005 - Hip Arthroscopy vs Physio for Impingement (FASHIoN)

Got something to say to this podcast? Send a voicemail, and you might hear yourself on the next episode! In this episode of Ortho Appraised, Dr Rajabifard appraises the FASHIoN body of work — the UK FASHIoN RCT in The Lancet, the Personalised Hip Therapy protocol paper in the British Journal of Sports Medicine, and the Australian FASHIoN trial in BMC Musculoskeletal Disorders. The clinical question: for femoroacetabular impingement in young adults, does hip arthroscopy beat a structured physiotherapy programme — and why? The answer is nuanced: a real symptom benefit, but no demonstrated disease modification. 📄 Citation: Griffin DR, et al. Hip arthroscopy versus best conservative care for FAI syndrome (UK FASHIoN). Lancet. 2018;391:2225–35. DOI: https://doi.org/10.1016/S0140-6736(18)31202-9 · Wall PDH, et al. Personalised Hip Therapy: development of a non-operative protocol. Br J Sports Med. 2016;50:1217–23. DOI: https://doi.org/10.1136/bjsports-2016-096368 · Hunter DJ, Bennell KL, et al. Australian FASHIoN trial (hip cartilage metabolism). BMC Musculoskelet Disord. 2021;22:697. DOI: https://doi.org/10.1186/s12891-021-04576-z Key Takeaways: * Three linked papers: the UK FASHIoN RCT (n=348), the comparator-protocol paper, and the Australian FASHIoN trial (n=99) using hip cartilage metabolism as its primary outcome. * Hip arthroscopy improved symptoms over conservative care in both trials. * The Australian trial found no benefit to hip cartilage metabolism — the disease-modification rationale was not supported. * Practice implication: offer surgery for symptom relief rather than to alter the joint's natural history; well-delivered physiotherapy is a legitimate comparator. * The magnitude of the symptom benefit is modest and depends on how well the conservative arm is delivered. 🔗 Full papers: https://doi.org/10.1016/S0140-6736(18)31202-9 · https://doi.org/10.1136/bjsports-2016-096368 · https://doi.org/10.1186/s12891-021-04576-z Keywords: femoroacetabular impingement, hip arthroscopy, FASHIoN trial, personalised hip therapy, hip preservation. New episodes every Sunday. Subscribe so you never miss one.