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This is a summary of the NEW Devon CCG commissioning policy for open or arthroscopic surgery for the treatment of femoro–acetabular impingement (FAI)
Non operative treatment of FAI includes rest, physiotherapy, and activity modification to reduce unnecessary hip motion, rest, anti-inflammatory medication and core strengthening, proceeding to surgery if symptoms persist.
However although these are the usual first line treatment in musculoskeletal injuries, their benefits are questioned in FAI and with recommendation of corrective surgery in all FAI diagnosed patients to avoid delay which could result in disease progression to the point where joint preservation is no longer possible.
Open or arthroscopic surgery for the treatment of femoro-acetabular impingement will be routinely commissioned only for patients who fulfil all the following criteria:
Patients not included in these criteria are:
Patients undergoing hip arthroscopy are subject to prospective study using validated scores. Standard data on perception of pain and interference in daily living are requested to accompany the prior notification form. A consistent reasonable data collection as decided by the clinical team is required in order to get consistency in use of outcome measures e.g. Oxford Hip Scores or Non arthritic Hip Scores
Prior approval is not required for patients being treated in accordance with this policy, although a Prior Notification form (example enclosed) should continue to be sent to the Exceptional Treatments Panel at the time a decision to treat is made.
If the patient does not meet all the criteria described above but the clinician still feels that this treatment is recommended then a funding request should be made in the normal manner.
Treatment of FAI should be restricted to centres experienced in treating this condition and staffed by surgeons adequately trained in techniques addressing FAI and all governance and audit undertaken in accordance with NICE IPG 403 and IPG 408.