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Hip arthroscopy for femoroacetabular impingement: use escalating beyond the evidence

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There is a concerning lack of data comparing surgical with non-surgical management of femoroacetabular impingement

Femoroacetabular impingement (FAI) is a common cause of groin pain in physically active young adults, accompanied by limited hip movements. It occurs when bony anatomical abnormalities of the femoral head-neck junction (cam deformity) and acetabular rim (pincer deformity) result in abnormal contact between the two joint surfaces during hip motion. Radiological evidence of FAI is present in about 25% of asymptomatic young adults in the general community.1 FAI increases the risk of end-stage hip osteoarthritis (OA) in later life and is a long term risk factor for joint replacement;2 it may be very disabling. The quality of life of young adults with FAI is comparable to that of older adults who had a total hip replacement for OA.3

No effective treatment for FAI currently exists. However, there has been a very rapid increase in the use of hip arthroscopy for this condition, a procedure that aims to correct hip bone shape and improve symptoms. Hip arthroscopy rates have increased almost four-fold from 2004 to 2009 in the United States4 and over seven-fold from 2002 to 2013 in England,5 with FAI being the most common indication.4