Fabricant Peter D, Fields Kara G, Taylor Samuel A, Magennis Erin, Bedi Asheesh, Kelly Bryan T
Department of Orthopaedic Surgery (P.D.F.), Healthcare Research Institute (K.G.F), Sports Medicine and Shoulder Service (S.A.T. and B.T.K.), and Center for Hip Pain and Preservation (E.M. and B.T.K.), Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for P.D. Fabricant:
Domino's Farms, MedSport, University of Michigan, 24 Frank Lloyd Wright Drive, Ann Arbor, MI 48105.
J Bone Joint Surg Am. 2015 Apr 1;97(7):537-43. doi: 10.2106/JBJS.N.00266.
The impact of proximal femoral and combined femoral and acetabular version on patient-reported outcomes after arthroscopic surgery for femoroacetabular impingement (FAI) remains undefined. The purpose of this study was to identify associations of proximal femoral version as well as combined version (McKibbin index) with disease-specific, validated, patient-reported outcomes following arthroscopic correction of symptomatic FAI.
A prospective hip arthroscopy registry was utilized to evaluate 243 patients who underwent arthroscopic surgery to correct FAI. Femoral version and the McKibbin index were measured prospectively on preoperative computed tomography scans. Disease-specific, patient-reported outcomes included the modified Harris hip score (mHHS) and the Hip Outcome Score (HOS) ADL (Activities of Daily Living) and Sports subscales. Disease impact on quality of life was determined with use of the International Hip Outcome Tool (iHOT-33). Comparative analyses were used to evaluate the impact of femoral version on changes in patient-reported outcome scores; multiple regression was used to adjust for potential confounders.
The patient cohort contained 243 patients (123 female and 120 male) with a mean age of 29.2 years and a mean postoperative follow-up of twenty-one months (range, twelve to forty-two months). The cohort experienced significant improvements (p < 0.001) in all patient-reported outcome measures, with most patients improving by at least the minimal clinically important difference for all of these measures. The mean improvement was 20 points for the mHHS, 15 for the HOS ADL, 23 for the HOS Sports, and 23 for the iHOT-33. When stratified by femoral version, the postoperative improvements in patients with relative femoral retroversion (<5° anteversion) were clinically important but of significantly smaller magnitude than those in the other version groups. We did not find any associations between the McKibbin index and any patient-reported outcomes.
Although clinically important improvements can be expected after arthroscopic FAI surgery in all femoral version groups, patients with relative femoral retroversion (<5° femoral anteversion) may experience less improvement than those with normal or increased version.
股骨近端以及股骨与髋臼联合旋转角度对关节镜下治疗股骨髋臼撞击症（FAI）后患者报告的结局的影响尚不清楚。本研究的目的是确定股骨近端旋转角度以及联合旋转角度（麦吉宾指数）与症状性FAI关节镜矫正术后疾病特异性、经过验证的患者报告结局之间的关联。
利用一个前瞻性髋关节镜登记系统评估243例行关节镜手术矫正FAI的患者。术前通过计算机断层扫描前瞻性测量股骨旋转角度和麦吉宾指数。疾病特异性、患者报告的结局包括改良Harris髋关节评分（mHHS）以及髋关节结局评分（HOS）日常生活活动（ADL）和运动亚量表。使用国际髋关节结局工具（iHOT-33）确定疾病对生活质量的影响。采用比较分析评估股骨旋转角度对患者报告结局评分变化的影响；使用多元回归对潜在混杂因素进行校正。
患者队列包括243例患者（123例女性和120例男性），平均年龄29.2岁，术后平均随访21个月（范围12至42个月）。该队列在所有患者报告的结局指标上均有显著改善（p < 0.001），大多数患者在所有这些指标上至少改善了最小临床重要差异。mHHS平均改善20分，HOS ADL改善15分，HOS运动改善23分，iHOT-33改善23分。按股骨旋转角度分层时，相对股骨后倾（前倾角<5°）患者术后的改善具有临床意义，但幅度明显小于其他旋转角度组的患者。我们未发现麦吉宾指数与任何患者报告的结局之间存在关联。
尽管在所有股骨旋转角度组中，关节镜下FAI手术后均可预期获得具有临床意义的改善，但相对股骨后倾（股骨前倾角<5°）的患者可能比正常或增加旋转角度的患者改善程度更小。
