A systematic review of hip impingement treatments - Upright Health

A systematic review of hip impingement treatments

Hip impingement surgery is still the go-to medical treatment for hip pain associated with FAI even though there’s lack of evidence to support its results. This is a topic we’ve talked about before (like here, here, and in this video).

The rates of hip surgery are rising. But is surgery as helpful as studies claim? Does it really improve hip pain? Can you go back to your normal life after hip surgery? Is it really worth the cost, the pain, and your time?

To answer those questions, we’ll take a look at a systematic review published in 2016. It examines surgical and non-surgical treatments for hip impingement. It compares their efficacy for both symptoms and structural outcomes.

What is a systematic review?

A systematic review collects and analyzes many research studies about a topic. This one takes 18 studies about surgical and non-surgical management of hip impingement.

In other words, this systematic review is a feast of information about hip impingement surgery and its outcomes.

Why bother with a systematic review about hip surgery for FAI?

Surgeons claim that surgery works spectacularly well for femoroacetabular impingement. But many orthopedic surgeries in the past have followed the same trajectory. The surgeries become extremely popular based on the over-exaggerated claims of surgeons...and then later research shows them to be very expensive, risky placebos. 

So we need to look at this relatively new diagnosis and surgery with critical eyes.

The main​ ​reasons for hip impingement surgery are hip pain and lack of movement. The surgeon’s expectations are:

Are these expectations met? Do patients have less pain after hip surgery? Does surgery help prevent hip osteoarthritis in FAI patients?

An effective way to answer those questions is by comparing lots of studies done about the topic. That’s where the systematic review comes in.

Highlights of the systematic review on hip impingement treatments

We recommend that you read through the entire paper when you have some free time. But here are highlights from this study on femoracetabular impingement treatments.

  • There is evidence of a strong placebo effect from surgery. That’s why it might be a short-term symptom improvement.
  • It’s not possible to determine in advance which patients may benefit from surgery. All the tests and radiographic findings have no correlation to positive outcomes.
  • There’s evidence that supports similar or better symptom outcomes with labral preservation in surgery for FAI. This means that the less you touch the labrum, the better.
  • Evidence suggests that surgery may be associated with progression of hip osteoarthritis. Read that again. The surgery may WORSEN the hip.
  • There’s little research available for non-surgical management for FAI. However, some evidence suggests that conservative measures (non-surgical methods) may avert surgery in 39–89% of people with FAI over 12–28 months.

Read that list over again. For surgeons, there are some shocking implications.

One key point is that surgery may actually be making hips worse. Another is that leaving a labrum alone is actually better than removing pieces of it. These two observations alone suggest that FAI surgery is following the same historical path as knee meniscus surgeries. Namely, the aggressive surgery is being oversold and delivering poor results when assessed honestly. 

For anyone looking closely at the medical literature, none of this will be that shocking since other research consistently shows the FAI morphology (cam, pincer, or mixed)  is UNRELATED TO PAIN.

KEY TAKEAWAYS

There is no way to predict who will benefit from hip impingement surgery. No tests or radiographic findings predict pain relief from surgery.


Surgery may actually make hips WORSE. 


When surgery does provide benefit, it may be attributable to the placebo effect.

Final thoughts on hip impingement surgery

The evidence suggests that hip surgery may offer more problems than previously believed. And non-surgical approaches should be studied in depth. 

But for non-surgical approaches to work, the medical world needs to recognize a key fact: the treatment for FAI must be personalized. Hip problems can AND DO vary from person to person.

From our perspective, the answer has nothing to do with bones. It’s all about muscles.

Muscular weakness and coordination issues vary wildly from person to person. This is evident watching any group of athletes. The way people move and CAN move is highly dependent on lifestyle and training.

That’s why we work on an individual basis with our clients. That's why our FAI Fix program focuses on helping people identify individual issues rather than throwing up a one-size-fits-all approach. 

Eliminating hip pain requires exercise, experimentation, and persistence. And it requires time. 


Looking for more info on FAI?

In this video I talk in-depth about the muscular perspective of hip impingement:

An alternative muscular theory for femoroacetabular impingement

Still considering surgery as an option for FAI? Please watch this video:

Don't get surgery for femoroacetabular impingement (FAI) until you see this!


Learn more about our DIY program to help you train out of hip pain.

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