Griffin Daniel W, Kinnard Matthew J, Formby Peter M, McCabe Michael P, Anderson Terrence D
Department of Orthopedic Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.
Carondelet Orthopedic Surgeons and Sports Medicine, Overland Park, Kansas, USA.
Am J Sports Med. 2017 Jul;45(8):1928-1936. doi: 10.1177/0363546516667915. Epub 2016 Oct 18.
BACKGROUND: The indications for hip preservation surgery have expanded to include treatment of hip pathology in older adults. While several studies have examined the efficacy of hip arthroscopy in the setting of osteoarthritis, there has been no review of outcomes in older adults. PURPOSE: To review the outcomes of hip arthroscopy in older adults and identify factors associated with treatment failures. STUDY DESIGN: Systematic review. METHODS: PubMed, EMBASE, and the Cochrane Library were searched through March 2016 for studies reporting outcomes of primary hip arthroscopy in patients older than 40 years. Inclusion in the review was based on age, patient-reported outcome (PRO) measures, and duration of follow-up. Two authors screened the results and extracted data for use in this review. Standardized mean difference was calculated to estimate effect size for PRO scores within studies. RESULTS: Eight studies with 401 total patients undergoing hip arthroscopy for femoroacetabular impingement (FAI) or labral tears were included in this review. Seven of the 8 studies reported favorable PRO scores and significant postoperative improvement with moderate to large effect size. The included studies demonstrated a trend toward higher effect sizes with an increasing percentage of labral repair compared to isolated labral debridement. The complication rate was comparable to that of previous reports involving younger patients; however, the overall reoperation rate was 20.8%. Conversion to hip arthroplasty ranged from 0% to 30%, with an overall conversion rate of 18.5% at a mean time of 17.5 months following arthroscopy. The most common risk factors for conversion to arthroplasty were low preoperative PRO scores and advanced arthritis. CONCLUSION: Hip arthroscopy appears to be a safe and efficacious treatment for labral tears and FAI in older patients who do not have significant underlying degenerative changes. However, in this population, there is a significant proportion of patients who eventually require hip arthroplasty. Outcomes may be affected by type of treatment (ie, labral debridement vs repair). Additional high-quality studies are needed to understand how these factors affect outcomes.
背景：保髋手术的适应证已扩大至包括治疗老年人的髋关节病变。虽然已有多项研究探讨了髋关节镜检查在骨关节炎治疗中的疗效，但尚未有针对老年人治疗结果的综述。 目的：回顾老年人髋关节镜检查的结果，并确定与治疗失败相关的因素。 研究设计：系统评价。 方法：检索截至2016年3月的PubMed、EMBASE和Cochrane图书馆，查找报告40岁以上患者初次髋关节镜检查结果的研究。纳入本综述基于年龄、患者报告结局（PRO）指标和随访时间。两名作者筛选结果并提取数据用于本综述。计算标准化均数差以估计各研究中PRO评分的效应量。 结果：本综述纳入了8项研究，共401例因股骨髋臼撞击症（FAI）或盂唇撕裂接受髋关节镜检查的患者。8项研究中的7项报告了良好的PRO评分，术后有显著改善，效应量为中度至重度。纳入的研究表明，与单纯盂唇清创术相比，随着盂唇修复比例的增加，效应量有升高趋势。并发症发生率与先前涉及年轻患者的报告相当；然而，总体再次手术率为20.8%。转为髋关节置换术的比例为0%至30%，平均在关节镜检查后17.5个月时，总体转换率为18.5%。转为置换术最常见的危险因素是术前PRO评分低和晚期关节炎。 结论：对于没有明显潜在退行性改变的老年患者，髋关节镜检查似乎是治疗盂唇撕裂和FAI的一种安全有效的方法。然而，在这一人群中，有相当比例的患者最终需要进行髋关节置换术。治疗结果可能受治疗类型（即盂唇清创术与修复术）的影响。需要更多高质量研究来了解这些因素如何影响治疗结果。
Am J Sports Med. 2017-7
Cochrane Database Syst Rev. 2020-10-19
Cochrane Database Syst Rev. 2021-4-19
Cochrane Database Syst Rev. 2022-2-14
Arthroscopy. 2017-2
Orthop Traumatol Surg Res. 2023-6
J Korean Med Sci. 2025-6-30
Curr Rev Musculoskelet Med. 2024-3
Arthrosc Sports Med Rehabil. 2021-12-7
Arthrosc Sports Med Rehabil. 2022-1-22
Zotero 插件