Hip arthroscopy for the treatment of femoroacetabular impingement (FAI) syndrome may give the best functional outcome

This multicentre, randomised controlled trial (RCT) published in the Lancet has found that hip arthroscopy provided a better level of function at 12 month follow-up when compared to a tailored rehabilitation programme.1

Femoroacetabular impingement syndrome (FAIS) is a potential cause of hip pain in young adults and is increasingly being diagnosed in football players. Impingement is associated with abnormalities involving the femoral neck, the acetabulum or both, and may lead to damage to both the articular cartilage and acetabular labrum. Hip arthroscopy acts by re-shaping the hip with a goal of preventing impingement and relieving symptoms. Non-operative management of FAIS typically involves exercise physiotherapy, education, analgesia and guided injections.

This multicentre RCT involved a total of 348 participants followed up for 12 months. Based on the results of this study hip arthroscopy appears to lead to better patient functioning at 12 month follow-up when compared with conservative hip therapy. The rehabilitation in this study involved a multimodal rehabilitation programme involving physiotherapy treatments, analgesics and injection therapy. Quality of life related to hip functioning was measured using the international Hip Outcome Tool. This patient-reported tool records symptoms and functional limitations, sports and recreational physical activities, job-related concerns, and social, emotional and lifestyle concerns. The higher scores recorded in this study following hip arthroscopy do come at some cost, with an increased financial cost associated with arthroscopy and higher risk of adverse events. It is also unclear whether the greater patient-reported improvements from arthroscopy are maintained in the longer-term.

High quality studies relating to the surgical treatment of common football conditions are lacking. This study does show that surgical treatment of FAI, at least in the short-medium term, may be associated with improved outcomes. This may in turn improve the probability of a successful return to play and prolong a player’s career. It is important to acknowledge that this study did not involve a dedicated cohort of football players – and as a result the studies generalisability to this unique group cannot be assumed. The rehabilitation programme used in this study, while comprehensive, may also not be as intensive or as effective as those seen in a professional environment where there may be more resources available.

To learn more about hip complaints among football players complete the ‘hip module’ in the FIFA Diploma in Football Medicine.

1. Griffin DR, Dickenson EJ, Wall PDH, et al. Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome (UK FASHIoN): a multicentre randomised controlled trial. Lancet 2018; 391:2225-35.


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drlabelleMark FulcherBangouraAlexisClem Nihill Recent comment authors
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As some universities are cracked ng down on fake science reviews, we chuck this report into the dubious reporting file. Reading the journal article and references their is two pieces of fake news. “may “ and “benefit “ created which are false or misleading or untrue to the facts. The other concern is the patients ‘lost’ with hospital records losing that many patients is a odd, the challenge is lost patients excluding those who got worse and went to other hospitals or died in other hospitals, comparing the successful surgery patients with those who did not complete the therapies was… Read more »

Mark Fulcher

Some interesting comments Steven. This is exactly the point of these posts – to try to stimulate some debate and discussion. I don’t expect people to read these articles and accept them as fact. I think that you would acknowledge that there is very little ‘good’ science that compares the surgical treatment of common sports injuries with non-surgical treatment. As you state the study’s findings are far from conclusive. The sample size and composition, as well as the relatively short follow-up period, are other major issues. The upshot of this study I think is that we MAY want to consider… Read more »


Hey, Mark, how come pain was not used an outcome measure…? Isn’t that usually the most important measure (and main reason for consultation) in most patients? Moreover, did the patients who got the arthroscopy aslo get physical therapy on the side? Also, why did the patients not get a fake surgery (incision only)? Seems like a simple way to avoid patients feeling like they were getting inferior care because they had no surgery…

Mark Fulcher

Hey Alexis. Good comments. Firstly pain was part of outcomes that were studied. The outcome measure was an outcome score that considers the patients function. This encompasses their symptoms, their ability to play sport and work as well as psychological factors. To find out more about the scale have a look at this… https://www.physio-pedia.com/International_Hip_Outcome_Tool_(iHOT) Sham surgery would have been a better option to answer this question. It would help remove some of the limitations of the study that others have raised. As you may know this sort of study has recently been done to look at outcomes following knee arthroscopy.… Read more »


A few points to add on this report: 1. FAI is not «a potential cause of hip pain». For FAI to be diagnosed, the patient must be in pain as per the recent Warwick agreement. The industry needs to get on the same page as regards definitions of terms like these. 2. I’m not sure we can call CAM or pincer formations at the hip «abnormalities» since the MAJORITY of football players who are asymptomatic show these formations when scanned and are asymptomatic. This is according to research carried out in football (most recent at ASPETAR). We need to be… Read more »

Mark Fulcher

Agree with most of your comments. To be clear this article is about FAI syndrome – not FAI (as outlined in the first sentence). I am completely on board with the Warwick consensus statement. For anyone who has not read this document I would encourage you to look here… http://www.acsep.org.au/content/Document/warwick%20agreement%20FAI%20BJSM%202016.pdf When a patient has pain, restricted movement/hip signs and bony changes I do think that the CAM or pincer formations are indeed “abnormalities”. I am however in total agreement with your comments about the need to not ‘pathologise’ these radiological findings when there are no (or minimal) signs of symptoms.… Read more »


L arthroscopie est une technique chirurgicale qui consiste à explorer l intérieur d une articulation elle permet à nos jours de traiter plusieurs pathologie osteo articulaires Chez les sportifs l une des pathologies les plus courantes est le conflit femoro acetabulaire causées soit par des micro traumatisme sur le col du fémur soit une anomalie morphologique Les contacts fréquents peuvent avoir une incidence sur les tissus et le cartilage Le traitement médical est la premiere intention AINS ANTALGIQUE Infiltration intra articulaire Physiothérapie Massage La chirurgie s impose en cas d échec du traitement médical Chez le jeune sportif le pronostic… Read more »


Our recommendations should still be conservative care first, with the possible exception of professional athletes who can’t loose 6 months doing rehab only to have arthroscopy anyway.