No evidence exists on outcomes of non-operative management in patients with femoroacetabular impingement and concomitant Tönnis Grade 2 or more hip osteoarthritis: a scoping review

Abstract

Abstract Purpose The purpose of this scoping review was to assess the outcomes of all the non-operative modalities of management for femoroacetabular impingement (FAI) and concomitant osteoarthritis (OA) Tönnis Grade 2 or more. Methods A systematic search of PubMed was performed from inception to December 1st 2021 for literature on outcomes of non-operative management strategies for young adults with symptomatic FAI using the PRISMA Extension for Scoping Reviews guidelines. Cohorts investigating FAI and concomitant hip OA Tönnis Grade 2 or more were considered eligible. Studies not written in English or German, below level 4 evidence, and reviews were excluded. A secondary analysis for FAI without OA stratification was conducted after the initial screening to allow identification of available non-operative interventions. Results No study reported outcomes separately for non-operative management of FAI with Tönnis Grade 2 OA or more and as such, did not fulfil the inclusion criteria. A secondary analysis included 24 studies that reported on outcomes for non-operative interventions for FAI irrespective of the degree of degeneration. Three studies investigated the efficacy of hyaluronic acid injection, 5 reports investigated corticosteroid injections, 2 studies evaluated the outcomes of hip bracing and 16 studies included a physiotherapy programme. Associations between the aforementioned interventions were analysed. There is level I evidence supporting the efficacy of activity modification and hip-specific physiotherapy for FAI and mild OA. Core-strengthening exercises are prevalent amongst successful regimens in the literature. Contradictory evidence questions the efficacy of hip bracing even for short-term outcomes. Corticosteroid injections have mostly failed in intention-to treat analyses but may be valuable in delaying the need for surgery; further studies are warranted. Reports on outcomes following hyaluronic acid injections are contradictory. Conclusion No evidence exists on outcomes following non-operative management of FAI with concomitant Tönnis Grade 2 or more OA of the hip. Further studies are required and should explore the non-operative interventions that were employed for FAI and milder OA. There is strong evidence for a hip-specific physiotherapy program including activity modification and core strengthening exercises. Adjunct interventions such as corticosteroid injections and NSAID consumption may be valuable in delaying the need for surgery. Level of evidence Level IV.