Reconstructive Orthopedics, 737 Main Street, Lumberton, NJ, USA
Am J Sports Med. 2013 Apr;41(4):762-8. doi: 10.1177/0363546513476854. Epub 2013 Feb 19.
Patients with symptomatic femoroacetabular impingement (FAI) frequently have bilateral deformity and inquire about the prognosis of their contralateral, asymptomatic hip. Idiopathic coxarthrosis has been established as an independent risk factor for joint failure on the other side.
To determine the prevalence of bilateral arthroscopic treatment for FAI and to identify predictive patient demographics and radiographic findings for bilateral, symptomatic disease.
Case control study; Level of evidence, 3.
Over a 2-year period, patients receiving single-sided FAI surgery for pain and radiographic deformity were identified as unilateral. In the same period, patients undergoing their second side were labeled bilateral, regardless of when the first surgery was performed. Proximal femoral alpha angle; lateral center edge angle; sagittal center edge angle; acetabular version at 1, 2, and 3 o'clock; and femoral torsion were measured on preoperative computed tomography scans.
The unilateral group included 514 patients, and the bilateral group included 132 patients. Women composed 48% of the unilateral group but only 35% of the bilateral group (P = .006). The mean age of unilateral patients was 30.3 (±10.7) years and 27.6 (±9.7) years for the first side of bilateral patients (P = .010). The bilateral hips had higher alpha angles (63.8° vs 59.8°, P = .004), less acetabular anteversion at the 3-o'clock position (13.0° vs 15.9°, P < .001), and similar femoral torsion (15.1° vs 15.5°, P = .793) compared with unilateral hips. A multivariable logistic regression model found that for every 5 years of younger age, 5° higher alpha angle, and 5° decrease in 3-o'clock acetabular version, patients were more likely to undergo bilateral treatment for FAI, by 13.5%, 14.5%, and 25.5%, respectively. In a side-to-side comparison of both hips in bilateral patients, alpha angle (r = 0.72) and acetabular version at 1 o'clock (r = 0.73) showed high correlation.
Male sex, younger age, higher alpha angles, and reduced acetabular anteversion at initial presentation are significant risk factors for identifying patients who may ultimately require bilateral surgery for symptomatic FAI. Among bilaterally treated patients, no radiographic parameters were predictive of which side would require treatment first. Patients with FAI requiring surgery should be closely monitored for contralateral hip disease.
患有症状性股骨髋臼撞击症（FAI）的患者常双侧畸形，并询问其对侧无症状髋关节的预后。特发性髋关节骨关节炎已被确立为对侧关节失效的独立危险因素。
确定双侧关节镜治疗 FAI 的患病率，并确定双侧症状性疾病的预测患者人口统计学和影像学发现。
病例对照研究；证据水平，3 级。
在 2 年期间，接受单侧 FAI 手术治疗疼痛和放射畸形的患者被确定为单侧。在同一时期，接受第二次手术的患者被标记为双侧，无论第一次手术何时进行。在术前 CT 扫描上测量股骨近端 alpha 角；外侧中心边缘角；矢状面中心边缘角；髋臼在 1、2 和 3 点钟的位置；以及股骨扭转。
单侧组包括 514 例患者，双侧组包括 132 例患者。女性在单侧组中占 48%，而在双侧组中仅占 35%（P =.006）。单侧患者的平均年龄为 30.3（±10.7）岁，双侧患者的第一侧年龄为 27.6（±9.7）岁（P =.010）。双侧髋关节的 alpha 角更高（63.8° vs 59.8°，P =.004），髋臼在 3 点钟位置的前倾角更小（13.0° vs 15.9°，P <.001），股骨扭转相似（15.1° vs 15.5°，P =.793）与单侧髋关节相比。多变量逻辑回归模型发现，每年轻 5 岁，alpha 角增加 5°，髋臼在 3 点钟位置的前倾角减少 5°，患者接受双侧 FAI 治疗的可能性分别增加 13.5%、14.5%和 25.5%。在双侧患者的双侧髋关节的侧对侧比较中，alpha 角（r = 0.72）和髋臼在 1 点钟的位置（r = 0.73）显示出高度相关性。
男性、年龄较小、alpha 角较高以及初始表现时髋臼前倾角降低是确定最终可能需要双侧手术治疗症状性 FAI 的患者的重要危险因素。在双侧治疗的患者中，没有任何影像学参数可以预测哪一侧将首先需要治疗。需要手术治疗 FAI 的患者应密切监测对侧髋关节疾病。
