Osteochondroplasty Benefits the Pragmatic Patient With Femoroacetabular Impingement: Analysis From the Embedded Prospective Cohort of the Femoroacetabular Impingement RandomiSed Controlled Trial (FIRST)
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PURPOSE: Our specific objective was to determine if arthroscopic osteochondroplasty demonstrated effectiveness in a pragmatic FAI patient population embedded within the FIRST trial. METHODS: All cohort patients were not randomized and were followed prospectively with a follow-up assessment protocol identical to that in the FIRST trial. The primary outcome was hip pain using a 100-point Visual Analogue Scale (VAS). Secondary outcomes included hip function (HOS, iHOT-12), health utility (EQ-5D), and health-related quality of life (SF-12) at 12 months, as well as operatively and non-operatively treated hip complications at 24 months. We performed multivariable regressions to compare these outcomes between three groups of patients: 1) those randomized to lavage in the FIRST trial, 2) those randomized to osteochondroplasty in the FIRST trial, and 3) those who received osteochondroplasty as part of the cohort study. RESULTS: All groups had improvements across all questionnaire outcomes from baseline to 12 months, with no significant differences. There were significantly more re-operations in the lavage trial group compared to those in the embedded cohort (adjusted odds ratio, OR 3.08; 95% confidence interval, CI 1.23 to 7.73; p = 0.016). There were significantly more non-operatively treated hip complications in the lavage trial group and in the osteochondroplasty trial group when compared to those in the embedded cohort (adjusted OR 3.81; 95% CI 1.19 to 12.17; p = 0.024 and adjusted OR 4.55; 95% CI 1.43 to 14.42; p = 0.010, respectively). CONCLUSION: Hip arthroscopic osteochondroplasty and lavage led to improvement in hip pain, function, and health-related quality of life at 12 months across both RCT and cohort patients. The pragmatic cohort receiving osteochondroplasty had: 1) significantly fewer complications than RCT patients, 2) significantly less re-operations than RCT patients randomized to arthroscopic lavage, and 3) fewer, though non-significant, re-operations than RCT osteochondroplasty patients.
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