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.
Keywords:
Femoroacetabular Impingement, Physical Therapy Modalities, Arthroscopy, Quality of Life, Range of Motion, Articular
Abstract
Femoro-acetabular impingement (FAI) is a clinical syndrome characterized by a space conflict between the acetabulum and the femoral head, which causes premature degeneration and joint pain. For this, an adequate therapeutic approach is necessary. However, there is no consensus on whether the primary treatment should be surgical or conservative. Therefore, the present study aimed to review the available scientific evidence on the effectiveness of physiotherapy compared to arthroscopy in patients with FAI. Following the “Preferred Reporting Items for Systematic Review and Meta-Analyses” (PRIS- MA) guidelines, we systematically reviewed randomized clinical trials published over the last 15 years comparing conservative treatment with the arthroscopic approach in FAI, analyzing joint function and patient quality of life. The search was performed in the Medline, “Physiotherapy Evidence Database” PEDro and Cochrane databases. In addition, the methodological quality was evaluated using the PEDro and the “Cuestionario Critical Appraisal Skills Programme Español” (CASPe) scales, and the risk of bias was assessed using the Cochrane tool. Six trials met the established selection criteria, including 744 patients aged 30 to 50 years. Significant improvements (p<0.05) in quality of life were observed with hip arthroscopy compared with conservative treatment. There is no consensus on joint function. In conclusion, the FAI approach via arthroscopic treatment could significantly improve patients’ quality of life compared with physiotherapy. These results would position surgical treatment as the best first-line treatment option for FAI. However, further studies with larger sample sizes and longer follow-ups are needed to evaluate the definitive approach to FAI.
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References
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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.
Published
2025-12-08
How to Cite
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
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