UK FASHIoN—how Clinically Relevant Are the Results?

We have read with great interest the UK FASHIoN study by Damian Griffin and colleagues.1Griffin DR Dickenson EJ Wall PDH et al.Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome (UK FASHIoN): a multicentre randomised controlled trial.Lancet. 2018; 391: 2225-2235Summary Full Text Full Text PDF PubMed Scopus (300) Google Scholar In this randomised controlled trial of 348 patients from 23 centres, the authors conclude that patients with femoroacetabular impingement syndrome have better hip-related quality of life at 12 months after hip arthroscopy than after conservative care. The pragmatic approach, in which orthopaedic surgeons from various backgrounds could recruit and operate on patients, not only deserves appreciation, but serves as an example for future trials. However, because the minimum clinically important difference of 6·1 points on the iHOT-33 was exceeded by only 0·7 points, we felt that a close look at the trial's results was warranted. The lower limit of the CI of the adjusted treatment effect (6·8 points; 95% CI 1·7–12·0) does not exceed the minimum clinically important difference of 6·1 points on the iHOT-33 used by the authors,1Griffin DR Dickenson EJ Wall PDH et al.Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome (UK FASHIoN): a multicentre randomised controlled trial.Lancet. 2018; 391: 2225-2235Summary Full Text Full Text PDF PubMed Scopus (300) Google Scholar nor the minimum clinically important difference of 12·1 points described by Nwachukwu and colleagues.2Nwachukwu BU Fields K Chang B Nawabi DH Kelly BT Ranawat AS Preoperative outcome scores are predictive of achieving the minimal clinically important difference after arthroscopic treatment of femoroacetabular impingement.Am J Sports Med. 2017; 45: 612-619Crossref PubMed Scopus (149) Google Scholar This is also true for all the subanalyses (appendix). If this is the case, is it legitimate to conclude that there is a clinically significant difference? We believe that the FASHIoN trial is extremely relevant in a field in which hardly any level 1 evidence exists so far. However, the conclusion of the FASHIoN trial might be better formulated by mentioning that there is a small effect of hip arthroscopy compared with conservative care in patients with femoroacetabular impingement syndrome, but whether this effect is clinically significant remains an open question. We declare no competing interests. Download .pdf (.11 MB) Help with pdf files Supplementary appendix Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome (UK FASHIoN): a multicentre randomised controlled trialHip arthroscopy and personalised hip therapy both improved hip-related quality of life for patients with femoroacetabular impingement syndrome. Hip arthroscopy led to a greater improvement than did personalised hip therapy, and this difference was clinically significant. Further follow-up will reveal whether the clinical benefits of hip arthroscopy are maintained and whether it is cost effective in the long term. Full-Text PDF Open Access