Wall, Peter D. H. (2013) Treatments for femoroacetabular impingement. PhD thesis, University of Warwick.

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Abstract

The hip is a ball and socket joint in which the femoral head (the ball) articulates with the
acetabulum (the socket). In a condition called femoroacetabular impingement (FAI) the hip
has a shape abnormality and is no longer perfectly spherical. The hip shape abnormality FAI
provokes premature impingement between the femoral head and rim of the acetabulum
leading to pain and in the longer term osteoarthritis. Slipped capital femoral epiphysis
(SCFE), an adolescent hip disease, is thought to be one cause of FAI. However, a cohort
study of patients with SCFE presented in this thesis found no evidence of an association
between worsening hip shape, function and pain. Factors other than abnormal hip shape
may therefore have an important role in the development of hip symptoms in both SCFE and
FAI.
Systematic reviews presented in this thesis highlight that surgery or physical therapy can be
used to treat FAI but the true clinical effectiveness of either treatment is not known. At least
100 surgeons undertook 2399 surgical procedures in the year 2011/12 in the UK National
Health Service for FAI of which 80% were done arthroscopically. A qualitative interview study
amongst 14 of these surgeons showed that many would like to engage in a RCT measuring
the clinical effectiveness of their surgery. To test recruitment to such a RCT a pilot RCT
comparing hip arthroscopy versus nonoperative care for FAI was undertaken. Forty-two out
of 60 (recruitment 70%) eligible patients were recruited. Twenty one patients were allocated
to nonoperative care, and 81% received per protocol treatment, with no evidence of serious
adverse events. The work in this thesis should now facilitate a RCT to be undertaken in an
area (treatment for FAI) where no RCTs have previously been conducted.

Item Type:	Thesis (PhD)
Subjects:	R Medicine > RD Surgery
Library of Congress Subject Headings (LCSH):	Hip joint -- Abnormalities -- Treatment, Orthopedic surgery, Hip joint -- Surgery
Official Date:	September 2013
Dates:	Date Event September 2013 Submitted
Institution:	University of Warwick
Theses Department:	Warwick Medical School
Thesis Type:	PhD
Publication Status:	Unpublished
Supervisor(s)/Advisor:	Griffin, Damian R.; Andrew, G.; Hutchinson, C.
Sponsors:	University Hospitals Coventry and Warwickshire NHS Trust; University of Warwick
Extent:	193 leaves : illustrations.
Language:	eng

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