Osteochondroplasty and labral repair for the treatment of young adults with femoroacetabular impingement

Key points

1. 01At 12 months, pain scores improved substantially in both groups but did not differ significantly between osteochondroplasty and lavage (mean difference 0.11 on a 100-point VAS, P = .98).
2. 02By 24 months, reoperations were significantly less common after osteochondroplasty (8/105) than after lavage (19/104), with an odds ratio of 0.37 (P = .026).
3. 0388.3% of participants had a labral tear found at surgery; 60.3% of tears were repaired across both groups.
4. 04Lavage showed a marginally better HOS activities-of-daily-living score at 12 months (mean difference -5.03, P = .049), though the confidence interval did not cross the minimally clinically important improvement threshold.
5. 05No significant differences were found between groups in health-related quality of life, physical and mental health, or non-operative adverse events at 24 months.

How it was conducted

Design

Parallel, multicenter, blinded randomized controlled trial (Level 1 evidence)

Participants

220 adults aged 18-50 years with cam- or mixed-type FAI who failed at least 6 months of nonoperative management, recruited at 10 centers in Canada, Finland, and Denmark (2012-2017); 214 included in final analysis

Groups

Arthroscopic osteochondroplasty with labral repair if indicated (n = 108) vs arthroscopic lavage with labral repair if indicated (n = 106)

Primary outcome

Pain on a 100-point visual analog scale (VAS) at 12 months

Secondary outcomes

Hip Outcome Score (HOS), iHOT-12, SF-12, EQ-5D at 12 months; reoperations and hip-related adverse events at 24 months

Follow-up

72% follow-up for primary outcome at 12 months; 94% for any outcome at 12 months; 97% for adverse events at 24 months

What they found

• Pain (VAS) at 12 months: mean difference 0.11 (95% CI, -7.22 to 7.45; P = .98) - no significant difference between groups.
• Osteochondroplasty group mean VAS improvement from baseline: 37.0 (95% CI, 30.5-43.6); lavage group: 32.6 (95% CI, 26.1-39.0) - both clinically important.
• Reoperations at 24 months: 8/105 (osteochondroplasty) vs 19/104 (lavage); odds ratio 0.37 (95% CI, 0.15-0.89; P = .026).
• HOS activities of daily living at 12 months: lavage better than osteochondroplasty by mean difference -5.03 (95% CI, -10.40 to -0.03; P = .049).
• Non-operative hip-related adverse events at 24 months: 15/105 vs 13/104; odds ratio 1.18 (95% CI, 0.53-2.62; P = .695) - no significant difference.
• Primary reasons for reoperation: hip pain (15/27, 55.6%) and labral reinjury (11/27, 40.7%).
• Osteochondroplasty surgical correction rated acceptable by adjudication committee in 83/100 (83.0%) cases with adequate imaging.
• Mean alpha angle correction in osteochondroplasty group: 11.5 degrees (95% CI, 8.3-14.7 degrees).

Limitations

• VAS data were missing for 27% of enrolled patients at 12 months, largely because the outcome was not collected during part of the pilot phase, though multiple imputation was used to address this.
• Both groups received labral repair or resection when indicated, making it difficult to isolate the contribution of osteochondroplasty alone versus labral treatment on reoperation rates.
• The majority of participants were White men with a mean age of 36 years, limiting generalizability to women, non-White patients, and older adults.
• Follow-up was only 2 years; longer-term data are needed to determine whether osteochondroplasty prevents osteoarthritis development compared with lavage.

Why it matters

For patients

Patients with FAI can expect meaningful pain relief from either surgical approach, but bone reshaping (osteochondroplasty) substantially reduces the chance of needing a second operation within 2 years.

For clinicians

Osteochondroplasty should remain the standard surgical intervention for FAI: it matches lavage for short-term pain outcomes but significantly lowers reoperation risk, supporting the value of correcting bony morphology.

For readers

This is a well-powered, blinded, multicenter RCT providing Level 1 evidence that osteochondroplasty is superior to lavage for FAI when reoperation rate is considered the key durability outcome.