement (FAI) ranges from 14-17% among asymptomatic young adults to almost 95% among competitive athletes. With FAI, there is abnormal contact between the proximal femur and the acetabulum, resulting in abnormal mechanics with terminal motion such as hip flexion and rotation. This condition results from bony anomalies of the acetabular rim (Pincer) and or femoral head/neck junction (CAM) and typically causes hip pain and decreased hip function.
The development of hip pain potentially serves as an indicator for early cartilage and labral damage that may result in hip osteoarthritis. Although surgical correction of the misshaped bony anatomy and associated intra-articular soft tissue damage of the hip is thought to improve hip pain and alter the natural history of degenerative disease, the supportive evidence is based upon low quality observational studies.
The Femoroacetabular Impingement RandomiSed controlled Trial (FIRST) compares outcomes following surgical correction of the impingement morphology (arthroscopic osteochondroplasty) with/without labral repair versus arthroscopic lavage of the hip joint in adults aged 18 to 50 diagnosed with FAI.
PREVIEW
Prospective Evaluation of Sport Activity and the Development of Femoroacetabular Impingement in the Adolescent Hip
Femoroacetabular impingement (FAI) is an important cause of hip pain in young and active individuals and occurs as a result of size and shape mismatch between the femoral head and acetabulum. Open physes in children can make hips more susceptible to injury, and high impact forces have been suggested to affect the developing femur. The diagnosis of FAI has recently risen, especially within adolescent populations, and there is an increasing trend towards year-round participation in sports with early specialization.
The PREVIEW study is an international longitudinal study designed to determine the association between sport specialization in adolescence and the development of hip impingement.
This is a multicentre prospective cohort study evaluating 200 participants between the ages of 12–14 that include sport specialists at the moderate to vigorous physical activity (MVPA) level and non-sport specialists at any activity level. The primary outcome is the incidence of FAI between groups at 2 years, determined via MRI. Secondary outcomes include hip function and health-related quality of life between subjects diagnosed with FAI versus no FAI at 2 years.
It is important to mitigate the risk of developing hip deformities at a young age. Our proposed prospective evaluation of the impact of sport activity and hip development is relevant in this era of early sport specialization in youth. Improving the understanding between sport specialization and the development of pre-arthritic hip disease such as FAI can lead to the development of training protocols that protect the millions of adolescents involved in sports annually.
DEFINE
Defining Parameters for Surgical Correction and Outcomes for Femoroacetabular Impingement through Consensus
Femoroacetabular impingement (FAI) is a hip disorder resulting from a mismatch of the hip joint, resulting in hip pain and can potentially cause osteoarthritis. Patients with FAI often fail non-operative interventions, including rest, physical therapy, oral anti-inflammatories, and hip injections. Surgical intervention usually involves correcting the existing deformities by reshaping the ball and socket (“osteoplasty” or “rim trimming”) so that they fit together more easily while repairing any other existing soft tissue damage in the hip joint (e.g. labral repair). The arthroscopic approach (i.e. “keyhole surgery”) has become increasingly popular due to its minimally invasive technology and out-patient basis of the surgery. Despite an exponential increase in the number of arthroscopic procedures for FAI in the last 15 years, defining “adequate” correction to the hip is highly subjective and varies surgeon to surgeon. In addition, there is no standard for defining hip complications related to the index surgery. Using a valid consensus method, our aim is to define a gold standard for the quality of FAI surgery and define objective outcomes for future FAI research.
ECHO
Stay tuned…