Department of Orthopaedic Surgery, Inselspital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland.
Clin Orthop Relat Res. 2014 Jan;472(1):337-48. doi: 10.1007/s11999-013-3268-0. Epub 2013 Sep 8.
Patients with femoroacetabular impingement (FAI) often develop pain, impaired function, and progression of osteoarthritis (OA); this is commonly treated using surgical hip dislocation, femoral neck and acetabular rim osteoplasty, and labral reattachment. However, results with these approaches, in particular risk factors for OA progression and conversion to THA, have varied.
QUESTIONS/PURPOSES: We asked if patients undergoing surgical hip dislocation with labral reattachment to treat FAI experienced (1) improved hip pain and function; and (2) prevention of OA progression; we then determined (3) the survival of the hip at 5-year followup with the end points defined as the need for conversion to THA, progression of OA by at least one Tönnis grade, and/or a Merle d'Aubigné-Postel score less than 15; and calculated (4) factors predicting these end points.
Between July 2001 and March 2003, we performed 146 of these procedures in 121 patients. After excluding 35 patients (37 hips) who had prior open surgery and 11 patients (12 hips) who had a diagnosis of Perthes disease, this study evaluated the 75 patients (97 hips, 66% of the procedures we performed during that time) who had a mean followup of 6 years (range, 5-7 years). We used the anterior impingement test to assess pain, the Merle d'Aubigné-Postel score to assess function, and the Tönnis grade to assess OA. Survival and predictive factors were calculated using the method of Kaplan and Meier and Cox regression, respectively.
The proportion of patients with anterior impingement decreased from 95% to 17% (p < 0.001); the Merle d'Aubigné-Postel score improved from a mean of 15 to 17 (p < 0.001). Seven hips (7%) showed progression of OA and another seven hips (7%) converted to THA Survival free from any end point (THA, progression of OA, or a Merle d'Aubigné-Postel < 15) of well-functioning joints at 5 years was 91%; and excessive acetabular rim trimming, preoperative OA, increased age at operation, and weight were predictive factors for the end points.
At 5-year followup, 91% of patients with FAI treated with surgical hip dislocation, osteoplasty, and labral reattachment showed no THA, progression of OA, or an insufficient clinical result, but excessive acetabular trimming, OA, increased age, and weight were associated with early failure. To prevent early deterioration of the joint, excessive rim trimming or trimming of borderline dysplastic hips has to be avoided.
患有股骨髋臼撞击症（FAI）的患者常出现疼痛、功能障碍和骨关节炎（OA）进展；这通常采用手术髋关节脱位、股骨颈和髋臼缘骨成形术以及盂唇再附着来治疗。然而，这些方法的结果，特别是 OA 进展和转换为全髋关节置换术（THA）的风险因素，存在差异。
问题/目的：我们询问了接受手术髋关节脱位和盂唇再附着治疗 FAI 的患者是否经历了（1）髋关节疼痛和功能改善；（2）OA 进展的预防；然后我们确定了（3）在 5 年随访时髋关节的存活率，终点定义为需要转换为 THA、OA 进展至少 1 个 Tönnis 等级、和/或 Merle d'Aubigné-Postel 评分<15；并计算了（4）预测这些终点的因素。
在 2001 年 7 月至 2003 年 3 月期间，我们对 121 名患者中的 146 名患者进行了这些手术。在排除了 35 名（37 髋）曾接受过开放性手术的患者和 11 名（12 髋）患有 Perthes 病的患者后，本研究评估了 75 名（97 髋，占同期我们进行的手术的 66%）患者，平均随访时间为 6 年（范围为 5-7 年）。我们使用前撞击试验评估疼痛，使用 Merle d'Aubigné-Postel 评分评估功能，使用 Tönnis 分级评估 OA。使用 Kaplan-Meier 方法和 Cox 回归分别计算生存率和预测因素。
有前撞击的患者比例从 95%降至 17%（p<0.001）；Merle d'Aubigné-Postel 评分从平均 15 分提高至 17 分（p<0.001）。7 髋（7%）出现 OA 进展，另外 7 髋（7%）转换为 THA。5 年时无任何终点（THA、OA 进展或 Merle d'Aubigné-Postel<15）的功能良好关节的生存率为 91%；髋臼缘过度修整、术前 OA、手术时年龄增加和体重是终点的预测因素。
在 5 年随访时，接受手术髋关节脱位、骨成形术和盂唇再附着治疗的 FAI 患者中，91%的患者未行 THA、OA 进展或临床效果不足，但髋臼过度修整、OA、年龄增加和体重与早期失败相关。为了防止关节早期恶化，必须避免髋臼缘过度修整或修整边缘发育不良的髋关节。
