Clinical equipoise in the management of patients with femoroacetabular impingement syndrome and concomitant Tönnis grade 2 or greater hip osteoarthritis: an international expert-panel Delphi study

Purpose

To gather global-expert opinion for the management of patients with femoroacetabular impingement syndrome (FAIS) and Tönnis grade 2 or greater hip osteoarthritis (OA).

Methods

An internet-based modified Delphi methodology was used via an online platform (Online Surveys UK). The expert panel comprised 27 members from 18 countries: 21 (78%) orthopaedic surgeons, 5 (18%) physiotherapists and 1 (4%) dual orthopaedic surgeon and sport and exercise medicine physician. Comments and suggestions were collected during each round and amendments were performed for the subsequent round. Between each round, the steering panel provided the experts with a summary of results and amendments. Consensus was set a priori as a minimum agreement of 80%.

Results

A complete participation (100%) was achieved in all four rounds . A final list of 10 consensus statements was formulated. Experts agreed that there is no single superior management strategy for FAIS with Tönnis stage 2 OA and that Tönnis stage 3 OA and the presence of bilateral cartilage defects (acetabular and femoral) is a contraindication for hip preservation surgery. Non-operative management should include activity modification and physiotherapy with hip-specific, lumbo-pelvic and core strengthening. There was no consensus for the need of three-dimensional imaging for initial quantification of joint degeneration.

Conclusion

There is clinical equipoise in terms of the best management strategy for patients with FAIS and Tönnis stage 2 OA and therefore, there is a need for performing a randomized controlled trial for this cohort with differing management strategies.