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Uh my review from the paper from the uh the F trial uh which is basically medium term results, a three year follow up comparing arthroscopy versus uh physiotherapy. Um This was um uh this is what is the, let me just see how I can hold this. Yeah, this was a multicenter randomized controlled trial published in the British uh British Journal of Sports Medicine in November of last year. And this is a well structured RCT therefore, would be can be attributed as level one evidence. Um So the primary treatment goal in patient uh patients with fai is to improve pain and function. The initial treatment is uh l incremental uh exercise rehab along with uh education and activity modification. Um For those uh they can a selective group of patients like we discussed may benefit with hip arthroscopy, especially those who have failed non operative management. And uh it's a, it's what's known is that it's effective in treating uh short term symptoms. The longest uh follow up that we have so far. Um Prior to this trial was from the Australian fashion trial which uh noted no effect of hips copy on disease progression at 12 months. So the need for this trial stems from the fact that longer term outcomes of hip arthroscopy, both in terms of its ability to improve symptoms and um potentially modify disease progression needed to be looked at. So the objective was to compare arthroscopic hip surgery with physiotherapy and activity modification for improving patient reported outcome measures in patients with symptomatic fai. Um The outcome measures uh which were reported at 38 months. Uh since the onset of the trial, the primary outcome measures were minimum joint space width, which is MJS SW and hip outcome score for activities of daily living. And the secondary outcome measures reported was the chambre score or the scoring hip osteoarthritis with uh MRI. So, uh just to highlight what the mjs SW is, it's basically the uh the narrowest width uh in the femur talar region. Um So if, if I don't know if anyone can see this uh cursor but uh um the from the source and uh and imagining the head of the femur, the point at which whether it it's the narrowest with and that's considered as the minimum joint space width um can be calculated in two ways either manual or automated. The um uh semi automated or automated is more accurate. So for, for the purpose of this trial, they use the software package to uh calculate this. The hip outcome score is actually a patient uh completed measure. Uh It has two components. The activities of daily living uh subscale which is uh uh has a scoring and then there's a sports subscale and it's uh a five point like uh scale uh response um um sort of questionnaire and it ranges from 0 to 100% for the p uh So a higher um uh hip outcome score suggests patient outcomes. So for the purpose of this trial, they use the ADL subscale and uh the chari score, the scoring hip oa with MRI uh is a semi quantitative method for giving grading hip osteoarthritis based on eight different features noted on an MRI and uh uh the higher the score, it would indicate uh greater the pathological changes. So this was a multicenter, a randomized controlled trial. Um It was ssl blinded, there were two parallel uh arms with uh 1 to 1 allocation. The trial started in May of 2013 and the current research article is for the 38 month follow up. It was multicenter by that, I mean seven NHS hospitals across the country were involved. Um The manuscript also stated about a feasibility study prior to this, describing the patient and public involvement and also factoring in equity diversity and inclusion. So the inclusion criteria comprised of um patients with symptomatic fai between the age group of 18 to 60 years who were diagnosed clinically and radiologically. And the ones who were excluded from this were those who have had a previous um surgery to the hip, those with established osteoarthritis or hip dysplasia who've completed a physiotherapy regimen for a previously, um, or those who have contraindication for an MRI. So after the, uh, screening of, um, these patients, um, baseline characteristics, um, uh, and after exclusion, baseline characteristics were recorded and then they're using a software, they were allocated either to the operative, um, or, um, um, uh, a, a standardized physiotherapy regimen. So for when we, we speak about the physiotherapy regimen, uh It was a goal based program with up to um eight sessions over five months. Um There was a standardized treatment checklist to improve basically the co stability and, and movement control. The patients were then encouraged to continue exercise at home at home and refrain from any activities that would involve extremes of hip flexion abduction and internal rotation, basically the impingement position. And if participants achieved all their goals within five months, they were discharged and asked to continue with exercises and activity modification in the community with regard to the operative arm. Um The operations were carried out by those surgeons who were involved in performing more than 100 hip arthroscopies o over a year. It um So once the hip scope um uh was done, if there was any la injury that was repaired, uh Chondroplasty was done. Uh microfracture needed to be done that was performed and postoperatively, uh all patients were allowed to fully weight bear after surgery unless they had had a micro fracture and they were asked to avoid high impact activities for a period of 8 to 12 weeks. These participants also in their postoperative period received um a physio uh regimen but that was quite distinct to the one that um the other um patients in the other arm received uh the primary outcome measures of the minimal joint space with uh hip outcome score. And um the uh uh uh chari score uh were measured at eight months post randomization and, and crossover was not permitted before this assessment any time thereafter. If a participant felt that they had not reached their goals and they wanted to seek further intervention with respect to their index hip, they were reviewed by a member of the recruiting surgical team and then um they were offered entry into the alternative arm. So coming to the results um on the left hand side of that busy slide is basically the baseline characteristics of the uh two arms. And um looking at it, both the arms were quite comparable for their characteristics. The one high, the ones highlighted in red is the only things that I noted slightly different, which was basically a predominance of women uh in the two arms. And also um majority of the patients having um a cam lesion. And uh looking at the trial flow chart, there were 222 participants who were included in the trial. There were 100 and 12 in the uh arthroscopy arm and 100 and 10 in the uh in the in the physiotherapy arm um radiographic data for the primary uh outcomes of mm mm uh The joint space with was uh a available for only 45% of patients. Um That was so it was the primary outcome measure was less for less than 50% essentially. And the hip outcome score for the activities of daily living and the MRI data was available for 77 and 62% of randomized participants respectively. Um during this trial, um follow up period, six participants in the arthroscopy um received further arthroscopy, it reads arthroplasty there. But by I think by that, what they mean is sort of preserving joint function rather than replacing it. And one participant in that group received a total hip arthroplasty and 22 of them received a hip injections. Whereas in the um in the other arm which underwent a physio regimen, 43 participants received further hip arthroscopies after eight months and uh seven underwent total hip arthroplasty and uh 26 received intraarticular um injections. Um So looking at the primary outcome measures and starting from the hip uh um uh osteoarthritis score, um this was statistically um significant throughout the duration of the follow up. However, it failed to meet the threshold for the MCD and similar was the case for the MRI score. It was neither statistically significant nor uh did it meet the threshold for MCI and even for the joint space width. But uh if um for the joint space with, they did a further analysis um especially for patients who um and subsequently ended up needing a total hip arthroplasty. And when they compared that particular subset that they noted uh uh a statistical significance. Uh but that was with the assumption that all these patients had a joint space width uh of zero millimeters, which is basically um in a sense meets bone on bone. Um So, I mean, there was six, although there was uh six times higher likelihood of uh receiving a hip replacement in the physiotherapy group. Um within the follow up period, the absolute number of patients who are undergoing total hip arthroplasty within the study remained small. Um The study mentioned that they were unable to extrapolate findings to suggest a disease modifying effect for hip arthroscopy. Um The effect of either scopy or physio to delay.