Femoroacetabular Junction Impingement (FAI) describes abnormalities
in the shape of the femoral head–neck junction, or abnormalities
in the orientation of the acetabulum. In the short term, FAI can
give rise to pain and disability, and in the long-term it significantly increases
the risk of developing osteoarthritis. The Femoroacetabular Impingement
Trial (FAIT) aims to determine whether operative or non-operative
intervention is more effective at improving symptoms and preventing
the development and progression of osteoarthritis. FAIT is a multicentre superiority parallel two-arm randomised
controlled trial comparing physiotherapy and activity modification
with arthroscopic surgery for the treatment of symptomatic FAI.
Patients aged 18 to 60 with clinical and radiological evidence of
FAI are eligible. Principal exclusion criteria include previous
surgery to the index hip, established osteoarthritis (Kellgren–Lawrence
≥ 2), hip dysplasia (centre-edge angle <
20°), and completion
of a physiotherapy programme targeting FAI within the previous 12
months. Recruitment will take place over 24 months and 120 patients
will be randomised in a 1:1 ratio and followed up for three years.
The two primary outcome measures are change in hip outcome score
eight months post-randomisation (approximately six-months post-intervention
initiation) and change in radiographic minimum joint space width
38 months post-randomisation. ClinicalTrials.gov: NCT01893034. Cite this article: Aims
Methods
The NHS will soon implement 18 week referral to treatment targets. A prospective study was performed whereby from 2004–6, referral letters from General Practitioners suggesting a diagnosis specifically of Morton’s neuroma, resulted in randomised assignment to either direct referral for USI or to the specialist Foot and Ankle outpatient clinic. Patients with less specific referral letters were evaluated in clinic and referred for USI as appropriate. A comparison was made of the sensitivity and specificity of the referral pathways, financial implications and the time to treatment (TTT).
Of 57 patients for whom the GP had diagnosed a MN, 40 (70%) had the diagnosis confirmed on USI (other diagnoses were: 7 NAD, 3 ganglions, 2 bursae, 2 degenerative change, 1 glomus tumour, 1 angioleiomyoma, 1 SOL); this was comparable to the overall number referred to radiology with a suspected MN (69%). In the directly referred group, the mean TTT was 115 days (95%CI = 89 – 141), compared to 241 days (95%CI = 223 – 259) for those patients who went via a Foot and Ankle clinic. P<
0.0001.
The mean wait of this group is within the 18 week government target without any changes to our current radiology protocols. Using this direct referral protocol we saved 29 outpatient appointments; if followed for all eligible patients we would have saved 57 outpatient appointments.
