Eficacia comparativa entre el tratamiento quirúrgico y el conservador en el choque fémoroacetabular. Una Revisión sistemática.
Comparative efficacy of surgical and conservative treatment for femoro-acetabular impingement. A Systematic Review.
Palabras clave:
Síndrome de Pinzamiento Femoroacetabular, Fisioterapia, Artroscopia, Calidad de Vida, Rango de Movimiento Articular
Resumen
El síndrome o choque de pinzamiento femoroacetabular (PFA), es un síndrome clínico caracterizado por un conflicto de espacio entre el acetábulo y la cabeza femoral, que provoca degeneración precoz y dolor articular, siendo necesario un tratamiento adecuado. Sin embargo, no existe consenso sobre si el tratamiento primario debe de ser quirúrgico o conservador. Por tanto, el objetivo del estudio fue revisar la evidencia científica sobre la efectividad de la fisioterapia respecto a la artroscopia en pacientes con PFA. Siguiendo las directrices “Preferred Reporting Items for Systematic Review and Meta-Analyses” (PRISMA), se revisaron sistemáticamente ensayos clínicos aleatorizados publicados en los últimos 15 años, que compararan el tratamiento conservador respecto al artroscópico en el PFA, analizando la función articular y la calidad de vida de los pacientes. La búsqueda se realizó en las bases de datos Medline, “Physiotherapy Evidence Database” PEDro y Cochrane. Adicionalmente se evaluó la calidad metodológica mediante las escalas PEDro y CASPe, y el riesgo de sesgo con la herramienta Cochrane. Seis ensayos cumplieron los criterios de selección, incluyendo 744 pacientes entre entre 30 y 50 años de edad. Se observaron mejoras significativas (p<0,05), en la calidad de vida de los pacientes con artroscopia de cadera, respecto a los que tuvieron tratamiento conservador. No existe consenso sobre la función articular. En conclusión, el tratamiento del PFA mediante artroscopia, podría mejorar significativamente la calidad de vida de los pacientes con respecto a la fisioterapia. Estos resultados posicionarían al abordaje quirúrgico, como mejor primera opción de tratamiento para el PFA. Sin embargo, se necesitan más estudios, con muestras más grandes, y seguimientos más prolongados para evaluar el abordaje definitivo del PFA.
Descargas
La descarga de datos todavía no está disponible.
Citas
Ganz R, Parvizi J, Beck M, Leunig M, Nötzli H, Siebenrock KA. Femoroacetabular impingement: A cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003; 417: 112–120. https://doi.org/10.1097/01.blo.0000096804.78689.c2
Safran MR, Foard SJ, Robell K, Pullen WM. Incidence of symptomatic femoroacetabular impingement: A 4-year study at a National Collegiate Athletic Association Division I Institution. Orthop J Sport Med. 2022; 10(4): 23259671221084979. https://doi.org/10.1177/23259671221084979
Szpak J. Review of femoroacetabular impingement. J Orthop Physician Assist. 2015; 3(1): 16–23. https://doi.org/10.2106/JBJS.JOPA.15.00064
Clohisy JC, Knaus ER, Hunt DM, Lesher JM, Harris-Hayes M, Prather H. Clinical presentation of patients with symptomatic anterior hip impingement. Clin Orthop Relat Res. 2009; 467(3): 638–644. https://doi.org/10.1007/s11999-008-0680-y
Terrell SL, Olson GE, Lynch J. Therapeutic exercise approaches to nonoperative and postoperative management of femoro-acetabular impingement syndrome. J Athl Train. 2021; 56(1): 31–45. https://doi.org/10.4085/1062-6050-0488.19
Qiao HY, Zhang YH, Ren YM, Tian MQ. Arthroscopic versus open treatment for femoroacetabular impingement: A systematic review and meta-analyses. Medicine (Baltimore). 2020; 99(47): e23364. https://doi.org/10.1097/MD.0000000000023364
Casartelli NC, Valenzuela PL, Maffiuletti NA, Leunig M. Effectiveness of hip arthros-copy on treatment of femoroacetabular impingement syndrome: A meta-analysis of randomized controlled trials. Arthritis Care Res (Hoboken). 2021; 73(8): 1140–1145. https://doi.org/10.1002/acr.24234
Anzillotti G, Iacomella A, Grancagnolo M, Bertolino EM, Marcacci M, Sconza C, et al. Conservative vs surgical management for femoro-acetabular impingement: A systematic review of clinical evidence. J Clin Med. 2022; 11(19): 5852. https://doi.org/10.3390/jcm11195852
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ. 2021; 372: n71. https://doi.org/101136/bmj.n71
da Costa Santos CM, de Mattos Pimenta CA, Nobre MRC. The PICO strategy for the research question construction and evidence search. Rev Lat Am Enfermagem. 2007; 15(3): 508–511. https://doi.org/10.1590/S0104-11692007000300023
Long HA, French DP, Brooks JM. Optimising the value of the critical apprai- sal skills programme (CASP) tool for quality appraisal in qualitative evidence synthesis. Res Methods Med Health Sci. 2020; 1(1): 31–42. https://doi.org/10.1177/2632084320947559
Moseley AM, Elkins MR, Van der Wees PJ, Pinheiro MB. Using research to guide practice: The Physiotherapy Evidence Database (PEDro). Brazilian J Phys Ther. 2020; 24(5): 384–391. https://doi.org/10.1016/j.bjpt.2019.11.002
Higgins JPT, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011; 343: d5928. https://doi.org/10.1136/bmj.d5928
Griffin DR, Dickenson EJ, Wall PDH, Achana F, Donovan JL, Griffin J, et al. Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome (UK FASHIoN): a multicentre randomised controlled trial. Lancet 2018; 391(10136): 2225–2235. https://doi.org/10.1016/S0140-6736(18)31202-9
Hunter DJ, Eyles J, Murphy NJ, Spiers L, Burns A, Davidson E, et al. Multi-centre randomised controlled trial comparing arthroscopic hip surgery to physiotherapistled care for femoroacetabular impingement (FAI) syndrome on hip cartilage metabolism: the Australian FASHIoN trial. BMC Musculoskelet Disord. 2021; 22(1):697. https://doi.org/10.1186/s12891-021-04576-z
Klaus HC. A randomized controlled trial comparing arthroscopic surgery a randomized controlled trial comparing arthroscopic surgery to conservative management of femoroacetabular impingement. 2013. Western University Open Repository. https://doi.org/10.71858/123456.
Mansell NS, Rhon DI, Meyer J, Slevin JM, Marchant BG. Arthroscopic surgery or physical therapy for patients with femoroacetabular impingement syndrome: A randomized controlled trial with 2-year follow-up. Am J Sports Med. 2018; 46(6): 1306–1314. https://doi.org/10.1177/0363546517751912
Martin SD, Abraham PF, Varady NH, Nazal MR, Conaway W, Quinlan NJ, et al. Hip arthroscopy versus physical therapy for the treatment of symptomatic acetabular labral tears in patients older than 40 years: A randomized controlled trial. Am J Sports Med. 2021; 49(5): 1199–1208. https://doi.org/10.1177/0363546521990789
Palmer AJR, Ayyar Gupta V, Fernquest S, Rombach I, Dutton SJ, Mansour R, et al. Arthroscopic hip surgery compared with physiotherapy and activity modification for the treatment of symptomatic femoroacetabular impingement: Multicentre randomised controlled trial. BMJ. 2019; 364: I185. https://doi.org/10.1136/bmj.l185.
Ruiz-Ibán MA, Seijas R, Sallent A, Ares O, Marín-Peña O, Muriel A, et al. The international Hip Outcome Tool-33 (iHOT-33): Multicenter validation and translation to Spanish. Health Qual Life Outcomes. 2015; 13: 62. https://doi.org/10.1186/s12955-015-0255-z
Martin RRL, Philippon MJ. Evidence of reliability and responsiveness for the hip outcome score. Arthroscopy. 2008; 24(6):676-682. https://doi.org/10.1016/j.arthro.2007.12.011
Samaan MA, Grace T, Zhang AL, Majumdar S, Souza RB. Short term outcomes of hip arthroscopy on hip joint mechanics and cartilage health in patients with femoroacetabular impingement syndrome. Clin Biomech (Bristol). 2020; 71: 214-220. https://doi.org/10.1016/j.clinbiomech.2019.11.014.
Stähelin L, Stähelin T, Jolles BM, Herzog RF. Arthroscopic offset restoration in femoroacetabular cam impingement: Accuracy and early clinical outcome. Arthroscopy. 2008; 24(1): 51-57.e1. https://doi.org/10.1016/j.arthro.2007.08.010
Philippon MJ, Briggs KK, Yen YM, Kuppersmith DA. Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction: Minimum two-year follow-up. J Bone Joint Surg Br. 2009; 91(1): 16–23. https://doi.org/10.1302/0301-620X.91B1.21329
Schmaranzer F, Haefeli PC, Hanke MS, Liechti EF, Werlen SF, Siebenrock KA, et al. How does the dGEMRIC index change after surgical treatment for FAI? A prospective controlled study: Preliminary results. Clin Orthop Relat Res. 2017; 475(4): 1080–1099. https://doi.org/10.1007/s11999-016-5098-3
Roos EM, Dahlberg L. Positive effects of moderate exercise on glycosaminoglycan content in knee cartilage: A four-month, randomized, controlled trial in patients at risk of osteoarthritis. Arthritis Rheum. 2005; 52(11): 3507–3514. https://doi.org/10.1002/art.21415
Nakano N, Lisenda L, Jones TL, Loveday DT, Khanduja V. Complications following arthroscopic surgery of the hip: A systematic review of 36 761 cases. Bone Joint J. 2017; 99-B (12): 1577–1583. https://doi.org/10.1302/0301-620X.99B12.BJJ-2017-0043.R2.
Safran MR, Foard SJ, Robell K, Pullen WM. Incidence of symptomatic femoroacetabular impingement: A 4-year study at a National Collegiate Athletic Association Division I Institution. Orthop J Sport Med. 2022; 10(4): 23259671221084979. https://doi.org/10.1177/23259671221084979
Szpak J. Review of femoroacetabular impingement. J Orthop Physician Assist. 2015; 3(1): 16–23. https://doi.org/10.2106/JBJS.JOPA.15.00064
Clohisy JC, Knaus ER, Hunt DM, Lesher JM, Harris-Hayes M, Prather H. Clinical presentation of patients with symptomatic anterior hip impingement. Clin Orthop Relat Res. 2009; 467(3): 638–644. https://doi.org/10.1007/s11999-008-0680-y
Terrell SL, Olson GE, Lynch J. Therapeutic exercise approaches to nonoperative and postoperative management of femoro-acetabular impingement syndrome. J Athl Train. 2021; 56(1): 31–45. https://doi.org/10.4085/1062-6050-0488.19
Qiao HY, Zhang YH, Ren YM, Tian MQ. Arthroscopic versus open treatment for femoroacetabular impingement: A systematic review and meta-analyses. Medicine (Baltimore). 2020; 99(47): e23364. https://doi.org/10.1097/MD.0000000000023364
Casartelli NC, Valenzuela PL, Maffiuletti NA, Leunig M. Effectiveness of hip arthros-copy on treatment of femoroacetabular impingement syndrome: A meta-analysis of randomized controlled trials. Arthritis Care Res (Hoboken). 2021; 73(8): 1140–1145. https://doi.org/10.1002/acr.24234
Anzillotti G, Iacomella A, Grancagnolo M, Bertolino EM, Marcacci M, Sconza C, et al. Conservative vs surgical management for femoro-acetabular impingement: A systematic review of clinical evidence. J Clin Med. 2022; 11(19): 5852. https://doi.org/10.3390/jcm11195852
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ. 2021; 372: n71. https://doi.org/101136/bmj.n71
da Costa Santos CM, de Mattos Pimenta CA, Nobre MRC. The PICO strategy for the research question construction and evidence search. Rev Lat Am Enfermagem. 2007; 15(3): 508–511. https://doi.org/10.1590/S0104-11692007000300023
Long HA, French DP, Brooks JM. Optimising the value of the critical apprai- sal skills programme (CASP) tool for quality appraisal in qualitative evidence synthesis. Res Methods Med Health Sci. 2020; 1(1): 31–42. https://doi.org/10.1177/2632084320947559
Moseley AM, Elkins MR, Van der Wees PJ, Pinheiro MB. Using research to guide practice: The Physiotherapy Evidence Database (PEDro). Brazilian J Phys Ther. 2020; 24(5): 384–391. https://doi.org/10.1016/j.bjpt.2019.11.002
Higgins JPT, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011; 343: d5928. https://doi.org/10.1136/bmj.d5928
Griffin DR, Dickenson EJ, Wall PDH, Achana F, Donovan JL, Griffin J, et al. Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome (UK FASHIoN): a multicentre randomised controlled trial. Lancet 2018; 391(10136): 2225–2235. https://doi.org/10.1016/S0140-6736(18)31202-9
Hunter DJ, Eyles J, Murphy NJ, Spiers L, Burns A, Davidson E, et al. Multi-centre randomised controlled trial comparing arthroscopic hip surgery to physiotherapistled care for femoroacetabular impingement (FAI) syndrome on hip cartilage metabolism: the Australian FASHIoN trial. BMC Musculoskelet Disord. 2021; 22(1):697. https://doi.org/10.1186/s12891-021-04576-z
Klaus HC. A randomized controlled trial comparing arthroscopic surgery a randomized controlled trial comparing arthroscopic surgery to conservative management of femoroacetabular impingement. 2013. Western University Open Repository. https://doi.org/10.71858/123456.
Mansell NS, Rhon DI, Meyer J, Slevin JM, Marchant BG. Arthroscopic surgery or physical therapy for patients with femoroacetabular impingement syndrome: A randomized controlled trial with 2-year follow-up. Am J Sports Med. 2018; 46(6): 1306–1314. https://doi.org/10.1177/0363546517751912
Martin SD, Abraham PF, Varady NH, Nazal MR, Conaway W, Quinlan NJ, et al. Hip arthroscopy versus physical therapy for the treatment of symptomatic acetabular labral tears in patients older than 40 years: A randomized controlled trial. Am J Sports Med. 2021; 49(5): 1199–1208. https://doi.org/10.1177/0363546521990789
Palmer AJR, Ayyar Gupta V, Fernquest S, Rombach I, Dutton SJ, Mansour R, et al. Arthroscopic hip surgery compared with physiotherapy and activity modification for the treatment of symptomatic femoroacetabular impingement: Multicentre randomised controlled trial. BMJ. 2019; 364: I185. https://doi.org/10.1136/bmj.l185.
Ruiz-Ibán MA, Seijas R, Sallent A, Ares O, Marín-Peña O, Muriel A, et al. The international Hip Outcome Tool-33 (iHOT-33): Multicenter validation and translation to Spanish. Health Qual Life Outcomes. 2015; 13: 62. https://doi.org/10.1186/s12955-015-0255-z
Martin RRL, Philippon MJ. Evidence of reliability and responsiveness for the hip outcome score. Arthroscopy. 2008; 24(6):676-682. https://doi.org/10.1016/j.arthro.2007.12.011
Samaan MA, Grace T, Zhang AL, Majumdar S, Souza RB. Short term outcomes of hip arthroscopy on hip joint mechanics and cartilage health in patients with femoroacetabular impingement syndrome. Clin Biomech (Bristol). 2020; 71: 214-220. https://doi.org/10.1016/j.clinbiomech.2019.11.014.
Stähelin L, Stähelin T, Jolles BM, Herzog RF. Arthroscopic offset restoration in femoroacetabular cam impingement: Accuracy and early clinical outcome. Arthroscopy. 2008; 24(1): 51-57.e1. https://doi.org/10.1016/j.arthro.2007.08.010
Philippon MJ, Briggs KK, Yen YM, Kuppersmith DA. Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction: Minimum two-year follow-up. J Bone Joint Surg Br. 2009; 91(1): 16–23. https://doi.org/10.1302/0301-620X.91B1.21329
Schmaranzer F, Haefeli PC, Hanke MS, Liechti EF, Werlen SF, Siebenrock KA, et al. How does the dGEMRIC index change after surgical treatment for FAI? A prospective controlled study: Preliminary results. Clin Orthop Relat Res. 2017; 475(4): 1080–1099. https://doi.org/10.1007/s11999-016-5098-3
Roos EM, Dahlberg L. Positive effects of moderate exercise on glycosaminoglycan content in knee cartilage: A four-month, randomized, controlled trial in patients at risk of osteoarthritis. Arthritis Rheum. 2005; 52(11): 3507–3514. https://doi.org/10.1002/art.21415
Nakano N, Lisenda L, Jones TL, Loveday DT, Khanduja V. Complications following arthroscopic surgery of the hip: A systematic review of 36 761 cases. Bone Joint J. 2017; 99-B (12): 1577–1583. https://doi.org/10.1302/0301-620X.99B12.BJJ-2017-0043.R2.
Publicado
2025-12-08
Cómo citar
Lantarón-Caeiro, E. M., López-Llorente, Álvaro, Santamaría-Gómez, G., & Fernández-Lázaro, D. (2025). Eficacia comparativa entre el tratamiento quirúrgico y el conservador en el choque fémoroacetabular. Una Revisión sistemática.: Comparative efficacy of surgical and conservative treatment for femoro-acetabular impingement. A Systematic Review. Investigación Clínica, 66(4), 454-466. https://doi.org/10.54817/IC.v66n4a08
Sección
Revisiones
