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.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:606128 |
| Date | January 2013 |
| Creators | Wall, Peter D. H. |
| Publisher | University of Warwick |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | http://wrap.warwick.ac.uk/60418/ |
Page generated in 0.0012 seconds