A large-scale trial is directly comparing keyhole surgery against a tailored exercise programme for a common cause of hip pain in young adults. The condition, femoro-acetabular impingement (FAI), occurs when the hip bones rub together, causing damage and pain that can lead to early arthritis. Surgeons increasingly offer arthroscopy to reshape the bone, but high-quality evidence that this surgery works better than non-surgical care has been lacking. This trial aims to settle that question. If the results show that personalised hip therapy works as well as surgery, many patients could avoid an operation, its risks, and recovery time. If surgery proves superior, the findings would justify its wider use within the NHS. The trial also measures cost-effectiveness, so the results will directly inform which treatment the health service should fund. Either way, the outcome will give patients and clinicians clear, evidence-based guidance on the best path forward.
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This is a pragmatic multi-centre randomised controlled trial of hip arthroscopy versus best conventional care for femoro-acetabular impingement (FAI). In patients with symptomatic FAI, aged at least 16 years, we will determine whether hip arthroscopy provides a beneficial effect in patient-reported quality of life compared with personalised hip therapy (PHT, a protocol for best conservative care). We will also compare patient satisfaction, need for further procedures, risk of complications and cost-effectiveness for the two treatment strategies. We have performed a feasibility study which demonstrated satisfactory recruitment rates and enabled us to develop inclusion criteria, outcome measures and trial procedures. As part of this feasibility study, an internal pilot trial has already recruited 42 patients. A further 302 patients (344 including pilot patients) will be recruited from 25 hospitals throughout the UK over 20 months. Patients will be randomly allocated to one of the two trial treatments and followed up at three, six and 12 months. The primary outcome is the International Hip Outcome Tool-33 (IHOT-33) score at 12 months. iHOT-33 is a patient reported quality of life tool specifically designed for young adults experiencing pre-arthritic hip pain. Secondary outcome measures include number and type of adverse events, need for further procedures, health related quality of life and patients satisfaction. The incremental cost and cost-effectiveness of hip arthroscopy and PHT will be evaluated from the NHS and societal perspectives; with cost-effectiveness being calculated using both within trial and lifetime horizons. An integrated programme of qualitative research will ensure successful recruitment and exploration of fidelity to treatment interventions, and provide detailed understanding about patients’ trial experiences and outcomes
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