Surgery or physiotherapy: the trials in briefMixed evidence
In the UK FASHIoN trial (348 people in 23 NHS hospitals), hip arthroscopy scored 6.8 points better than personalised physiotherapy on a 100-point hip quality-of-life score at 12 months, just over the smallest difference patients notice (6.1). In the UK FAIT trial (222 people), surgery scored 10 points better on a 100-point score of daily activities at 8 months, where 9 is noticeable, and 8.9 points better at about 3 years.
Across 21 trials (1,799 people), the average advantage fell short of the noticeable difference, and pain didn't differ. Patients knew which treatment they had in these trials. Our hip impingement and hip labral tear guides cover this choice in more detail.
Sources 17, 10, 18, 19
Surgery hasn't been shown to prevent arthritisEmerging evidence
At about 3 years in FAIT, X-rays showed no difference in joint space between surgery and physiotherapy, though only 45% had them, and cartilage scores on magnetic resonance imaging (MRI) looked better after surgery. Some patient pages say correcting impingement can prevent future damage; the trials haven't shown that. With arthritis already present, NICE says keyhole washout or tidying shouldn't be offered.
Sources 18, 3, 5
Reshaping the bone: fewer repeat operations, not less painEmerging evidence
In 220 people with impingement, reshaping the bone (with the same labral treatment) gave no less pain at 12 months than a keyhole washout, though it led to fewer repeat operations by 24 months (8 of 105 against 19 of 104). A trial comparing hip arthroscopy with sham surgery (HIPARTI) has published its plan, but we found no main results yet.
Sources 20, 21
Crutch and movement limits vary, and none has been tested against another
A review of 24 studies (2,231 people) found 7 different terms for weight-bearing advice, and not enough evidence to recommend any particular restriction. In 36 US hospital protocols, a brace was required in 36% (for about 3 weeks on average), and weight limits ranged from full weight to about 9 kg (20 lb), with movement limits and exercises that varied too. Reviews found that phased programmes with clear goals and progression checks went with better results for patients, but couldn't say which programme is best.
UK hospitals differ in the same way. One NHS trust lets you take full weight and move the hip as fully as you can unless told otherwise, with crutches until you stop limping; another asks some people to take half their weight; a third says restricted weight usually lasts 2 to 6 weeks; and a fourth lists precautions for up to 8 weeks. That's why your own team's leaflet comes first.
Sources 22, 23, 24, 25, 12, 26, 1, 27
Straight-leg raises: hospitals differMixed evidence
One detailed US hospital guideline leaves out straight-leg raises and other long leg lifts in the first weeks, avoids taking the hip back past straight early on, and keeps repeated hip lifting to a minimum until about 6 weeks, to protect the main hip flexor (the iliopsoas) from irritation. Lifting a straight leg makes that muscle work hard.
But some UK leaflets include hip lifts in the first fortnight: one starts seated knee lifts on the day of the operation and standing lifts from a week, and another includes standing lifts forwards and backwards from the start. No trial has compared the two approaches, so follow your team. Whichever you're given, groin pain that builds when you lift the leg is a reason to ease off and ask.
Sources 28, 26, 27
A steady rehab programme: well tolerated, though untested against noneEmerging evidence
In a 3-month programme tested in 29 people within a sham-controlled trial, 80% of those keeping diaries did 2 or more sessions a week, average pain during rehab stayed below 2 out of 10, and hip quality of life improved by 18.6 points at 6 months. Without a comparison group, it can't show the programme caused the gains, but it supports a steady, gentle, progressive plan like the one below.
Sources 29, 28
Back to sport takes monthsEmerging evidence
Across 35 studies (1,634 athletes), 74% returned to their pre-injury level of sport, on average 7 months after surgery. In 189 Danish athletes aged 18 to 30, 57% were playing their previous sport at their previous level about 3 years later, and only 17% of the whole group reported performing at their best. A review of 14 studies of mixed quality found a higher average return rate, 90%, with definitions that varied, and the time to return ranged from 7 to 32 weeks across rehab studies.
Sources 30, 31, 25, 24