Femoroacetabular Impingement Randomized Controlled Trial (FIRST)

Femoroacetabular impingement (FAI) is a condition of the hip where there is a mismatch of the femoral head (ball) and hip acetabulum (socket). This mismatch creates abnormal contact between the bones and causes hip pain which can lead to damage and eventually osteoarthritis of the hip. Patients tend to present in early to mid-adulthood with chronic pain and decreased function that has progressively worsened. Surgical treatment aims to correct the structure of the hip joint by shaving down the bone causing the impingement. Hip arthroscopy is a minimally invasive operation with a short recovery time, where the surgeon examines the joint with an arthroscope while making repairs through a small incision. This procedure has become a popular treatment option for the young, active patient population with FAI. However, the method is relatively new and most of the evidence is of low-quality. We propose a randomized controlled trial (RCT) to investigate whether surgical correction of the impingement (arthroscopic osteochondroplasty, or shaving down the bone) provides improved clinical results (decreased pain and increased function) at 12 months compared to arthroscopic lavage (washing out of painful inflammation debris) of the hip joint. The rationale for the proposed trial includes: (1) a five-fold growth in popularity during the last 10 years in the surgical management of FAI, (2) global uncertainty in the surgical community regarding efficacy of surgical management of FAI, (3) a lack of compelling RCTs evaluating the efficacy and safety of FAI surgery on patient important outcomes, (4) a large body of preparatory research including systematic reviews, surveys and agreement studies, and (5) growing international support and feasibility for a definitive surgical trial addressing FAI based upon our highly successful pilot phase. Identifying the optimal treatment strategy for FAI has enormous potential to prevent chronic pain and loss of function caused by hip osteoarthritis.