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Clinical Trials in Orthopaedics and the Future Direction of Clinical Investigations for Femoroacetabular Impingement

Femoroacetabular impingement (FAI) represents a heterogeneous group of disorders that affect a diverse patient population. The natural history of the disease, the role of nonsurgical management, the indications for surgery, optimal surgical techniques, and the predictors of treatment outcomes need to be further defined. To date, clinical research reports have included primarily surgical case series. Future clinical investigations are needed to establish improved clinical evidence to guide patient care. Most urgent is the need to better understand the potential role of standardized nonsurgical treatment options for FAI and to define the predictors of surgical and nonsurgical outcomes. Future randomized controlled trials and large observational cohort studies targeted at these clinical research deficiencies will strengthen the evidence and improve informed decision making regarding the management of symptomatic FAI.

Controversies in Diagnosis and Management of FAI

AAOS/ORS co-sponsored research symposium explores challenges, implications for clinical practice

Femoroacetabular impingement (FAI) in young adults can lead to the development of osteoarthritis (OA) of the hip, a leading cause of reduced quality of life and loss of function. In addition, arthroplasty to treat lower extremity OA is both common and costly—the number of total hip arthroplasty procedures is expected to increase by 200 percent over the next two decades. As a result, interest in treatment innovations focused on early detection of FAI and interventions to prevent or halt disease progression and preserve the natural hip joint is growing.

The recent 2012 AAOS/Orthopaedic Research Society (ORS) FAI Research Symposium emphasized a multidisciplinary approach and focused on summarizing current knowledge, developing consensus, and identifying research strategies for several key issues related to the condition. Under the direction of co-chairs John C. Clohisy, MD, of Washington University School of Medicine in St. Louis, and Young-Jo Kim, MD, PhD, of Children’s Hospital Boston, the 2-day symposium addressed, among other topics, disease definitions, radiographic and clinical assessment methods, treatment strategies, clinical outcome methods, and possible clinical trial designs to study the treatment efficacy for FAI.