Comba Fernando, Yacuzzi Carlos, Ali Pablo J, Zanotti Gerardo, Buttaro Martin, Piccaluga Francisco
Hip Surgery Unit, Institute of Orthopaedics "Carlos E. Ottolenghi", Hospital Italiano de Buenos Aires, Argentina.
Muscles Ligaments Tendons J. 2016 Dec 21;6(3):317-323. doi: 10.11138/mltj/2016.6.3.317. eCollection 2016 Jul-Sep.
The purpose of this study is to evaluate the clinical outcomes, radiological degenerative progression and the joint preservation rate in a series of patients with Femoroacetabular Impingement (FAI) treated with hip arthroscopy at a minimum follow-up of 7 years. The predictive factors for total hip arthroplasty (THA) requirement were analyzed.
Between February 2008 and February 2009, 42 consecutive patients treated with hip arthroscopy due to FAI syndrome were included. There were 15 women and 27 men with an average age of 38 years (range 23 to 56 years). The surgery involved joint damage stabilization (labral tears and/or chondrolabral injuries) and correction of associated bony deformities (cam and/or pincer lesions). A prospective clinical follow-up was made with no patient lost. We specifically addressed the need for THA. Predictive factors for THA were also analyzed.
At final follow up, joint preservation rate was 83.33% (CI 95% 68,64%-93,03%). Probability of evolving to a THA in patients with radiographic preoperative Tonnis grades 0 and I was of 0% (CI 95%: 0-12.77). Probability of evolving to a THA in patients with preoperative Tonnis grades II and III was 46,67% (CI 95%21.27%-73,41%). A statistically significant difference was present between both groups (p= 0.002). Patients older than 45 years at the time of hip arthroscopy were at significant risk of evolving to a THA (p=0.0012). Excluding those patients who undergone a THA: modified HHS was 88.25 points (80-96) and radiographic analysis addressed a 14,29% (IC95% 4,81%-30,26%) of progressive degenerative changes without affecting clinical results.
Hip arthroscopy for the treatment of patients with FAI syndrome showed favorable results regarding joint preservation. Patients with preoperative radiographic evidence of advanced-stage osteoarthritis and those older than 45 years at the time of surgery have higher risk of requiring THA.
IV.
本研究旨在评估一系列接受髋关节镜治疗的股骨髋臼撞击症（FAI）患者在至少7年随访期内的临床结果、影像学退变进展及关节保留率。分析了全髋关节置换术（THA）需求的预测因素。
2008年2月至2009年2月，纳入42例因FAI综合征接受髋关节镜治疗的连续患者。其中女性15例，男性27例，平均年龄38岁（范围23至56岁）。手术包括关节损伤稳定（盂唇撕裂和/或软骨盂唇损伤）及相关骨畸形（凸轮和/或钳夹病变）的矫正。进行了前瞻性临床随访，无患者失访。我们特别关注THA的需求。还分析了THA的预测因素。
末次随访时，关节保留率为83.33%（95%CI 68.64%-93.03%）。术前影像学Tonnis分级为0级和I级的患者发展为THA的概率为0%（95%CI：0-12.77）。术前Tonnis分级为II级和III级的患者发展为THA的概率为46.67%（95%CI 21.27%-73.41%）。两组间存在统计学显著差异（p=0.002）。髋关节镜检查时年龄大于45岁的患者发展为THA的风险显著（p=0.0012）。排除接受THA的患者：改良Harris髋关节评分（HHS）为88.25分（80-96），影像学分析显示14.29%（95%CI 4.81%-30.26%）有进行性退变改变，但不影响临床结果。
髋关节镜治疗FAI综合征患者在关节保留方面显示出良好效果。术前影像学有晚期骨关节炎证据的患者以及手术时年龄大于45岁的患者需要THA的风险更高。
IV级。
