Athletes such as hockey players and particularly goalies are at risk of bony changes in their hips especially when they participate in aggressive training camps during their teen years.Those with Femoro-acetabular impingement (FAI) report of groin pain that is reproduced by flexion and internal rotation. FAI is confirmed by x-ray.
FAI significantly increases the risk of future labral tears and hip OA.
Over 200 individuals with symptomatic FAI confirmed x-ray or MRI were randomised to receive arthroscopic hip surgery or physiotherapy prescribed exercises and activity modification.
After 8 months, those who received arthroscopic hip surgery had slightly higher functional scores when compared to those who received only physiotherapy.
Can we just agree that not all patients benefit from physiotherapy and certainly not all patients benefit from surgery? The question should not be which approach is superior, but which one does that individual patient need.
“Given the potential complications of surgery and observed clinical improvement with the physiotherapy programme, we currently recommend physiotherapy as first line treatment. If symptoms continue then the likelihood of symptom improvement with arthroscopic surgery should be considered.”Palmer et al 2019 BMJ
Reference: Palmer AJR, et al; FAIT Study Group. Arthroscopic hip surgery compared with physiotherapy and activity modification for the treatment of symptomatic femoroacetabular impingement: multicentre randomised controlled trial. BMJ. 2019 Feb 7;364:l185.