Gupta Asheesh, Redmond John M, Hammarstedt Jon E, Stake Christine E, Domb Benjamin G
American Hip Institute, Westmont, Illinois, USA.
American Hip Institute, Westmont, Illinois, USA Hinsdale Orthopaedics, Westmont, Illinois, USA Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, USA
Am J Sports Med. 2015 Apr;43(4):965-71. doi: 10.1177/0363546514565089. Epub 2015 Jan 23.
Hip arthroscopy has gained popularity over the past decade, and its indications have broadened as newer techniques have been developed. However, there has been a paucity of literature evaluating the outcomes of hip arthroscopy in obese patients.
To compare 2-year clinical outcomes of obese patients undergoing primary hip arthroscopy with matched nonobese controls.
Cohort study; Level of evidence, 3.
From February 2008 to February 2012, data were collected prospectively on all obese patients undergoing primary hip arthroscopy. A matched-pair nonobese control group was selected at a 1:2 ratio. All patients were assessed pre- and postoperatively with 4 patient-reported outcome (PRO) measures: the modified Harris Hip Score, Non-Arthritic Hip Score, Hip Outcome Score-Activities of Daily Living, and Hip Outcome Score-Sport Specific Subscale. Pain was estimated on the visual analog scale, and satisfaction was measured on a scale from 0 to 10.
Sixty-two hips (62 patients) were included in the obese group and 124 hips (124 patients) in the control group. At preoperative baseline, the obese group had significantly lower PRO scores when compared with the control group. Both groups demonstrated statistically significant postoperative improvement in all scores (P < .05). Absolute scores were significantly lower in the obese group for all PRO measures, pre- and postoperatively. However, the improvement (delta) in PRO scores from pre- to postoperative time was not significantly different between groups. The rate of conversion to total hip arthroplasty, the rate of revision, and the complication rate were not significantly different between the 2 groups; however, rates of conversion to total hip arthroplasty and revision tended to be twice as high in the obese patients, but the study was not powered for these 2 outcomes.
Overall, obese patients had lower absolute PRO scores preoperatively and at 2-year follow-up. Both obese and nonobese patients demonstrated significant improvement in all PRO scores, and the change in scores were similar between groups. These results indicate that while obese patients may not have similar absolute scores after hip arthroscopy, they may show similar gains in improvement when compared with baseline. Hip arthroscopy appears to be a viable treatment option in the obese patient as long as expectations are adjusted accordingly.
在过去十年中，髋关节镜检查越来越受欢迎，随着新技术的发展，其适应症也有所拓宽。然而，评估肥胖患者髋关节镜检查结果的文献较少。
比较接受初次髋关节镜检查的肥胖患者与匹配的非肥胖对照组的2年临床结果。
队列研究；证据等级，3级。
从2008年2月至2012年2月，前瞻性收集所有接受初次髋关节镜检查的肥胖患者的数据。以1:2的比例选择匹配的非肥胖对照组。所有患者在术前和术后均采用4种患者报告结局（PRO）指标进行评估：改良Harris髋关节评分、非关节炎髋关节评分、髋关节结局评分-日常生活活动以及髋关节结局评分-运动特定子量表。采用视觉模拟量表评估疼痛程度，并采用0至10分的量表测量满意度。
肥胖组纳入62例髋关节（62例患者），对照组纳入124例髋关节（124例患者）。在术前基线时，肥胖组的PRO评分显著低于对照组。两组在所有评分上术后均有统计学意义的显著改善（P <.05）。肥胖组术前和术后所有PRO指标的绝对评分均显著较低。然而，两组术前至术后PRO评分的改善（差值）无显著差异。两组之间全髋关节置换术的转换率、翻修率和并发症发生率无显著差异；然而，肥胖患者全髋关节置换术和翻修的转换率往往是对照组的两倍，但该研究未针对这两个结局进行统计学检验。
总体而言，肥胖患者术前和2年随访时的绝对PRO评分较低。肥胖和非肥胖患者在所有PRO评分上均有显著改善，且两组评分变化相似。这些结果表明，虽然肥胖患者在髋关节镜检查后可能没有相似的绝对评分，但与基线相比，他们可能显示出相似的改善程度。只要相应地调整预期，髋关节镜检查似乎是肥胖患者可行的治疗选择。
