The effectiveness of hip arthroscopic surgery for the treatment of femoroacetabular impingement syndrome: A systematic review and meta-analysis.

Femoroacetabular impingement syndrome, where hip bones don't fit together smoothly, is often treated with arthroscopic surgery, but how it compares with non-surgical care has been debated. This review pooled three randomised trials, together involving 650 participants, comparing hip arthroscopic surgery against non-operative approaches such as physiotherapy or no intervention. At 12 months, people who had surgery reported better hip-specific quality of life than those managed non-operatively, and this evidence was rated high certainty. By 24 months, though, the two groups looked similar, with the evidence here rated low quality and the result too imprecise to be confident about.

A key limitation is that none of the trials used a placebo or sham surgery comparison, so the extent to which the 12-month benefit reflects the surgery itself versus expectation or extra attention from treatment remains unclear.

If you're weighing up surgery versus non-surgical treatment for femoroacetabular impingement syndrome, a hip condition causing pain from the way the hip bones meet, this review looked at what the evidence says. Researchers combined results from three trials involving 650 people comparing hip arthroscopic surgery to non-surgical care like physiotherapy. At one year, people who had surgery reported better hip-related quality of life than those who had non-surgical care, and this finding was rated as strong evidence.

But by two years, the difference between the two groups wasn't clear anymore, and this later finding came from weaker evidence. One important caveat: none of the trials compared surgery to a fake or placebo surgery, so we can't be sure how much of the early benefit came from the operation itself rather than from the attention and expectations that come with having surgery.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This review addresses a question physiotherapists increasingly face: when counselling patients with femoroacetabular impingement syndrome about non-operative versus surgical pathways, what does the trial evidence actually support? The synthesis pooled three randomised controlled trials (650 participants enrolled, 574 analysed for the primary 12-month outcome) comparing hip arthroscopic surgery with non-operative care, including physiotherapy in some comparisons. The headline result, rated high certainty by GRADE, is a mean difference of 11.02 points (95% CI 4.83 to 17.21) favouring surgery for hip-specific quality of life at 12 months. However, this advantage was not sustained in the low-certainty 24-month data, where the confidence interval (-6.1 to 18.7) spanned both no difference and a substantial benefit, meaning no clear longer-term difference can be concluded. Critically, none of the included trials used a placebo or sham-surgery comparator, so the design cannot separate a true surgical effect from contextual factors such as attention, expectation, or the extensive rehabilitation that often accompanies surgical care.

The authors explicitly call for placebo-controlled trials to establish efficacy, meaning this review informs expectations about comparative outcomes but does not establish causal surgical benefit.