The management of femoroacetabular impingement syndrome with concomitant hip osteoarthritis Tönnis grade 2: laying the foundation for a randomised controlled trial

Background: There is inconclusive and contradictive evidence regarding the best management of femoroacetabular impingement (FAI) with concomitant hip osteoarthritis (OA) Tönnis grade 2 or more.

Methods: A systematic and scoping review were performed to outline gaps in the evidence regarding outcomes of hip arthroscopy and non-operative management for our patient population. Statements were developed based on these findings to further perform a Delphi survey with an international expert-panel group. Consensus findings were used to design a randomized controlled trial to deliver level I evidence.

Results: There is contradictory evidence regarding outcomes of hip arthroscopy for FAI with Tönnis stage 2 OA or more. There is no evidence on non-operative management outcomes. Experts did not achieve consensus on the best management for FAI with concomitant Tönnis stage 2 OA. However, a consensus was reached that Tönnis stage 3 are poor candidates for hip preservation surgery. A randomized controlled trial protocol was developed based on the clinical equipoise outlined and the findings of the systematic review, scoping review and Delphi survey.

Conclusion: In an area with gaps in the literature and clinical equipoise on the best management strategy for FAI with concomitant Tönnis stage 2 OA, there is a clear need for a randomized controlled trial to deliver level I evidence, the protocol of which was designed as part of this thesis.