The management of femoroacetabular impingement syndrome for the prevention of hip osteoarthritis

Abstract

Femoroacetabular impingement (FAI) syndrome is a condition in which abnormal motion-related interaction of the proximal femur and acetabulum produce hip and/or groin pain. It is thought to be a major cause of hip osteoarthritis, which carries a substantial burden of disease for individuals and economies worldwide. This thesis aims to enhance our understanding of how FAI syndrome should be optimally investigated and managed. Chapter One presents the thesis introduction, including a background on FAI syndrome in the context of it being a major precursor to hip osteoarthritis. In Chapter Two, the protocol for the Australian FASHIoN trial is presented. The Australian FASHIoN trial was a randomised controlled trial comparing hip arthroscopy to physiotherapist-led care for the treatment of FAI syndrome. Chapter Three is an exploratory cross-sectional study using baseline data from the Australian FASHIoN trial to examine the bony morphology measures and patient demographic factors associated with hip-related quality of life (iHOT-33 score) and age of symptom onset in patients with FAI syndrome. Chapter Four is an exploratory cross-sectional study using baseline data from the Australian FASHIoN trial to investigate the association of MRI features and version measurements with cartilage health, measured by the dGEMRIC score. Chapter Five presents secondary analyses from the Australian FASHIoN randomised controlled trial, investigating moderators, mediators, and prognostic indicators of treatment with hip arthroscopy or physiotherapy for FAI syndrome. Chapter Six is a between- and within-participants case-control study using EOS (biplanar radiography) to compare cases with FAI syndrome/acetabular labral tears to unmatched asymptomatic controls with respect to spinopelvic parameters and bony morphology. Chapter Seven provides a summary of the findings of this thesis, including its strengths and limitations, and proposes directions for future research.