Larson Christopher M, Giveans M Russell, Samuelson Kathryn M, Stone Rebecca M, Bedi Asheesh
Minnesota Orthopedic Sports Medicine Institute at Twin Cities Orthopedics, Edina, Minnesota, USA
Minnesota Orthopedic Sports Medicine Institute at Twin Cities Orthopedics, Edina, Minnesota, USA.
Am J Sports Med. 2014 Aug;42(8):1785-90. doi: 10.1177/0363546514534181. Epub 2014 May 29.
There are limited data reporting outcomes after revision arthroscopic surgery for residual femoroacetabular impingement (FAI).
(1) Revision arthroscopic FAI correction results in improved outcomes, but they are inferior to those of primary arthroscopic FAI correction. (2) Improved postrevision radiographic parameters are predictive of better outcomes.
Cohort study; Level of evidence, 3.
Patients who underwent arthroscopic hip revision for residual FAI were reviewed. Pathomorphological findings, intraoperative findings, and preoperative and postoperative modified Harris Hip Score (MHHS), Short Form-12 (SF-12), and pain on a visual analog scale (VAS) values were evaluated. Outcomes after revision arthroscopic FAI correction were compared with outcomes of a matched cohort who underwent primary arthroscopic FAI correction.
A total of 79 patients (85 hips) with a mean age of 29.5 years underwent arthroscopic revision FAI correction (mean follow-up, 26 months). The labrum was debrided (27 hips), repaired (49 hips), or reconstructed (7 hips). Two labrums were stable and required no treatment. The results of revision arthroscopic FAI correction were compared with those of 220 age- and sex-matched patients (237 hips) who underwent primary arthroscopic FAI correction (mean follow-up, 23 months). The mean improvement in outcome scores after revision FAI correction was 17.8 (MHHS), 12.5 (SF-12), and 1.4 (VAS) points compared with 23.4 (MHHS), 19.7 (SF-12), and 4.6 (VAS) points after primary arthroscopic FAI correction. The mean improvement was significantly better in the primary cohort compared with the revision cohort (P < .01 for MHHS, SF-12, and VAS values). Good/excellent results were achieved in 81.7% of the primary cohort and 62.7% of the revision cohort (P < .01). Greater postoperative head-neck offset (P = .024), subspine/anterior inferior iliac spine (AIIS) decompression (P = .014), labral repair/reconstruction (P = .009), and capsular plication (P = .032) were significant predictors for better outcomes after revision surgery.
Arthroscopic hip revision surgery for residual FAI yielded significantly improved outcome measures, but these were inferior to those after primary arthroscopic FAI corrective surgery. Improved femoral head-neck offset after cam decompression, identification and treatment of subspine/AIIS impingement, labral preservation/reconstruction, and capsular preservation/plication may be paramount to achieve satisfactory outcomes.
关于关节镜下翻修手术治疗残留股骨髋臼撞击症（FAI）后的疗效数据有限。
（1）关节镜下翻修FAI矫正可改善疗效，但不如初次关节镜下FAI矫正。（2）翻修后影像学参数的改善可预测更好的疗效。
队列研究；证据等级，3级。
对接受关节镜下髋关节翻修治疗残留FAI的患者进行回顾性分析。评估病理形态学结果、术中发现以及术前和术后改良Harris髋关节评分（MHHS）、简短健康调查简表12（SF-12）和视觉模拟量表（VAS）疼痛值。将关节镜下翻修FAI矫正后的疗效与接受初次关节镜下FAI矫正的匹配队列的疗效进行比较。
共有79例患者（85髋），平均年龄29.5岁，接受了关节镜下翻修FAI矫正（平均随访26个月）。对盂唇进行了清创（27髋）、修复（49髋）或重建（7髋）。2个盂唇稳定，无需治疗。将关节镜下翻修FAI矫正的结果与220例年龄和性别匹配、接受初次关节镜下FAI矫正的患者（237髋）（平均随访23个月）的结果进行比较。翻修FAI矫正后，结果评分的平均改善为17.8分（MHHS）、12.5分（SF-12）和1.4分（VAS），而初次关节镜下FAI矫正后为23.4分（MHHS）、19.7分（SF-12）和4.6分（VAS）。与翻修队列相比，初次队列的平均改善明显更好（MHHS、SF-12和VAS值P <.01）。初次队列中81.7%和翻修队列中62.7%取得了良好/优秀的结果（P <.01）。术后更大的头颈偏移（P =.024）、转子下/髂前下棘（AIIS）减压（P =.014）、盂唇修复/重建（P =.009）和关节囊折叠（P =.032）是翻修手术后更好疗效的显著预测因素。
关节镜下髋关节翻修手术治疗残留FAI可显著改善疗效指标，但不如初次关节镜下FAI矫正手术。凸轮减压后改善股骨头颈偏移、识别和治疗转子下/AIIS撞击、保留/重建盂唇以及保留/折叠关节囊对于获得满意疗效可能至关重要。
