Critically appraised paper: Hip arthroscopy is more effective than personalised hip therapy for improving hip-related quality of life in patients with femoroacetabular impingement syndrome [synopsis]

Question: Does hip arthroscopy improve hip-related quality of life more than best conservative care in patients with femoroacetabular impingement syndrome? Is there a difference in health-related quality of life, adverse events, and healthcare resource use between treatment approaches? Design: Pragmatic, multicentre, assessor-blind, randomised controlled trial with concealed allocation. Setting: Twenty-three National Health Service hospitals in the United Kingdom. Participants: Recruitment occurred at the specialist hip arthroscopy service at each hospital. Inclusion criteriawere: hip pain, radiographic features of cam or pincer morphology, being aged 16 years, being able to give informed consent, and the treating surgeon believed that the patient would benefit from surgery.Patientswithhiposteoarthritis, ahistoryofhippathology,orpreviouship injuries or shape-changing surgery were excluded. Randomisation of 348 participants allocated 171 to hip arthroscopy and 177 to personalised hip therapy. Interventions: The arthroscopy group received arthroscopic treatment of hip shape abnormalities and labral and cartilage pathology (by 1 of 27 senior surgeons), followed by outpatient physiotherapy for rehabilitation as per usual care for the treatingsurgeon.Thepersonalisedhip therapygroupreceivedapackageof physiotherapist-led rehabilitation (6 to 10 contacts over 12 to 24 weeks): assessment of pain, function, and hip range of motion; patient education; an individualised, progressive home exercise program; and help with pain relief.