Surgery may improve outcomes of labral tears, concomitant FAI vs physical therapy
CHICAGO — When patients with labral tears and concomitant femoroacetabular impingement fail to improve with physical therapy, surgical treatment may provide superior functional outcomes, according to results presented here.
“If after 3 months of conservative treatment we see that the patient is not improving, they will likely improve with surgery,” John W. Stelzer, MS, said in his presentation at the Arthroscopy Association of North American Annual Meeting. “If they are improving, they might in that small subset of patients ... that continued to do well with [physical therapy] PT. However, if they, at some point do not continue to improve, crossing over to surgery will still give them a great outcome.”
Stelzer and colleagues randomly assigned 88 patients with labral tears and concomitant femoroacetabular impingement (FAI) who were eligible for surgery into either a physical therapy group or surgical treatment group. Researchers collected data at pre-intervention and 3, 6, 12 and 24 months postoperatively.
“If during physical therapy at some point they were deemed to plateau by both the surgeon and the physical therapist, they were eligible for crossover,” Stelzer said.
Overall, 72 patients with at least 6-month follow-up were included in the analysis. Stelzer noted the surgery, physical therapy and crossover groups had no differences in improvement or follow-up scores.
“In the three-group analysis — surgery, those that stayed in PT and those that crossed over — we can see that they all get significantly better from baseline to follow-up,” Stelzer said.
However, when determining the effect of surgery in the crossover group, Stelzer said physical therapy was not significantly better than surgery. Results showed a 15-point improvement in the modified Harris hip score for the surgery group vs. a 2-point improvement in the physical therapy group.
“In this analysis, whether we look at improvement or follow-up, surgery is well over performing the physical therapy group,” Stelzer said. – by Casey Tingle
Stelzer JW, et al. Paper 31. Presented at: Arthroscopy Association of North America Annual Meeting; April 26-28, 2018; Chicago.
Disclosure: Stelzer reports no relevant financial disclosures.