Clinical Equipoise in the Management of Patients With Femoroacetabular Impingement Syndrome and Concomitant Tönnis Grade 2 Hip Osteoarthritis or Greater: An International Expert-Panel Delphi Study

Octavian Andronic; Victor Lu; Leica Sarah Claydon-Mueller; Rachael Cubberley; International FAIS Expert Panel,; Vikas Khanduja

doi:10.1016/j.arthro.2023.12.010

Clinical Equipoise in the Management of Patients With Femoroacetabular Impingement Syndrome and Concomitant Tönnis Grade 2 Hip Osteoarthritis or Greater: An International Expert-Panel Delphi Study

Arthroscopy. 2023 Dec 28:S0749-8063(23)01014-9. doi: 10.1016/j.arthro.2023.12.010. Online ahead of print.

Authors

Octavian Andronic¹, Victor Lu², Leica Sarah Claydon-Mueller³, Rachael Cubberley³; International FAIS Expert Panel,; Vikas Khanduja⁴

Collaborators

Affiliations

¹ Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland; Medical Technology Research Centre, Anglia Ruskin University, Chelmsford, England; Department of Trauma and Orthopaedics, Young Adult Hip Service, Addenbrooke's-Cambridge University Hospital, Cambridge, England.
² School of Clinical Medicine, University of Cambridge, Cambridge, England.
³ Medical Technology Research Centre, Anglia Ruskin University, Chelmsford, England.
⁴ Medical Technology Research Centre, Anglia Ruskin University, Chelmsford, England; Department of Trauma and Orthopaedics, Young Adult Hip Service, Addenbrooke's-Cambridge University Hospital, Cambridge, England. Electronic address: vk279@cam.ac.uk.

PMID: 38158166
DOI: 10.1016/j.arthro.2023.12.010

Abstract

Purpose: To gather global-expert opinion on the management of patients with femoroacetabular impingement syndrome (FAIS) and Tönnis grade 2 hip osteoarthritis (OA) or greater.

Methods: An internet-based modified Delphi methodology was used via an online platform (Online Surveys) using the CREDES (Conducting and Reporting Delphi Studies) guidelines. The expert panel comprised 27 members from 18 countries: 21 orthopaedic surgeons (78%), 5 physiotherapists (18%), and 1 dual orthopaedic surgeon-sport and exercise medicine physician (4%). Comments and suggestions were collected during each round, and amendments were performed for the subsequent round. Between each pair of rounds, the steering panel provided the experts with a summary of results and amendments. Consensus was set a priori as minimum agreement of 80%.

Results: Complete participation (100%) was achieved in all 4 rounds. A final list of 10 consensus statements was formulated. The experts agreed that there is no single superior management strategy for FAIS with Tönnis grade 2 OA and that Tönnis grade 3 OA and the presence of bilateral cartilage defects (acetabular and femoral) is a contraindication for hip preservation surgery. Nonoperative management should include activity modification and physiotherapy with hip-specific strengthening, lumbo-pelvic mobility training, and core strengthening. There was no consensus on the need for 3-dimensional imaging for initial quantification of joint degeneration.

Conclusions: There is clinical equipoise in terms of the best management strategy for patients with FAIS and Tönnis grade 2 OA, and therefore, there is an urgent need to perform a randomized controlled trial for this cohort of patients to ascertian the best management strategy.

Level of evidence: Level V, expert opinion.