Abstract
Purpose
Currently, there is a lack of high-level evidence addressing the variety of treatment options available for patients diagnosed with femoroacetabular impingement (FAI). The objective was to determine the current state of practice for FAI in Canada.
Methods
A questionnaire was developed and pretested to address the current state of knowledge among orthopaedic surgeons regarding FAI treatment using a focus group of experts, reviewing prior surveys, and reviewing online guidelines addressing surgical interventions for FAI. The membership of the Canadian Orthopaedic Association (COA) was surveyed through email and mail in both French and English.
Results
Two hundred and two surveys were obtained (20 % response rate), of which 74.3 % of respondents manage patients under age 40 with hip pain. Most surgeons (62 %) considered failure of non-operative management as the most important indication for the surgical management of FAI, usually by treating both bony and soft tissue damage (54.4 %). The majority of surgeons were unsure of the existence of evidence supporting the best clinical test for FAI, the use of a diagnostic intra-articular injection for diagnosis of FAI, and for non-operative management of FAI. One in four respondents supported a sham surgery (24.8 %) control arm for a trial evaluating the impact of surgical intervention on FAI.
Conclusions
This survey elucidates areas of research for future studies relevant to FAI and highlights controversial areas of treatment. The results suggest that the current management of FAI by members of the COA is limited by a lack of awareness of high-level evidence.
Level of evidence
III.
Similar content being viewed by others
References
Ayeni OR, Wong I, Chien T, Musahl V, Kelly BT, Bhandari M (2012) Surgical indications for arthroscopic management of femoroacetabular impingement. Arthroscopy 28(8):1170–1179
Banerjee P, McLean CR (2011) Femoroacetabular impingement: a review of diagnosis and management. Curr Rev Musculoskelet Med 164(1):23–32
Bedi A, Chen N, Robertson W, Kelly BT (2008) The management of labral tears and femoroacetabular impingement of the hip in the young, active patient. Arthroscopy 24(10):1135–1145
Botser IB, Smith TW Jr, Nasser R, Domb BG (2011) Open surgical dislocation versus arthroscopy for femoroacetabular impingement: a comparison of clinical outcomes. Arthroscopy 27(2):270–278
Burnett RS, Della Rocca GJ, Prather H, Curry M, Maloney WJ, Clohisy JC (2006) Clinical presentation of patients with tears of the acetabular labrum. J Bone Jt Surg Am 88(7):1448–1457
Clohisy JC, Knaus ER, Hunt DM, Lesher JM, Harris-Hayes M, Prather H (2009) Clinical presentation of patients with symptomatic anterior hip impingement. Clin Orthop Relat Res 467:638–644
Farrokhyar F, Karanicolas PJ, Thoma A et al (2010) Randomized controlled trials of surgical interventions. Ann Surg 251(3):409–416
Ganz R, Leunig M, Leunig-Ganz K, Harris WH (2008) The etiology of osteoarthritis of the hip: an integrated mechanical concept. Clin Orthop Relat Res 466:264–272
Kavanagh EC, Read P, Carty F, Zoga AC, Parvizi J, Morrison WB (2011) Three-dimensional magnetic resonance imaginganalysis of hip morphology in the assessment of femoral acetabular impingement. Clin Radiol 66(8):742–747
Larson CM, Giveans MR (2008) Arthroscopic management of femoroacetabular impingement: early outcomes measures. Arthroscopy 24(5):540–546
Leece P, Bhandari M, Sprague S et al (2004) Internet versus mailed questionnaires: a controlled comparison (2). J Med Internet Res 6(4):e3
McDonald PJ, Kulkarni AV, Farrokhyar F, Bhandari M (2010) Ethical issues in surgical research. Can J Surg 53(2):133–136
Nepple JJ, Zebala LP, Clohisy JC (2009) Labral disease associated with femoroacetabular impingement: do we need to correct the structural deformity? J Arthroplasty 24(6 Suppl):114–119
Ng VY, Arora N, Best TM, Pan X, Ellis TJ (2010) Efficacy of surgery for femoroacetabular impingement: a systematic review. Am J Sports Med 38(11):2337–2345
Ochoa LM, Dawson L, Patzkowski JC, Hsu JR (2010) Radiographic prevalence of femoroacetabular impingement in a young population with hip complaints is high. Clin Orthop Relat Res 468:2710–2714
Petrisor B, Jeray K, Schemitsch E et al on behalf of the FLOW Investigators (2008) Fluid lavage in patients with open fracture wounds (FLOW): an international survey of 984 surgeons. BMC Musculoskelet Disord 23:9–7
Philippon MJ, Briggs KK, Yen YM, Kuppersmith DA (2009) Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction: minimum two-year follow-up. J Bone Jt Surg Br 91(1):16–23
Sprague S, Quigley L, Bhandari M (2009) Survey design in orthopaedic surgery: getting surgeons to respond. J Bone Jt Surg Am 91(Suppl 3):27–34
Tijssen M, van Cingel R, Willemsen L, de Visser E (2012) Diagnostics of femoroacetabular impingement and labral pathology of the hip: a systematic review of the accuracy and validity of physical tests. Arthroscopy 28(6):860–871
Acknowledgments
Dr. Bhandari is funded in part by a Canada Research Chair. No funding was received for the completion of this manuscript.
Conflict of interest
There are no possible conflict of interest associated with this manuscript.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ayeni, O.R., Belzile, E.L., Musahl, V. et al. Results of the PeRception of femOroaCetabular impingEment by Surgeons Survey (PROCESS). Knee Surg Sports Traumatol Arthrosc 22, 906–910 (2014). https://doi.org/10.1007/s00167-014-2882-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00167-014-2882-z