Is hip arthroscopic surgery a sham? Researchers seek answer

Minimal access hip arthroscopy surgery has become the treatment of choice for hip pain in young adults, especially athletes, but a team of McMaster University surgeons is looking to see if the procedure is a sham.

To evaluate the surgery, the team is examining how patients do after having hip arthroscopy operations and comparing those results to patients undergoing a placebo surgery that skips the step of actual repair and tests whether patients feel relief.

In North America, arthroscopic hip surgeries have replaced open surgeries as the go-to cure for femoroacetabular impingement (FAI), a common source of hip pain in young adults, where abnormal femurs lead to damaged cartilage in the hip joint. The number of such procedures increased 18-fold in the U.S. within a decade, especially with athletes.

The problem, illustrated by surgeon Dr. Mohit Bhandari in a paper published today in the scientific journal Nature Reviews, is that although there are a lot of new studies assessing FAI surgery and its outcomes, many are hampered by small sample sizes and other major limitations.

"The evidence to date is by no means conclusive. Whether hip arthroscopy works, and for whom it works, remains a highly debated issue in our field," says Bhandari, professor of orthopedics for McMaster's Michael G. DeGroote School of Medicine.

First author of the review, Dr. Moin Khan adds: "Newly graduating sports medicine focused surgeons want to use the latest evidence-based approaches to differentiate themselves. Good data is needed to help them decide what procedures work, and which ones don't." Khan is a fellow of orthopedic surgery at McMaster's medical school.

Bhandari and Dr. Femi Ayeni, a McMaster associate professor of surgery, are co-principal investigators for a clinical trial to measure results of such surgery.

"The trial will aim to carefully test the effect of hip arthroscopy against a placebo procedure and determine, once and for all, whether the exponential rise in hip scope procedures has a scientific basis and true benefit to patients," Bhandari says.

"Similar placebo surgeries with patients' knee operations have shown that there have been no additional benefits between real and placebo operations. Patients with knee issues that were given placebo surgeries showed considerable relief of their symptoms."

The clinical trial, named FIRST, is currently underway, and enrolment of participants will be completed in the next year. The research is funded by the Canadian Institutes for Health Research.