Horner Nolan S, Ekhtiari Seper, Simunovic Nicole, Safran Marc R, Philippon Marc J, Ayeni Olufemi R
Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada.
Centre for Evidence Based Orthopaedics, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.
Arthroscopy. 2017 Feb;33(2):464-475.e3. doi: 10.1016/j.arthro.2016.06.044. Epub 2016 Sep 10.
To (1) report clinical outcomes, complication rates, and total hip arthroplasty (THA) conversion rates for patients age 40 or older who underwent hip arthroscopy, and (2) report any age-related predictors of outcome identified in the literature.
MEDLINE, EMBASE, and PubMed were searched for relevant studies and pertinent data were abstracted from eligible studies. No meta-analysis was performed because of heterogeneity amongst studies.
Seventeen studies were included in this review comprising 16,327 patients, including 9,954 patients age 40 or older. All studies reported statistically significant improvements in outcomes after hip arthroscopy for femoral osteochondroplasty, labral repair, or unspecified indications. In patients 40 or older who underwent labral debridement, these improvements were not clinically significant. Obesity and osteoarthritic changes predicted poorer outcomes. Only 1 of 3 studies directly comparing the 2 groups found that patients 40 or older had a significantly less improvement in a standardized hip outcome score than patients under 40 after hip arthroscopy, but all found that patients 40 or older had significantly higher rates of THA conversion. The rate of conversion to THA was 18.1% for patients 40 or older, 23.1% for patients over 50, and 25.2% for patients over 60 with a mean of 25.0 months to THA.
Indications for hip arthroscopy including femoral osteochondroplasty and labral repair resulted in clinically significant improvements in patients 40 or older in most research studies examined in this review, whereas labral debridement did not produce clinically significant improvements postoperatively in the same studies. In these studies, the rate of conversion to THA is higher than in patients under 40 and increases with each decade of life, with many individual studies showing a significant increase in the rate of THA conversion. Hip arthroscopy may be suitable for some patients 40 or older, but patient selection is key and patients should be informed of the higher risk of conversion to THA.
Level IV, systematic review of Level III and IV studies.
(1) 报告年龄40岁及以上接受髋关节镜检查患者的临床结果、并发症发生率和全髋关节置换术（THA）转换率，(2) 报告文献中确定的任何与年龄相关的结果预测因素。
检索MEDLINE、EMBASE和PubMed以查找相关研究，并从符合条件的研究中提取相关数据。由于研究之间存在异质性，未进行荟萃分析。
本综述纳入了17项研究，共16327例患者，其中包括9954例年龄40岁及以上的患者。所有研究均报告，髋关节镜检查后，在股骨骨软骨成形术、盂唇修复或未明确指征方面，结果有统计学意义的改善。在接受盂唇清创术的40岁及以上患者中，这些改善在临床上并不显著。肥胖和骨关节炎改变预示着预后较差。在3项直接比较两组的研究中，只有1项发现，40岁及以上患者在髋关节镜检查后的标准化髋关节结果评分改善程度明显低于40岁以下患者，但所有研究都发现，40岁及以上患者的THA转换率显著更高。40岁及以上患者的THA转换率为18.1%，50岁以上患者为23.1%，60岁以上患者为25.2%，平均至THA的时间为25.0个月。
在本综述中研究的大多数研究中，包括股骨骨软骨成形术和盂唇修复在内的髋关节镜检查指征，在40岁及以上患者中产生了临床上显著的改善，而在同一研究中，盂唇清创术术后并未产生临床上显著的改善。在这些研究中，THA转换率高于40岁以下患者，且随年龄每增长十岁而增加，许多个体研究显示THA转换率显著增加。髋关节镜检查可能适用于一些40岁及以上的患者，但患者选择是关键，应告知患者THA转换风险较高。
IV级，III级和IV级研究的系统评价。
