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Femoroacetabular Impingement RandomiSed Controlled Trial (FIRST)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01623843
Recruitment Status : Completed
First Posted : June 20, 2012
Last Update Posted : August 25, 2020
Canadian Institutes of Health Research (CIHR)
McMaster Surgical Associates
Canadian Orthopaedic Foundation
American Orthopaedic Society for Sports Medicine
Information provided by (Responsible Party):
McMaster University

Brief Summary:
The purpose of this study is to determine whether surgical correction of hip impingement morphology via arthroscopic osteochondroplasty (shaving of bone) will provide improved clinical results (decreased pain and improved function) in adult patients with femoroacetabular impingement (FAI) compared to arthroscopic lavage (washing out of painful inflammation debris) and treating obvious damage of the hip joint.

Condition or disease Intervention/treatment Phase
Femoroacetabular Impingement Procedure: Arthroscopic Lavage Procedure: Arthroscopic Osteochondroplasty Not Applicable

Detailed Description:

Femoroacetabular impingement (FAI) is a condition of the hip where there is a mismatch of the ball and socket in the hip joint. This mismatch creates abnormal contact in the hip which can cause patients to experience hip pain. This can eventually lead to hip damage and osteoarthritis. Hip arthroscopy, a form of minimally invasive surgery has become a popular treatment option. The investigators are conducting a definitive randomized controlled trial (RCT) to determine whether surgical correction of the impingement morphology via arthroscopic osteochondroplasty (shaving of bone) will provide improved clinical results (decreased pain and improved function) in adult FAI patients compared to arthroscopic lavage (washing out of painful inflammation debris) and treating obvious damage of the hip joint.

Like most RCTs, FIRST is designed to demonstrate efficacy (i.e. that an intervention can work theoretically under optimal conditions). In order to address generalizability and improve external validity of the FIRST trial, we are including an external validation cohort using a "RCT with and Embedded ProspectIve Cohort design" (FIRST-EPIC). This pragmatic cohort will allow us to: 1) safeguard against bias attributable to patients declining to take part in the RCT; 2) corroborate or refute whether our efficacy (RCT) population represents the best case scenario (i.e. those with optimal response to osteochondroplasty); 3) evaluate effectiveness of osteochondroplasty and other standard of care treatments for FAI in patients with potentially distinct prognostic factors; and 4) evaluate the cost-effectiveness of the interventions.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 220 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Femoroacetabular Impingement RandomiSed Controlled Trial (FIRST); Sub-study: Femoroacetabular Impingement RandomiSed Controlled Trial With an Embedded Prospective Cohort (FIRST-EPIC)
Actual Study Start Date : September 2012
Actual Primary Completion Date : December 2019
Actual Study Completion Date : March 2020

Arm Intervention/treatment
Active Comparator: Arthroscopic Lavage
Participants have three hip portals (antero-lateral, mid anterior, distal antero-lateral) with limited capsulotomy allowing for a complete assessment of the central and peripheral compartments. The participant has a diagnostic arthroscopy and lavage of the hip joint with three litres of normal saline. No osteochondroplasty or rim resection is completed in this group. No instruments are used to treat minor cartilage or labral damage. The labrum should only be repaired if mechanically unstable once probed with visible displacement or chondrolabral separation. The labrum will be refixated only if the above criteria for labral instability is met.
Procedure: Arthroscopic Lavage
Lavage: inflammation debris caused from continual friction in the hip is washed out.

Experimental: Arthroscopic Osteochondroplasty
After establishing standard portals, an inter-portal capsulotomy will be completed to allow for complete evaluation of the central compartment of the hip. Significant and obvious labral tears and cartilage damage will be addressed. The labrum will be repaired if mechanically unstable once probed with visible displacement or chondrolabral separation. The acetabular rim will be evaluated and any evident Pincer lesion will be resected using an arthroscopic burr under fluoroscopic guidance. Following this resection, the labrum will be refixated only if the criteria for labral instability is met. Following this, a limited capsulotomy will be completed along the head-neck junction of the femoral neck to allow for visualization and treatment of the impingement lesion in the peripheral compartment. For the FIRST-EPIC sub-study, participants will receive the osteochondroplasty intervention as per standard of care.
Procedure: Arthroscopic Osteochondroplasty
Osteochondroplasty: reshaping the hip ball and socket ("osteoplasty" or "rim trimming").

Primary Outcome Measures :
  1. Pain (measured using a Visual Analog Scale) [ Time Frame: 12 months ]
    The VAS is one of the most frequently used pain rating scales in clinical practice and research. The VAS is a validated unidimensional scale that is easy to use, requires no verbal or reading skills, and is sufficiently versatile to be employed in a variety of settings. The VAS will be administered during routine follow up visits at baseline, 2 weeks, 6 weeks, 3 months, 6 months, and 12 months.

Secondary Outcome Measures :
  1. Function (measured using the Hip Outcome Score) [ Time Frame: 12 months ]
    The HOS is a self-administered hip score that was designed to capture hip function and outcomes following surgical therapies such as arthroscopy. The HOS has been shown to have the greatest clinimetric evidence for use in patients with FAI or labral tears.

  2. Health-related quality of life (measured using the Short-Form 12) [ Time Frame: 12 months ]
    The SF-12 may be self or interview-administered and will help document general health status as well as the burden of illness that FAI presents.

  3. Function and lifestyle (measured using the International Hip Outcome Tool) [ Time Frame: 12 months ]
    The iHOT-12 is a shorter version of the iHOT-33 designed to be easier to complete in routine clinical practice to measure both health-related quality of life and changes after treatment in young, active patients with hip disorders. This questionnaire has been shown to be valid, reliable, and responsive to change.

  4. Health utility (measured using the Euro-Quol 5 Dimensions) [ Time Frame: 12 months ]
    The EQ-5D is a standardized instrument for use as a measure of health outcome. The EQ-5D comprises five dimensions of health (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression). The EQ-5D has been used in previous studies involving patients with hip pain and has been extensively validated. Our decision to the use EQ-5D was based upon our interest in collecting health utility data for a formal economic analysis.

  5. Urinary function (measured using the Male/Female Lower Urinary Tract Symptoms questionnaires) [ Time Frame: 12 months ]
    The two validated questionnaires selected that pertain to male and female urinary symptoms are gender specific variations of the International Consultation on Continence Questionnaire (ICIQ). The ICIQ-MLUTS (male) and ICIQ-FLUTS (female). These are validated patient-completed questionnaires, which evaluate male and female lower urinary tract symptoms (LUTS), as well as quality of life. Both questionnaires have demonstrated validity, reliability and responsiveness internally and externally.

  6. Sexual function (measured using the International Index of Erectile Dysfunction and the Female Sexual Function Index) [ Time Frame: 12 months ]
    The FSFI is a brief psychometrically sound and reliable tool that assesses female sexual function, and has proven ability to discriminate between clinical and nonclinical populations.The FSFI is also designed to measure the impact on quality of life. The IIEF is a brief self-administered questionnaire assessing sexual experience within the previous 4 weeks, consisting of 15 questions designed to address 5 relevant aspects of male sexual function, specifically erectile function, sexual desire, orgasmic function, intercourse satisfaction and overall satisfaction. This instrument is psychometrically sound with high sensitivity and specificity, which has been validated for administration in research and clinical settings, and across cultures with linguistically validated versions.

  7. Complications / Adverse events [ Time Frame: 12 and 24 months ]
    Includes additional surgery, infection, reduced range of motion, and other adverse events

Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.

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Ages Eligible for Study:   18 Years to 50 Years   (Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  1. Adult men or women ages 18 to 50 years
  2. Hip pain for greater than 6 months with no relief from non-operative means (physiotherapy, non-steroidal anti-inflammatory medication, rest)
  3. Documentation of failed physiotherapy, including core conditioning of the hip, back, and abdomen
  4. CAM or Mixed Type FAI as diagnosed on x-rays and magnetic resonance imaging (MRI) or magnetic resonance arthrogram (MRA)
  5. Temporary relief from an intra-articular hip injection
  6. Informed consent from participant
  7. Ability to speak, understand and read in the language of the clinical site

Exclusion Criteria:

  1. Previous inclusion in a study involving FAI
  2. Evidence of hip dysplasia (centre edge angle less than 20)
  3. Presence of advanced hip osteoarthritis (Tonnis Grade 2 or 3)
  4. Presence of other hip syndromes (concurrent non-FAI related pathology)
  5. Previous trauma to the affected hip
  6. Previous surgery on the affected hip or contralateral hip
  7. Severe acetabular deformities (e.g. acetabular protrusion, coxa profunda, circumferential labral ossification)
  8. Immunosuppressive medication use
  9. Chronic pain syndromes
  10. Significant medical co-morbidities (requiring daily assistance for ADLs)
  11. History of paediatric hip disease (Legg-Calve-Perthes; slipped capital femoral epiphysis)
  12. Ongoing litigation or compensation claims secondary to hip problems
  13. Any other reasons given to exclude the patient

    • If a patient does not meet the eligibility criteria for the FIRST trial, they may be considered eligible for the FIRST-EPIC sub-study.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT01623843

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Canada, Nova Scotia
Dalhousie University
Halifax, Nova Scotia, Canada
Canada, Ontario
McMaster University
Hamilton, Ontario, Canada, L8N 3Z5
Kingston General Hospital
Kingston, Ontario, Canada
Fowler Kennedy Sports Medicine Clinic
London, Ontario, Canada
London Health Sciences
London, Ontario, Canada
St. Michael's Hospital
Toronto, Ontario, Canada
Canada, Quebec
CHU de Québec, L'Hôtel-Dieu de Québec
Quebec City, Quebec, Canada
Odense University Hospital
Odense, Denmark
Hatanpää Hospital
Tampere, Finland, 33900
Turku University Hospital
Turku, Finland, 20540
Sponsors and Collaborators
McMaster University
Canadian Institutes of Health Research (CIHR)
McMaster Surgical Associates
Canadian Orthopaedic Foundation
American Orthopaedic Society for Sports Medicine
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Principal Investigator: Olufemi Ayeni, MD, MSc, FRCSC McMaster Univerity
Schenker ML, Martin R, Weiland DE, Philippon MJ. Current trends in hip arthroscopy: a review of injury diagnosis, techniques and outcome scoring. Current opinion in orthopeadics.2005;16:89-94.

Publications automatically indexed to this study by Identifier (NCT Number):
Femoroacetabular Impingement Randomized Controlled Trial (FIRST) Investigators, Ayeni OR, Karlsson J, Heels-Ansdell D, Thabane L, Musahl V, Simunovic N, Duong A, Bhandari M, Bedi A, Järvinen T, Naudie D, Seppänen M, Slobogean G, Skelly M, Shanmugaraj A, Crouch S, Sprague S, Buckingham L, Ramsay T, Lee J, Kousa P, Carsen S, Choudur H, Sim Y, Johnston K, Sprague S, Wong I, Murphy R, Sparavalo S, Whelan D, Khan R, Wood GCA, Howells F, Grant H, Naudie D, Zomar B, Pollock M, Willits K, Firth A, Wanlin S, Remtulla A, Kaniki N, Belzile EL, Turmel S, Jørgensen U, Gam-Pedersen A, Hatanpää T, Sihvonen R, Raivio M, Toivonen P, Routapohja MP. Osteochondroplasty and Labral Repair for the Treatment of Young Adults With Femoroacetabular Impingement: A Randomized Controlled Trial. Am J Sports Med. 2021 Jan;49(1):25-34. doi: 10.1177/0363546520952804. Epub 2020 Sep 24.

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Responsible Party: McMaster University Identifier: NCT01623843    
Other Study ID Numbers: FIRST-01
First Posted: June 20, 2012    Key Record Dates
Last Update Posted: August 25, 2020
Last Verified: August 2020
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No
Keywords provided by McMaster University:
hip arthroscopy
Additional relevant MeSH terms:
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Femoracetabular Impingement
Joint Diseases
Musculoskeletal Diseases
Pathologic Processes