Multi-centre randomised controlled trial comparing arthroscopic hip surgery to physiotherapist-led care for femoroacetabular impingement (FAI) syndrome on hip cartilage metabolism: the Australian FASHIoN trial

Abstract Background Arthroscopic surgery for femoroacetabular impingement syndrome (FAI) is known to lead self-reported symptom improvement. In the context of surgical interventions with contextual effects and no true sham comparator trials, it important ascertain outcomes that are less susceptible placebo effects. The primary aim this trial was determine if study participants FAI who have hip arthroscopy demonstrate greater improvements in delayed gadolinium-enhanced magnetic resonance imaging (MRI) cartilage (dGEMRIC) index between baseline 12 months, compared undergo physiotherapist-led management. Methods Multi-centre, pragmatic, two-arm superiority randomised controlled comparing management FAI. were recruited from participating orthopaedic surgeons clinics, randomly allocated receive either conservative care or surgery. intervention arthroscopic an individualised physiotherapy program, named Personalised Hip Therapy (PHT). outcome measure change dGEMRIC score months. Secondary included a range patient-reported structural measures relevant pathoanatomy osteoarthritis development. Interventions by intention-to-treat analysis. Results Ninety-nine recruited, mean age 33 years 58% male. Primary data available 53 (27 group, 26 PHT). adjusted group difference at months -59 ms (95%CI − 137.9 - 19.6) ( p = 0.14) favouring PHT. Hip-related quality life (iHOT-33) showed both groups between-group showing statistically clinically improvement 14 units (95% CI 5.6 23.9) 0.003). Conclusion significant PHT follow-up. Patients treated reported benefits symptoms PHT, but these not explained better metabolism. Trial registration details Australia New Zealand Clinical Trials Registry reference: ACTRN12615001177549 . registered 2/11/2015.