Domb Benjamin G, Chaharbakhshi Edwin O, Rybalko Danil, Close Mary R, Litrenta Jody, Perets Itay
American Hip Institute, Westmont, Illinois, USA.
Hinsdale Orthopaedics, Hinsdale, Illinois, USA.
Am J Sports Med. 2017 Aug;45(10):2294-2302. doi: 10.1177/0363546517706957. Epub 2017 Jun 13.
Studies on midterm outcomes of the arthroscopic treatment of femoroacetabular impingement (FAI) and labral tears with mild osteoarthritis (OA) are limited.
To evaluate outcomes of the arthroscopic treatment of FAI and labral tears in patients with mild preoperative OA (Tönnis grade 1) at a minimum 5-year follow-up, and to perform a matched-pair comparison to a control group with Tönnis grade 0.
Cohort study; Level of evidence, 3.
Data were prospectively collected on patients who underwent hip arthroscopic surgery between February 2008 and April 2011. Inclusion criteria were arthroscopic treatment for FAI and labral tears and having preoperative patient-reported outcome (PRO) scores, including the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), and Hip Outcome Score-Sports-Specific Subscale (HOS-SSS), and visual analog scale (VAS) scores for pain. Exclusion criteria were workers' compensation claims, preoperative Tönnis grade ≥2, and previous hip conditions (ipsilateral surgery, slipped capital femoral epiphysis, avascular necrosis, and dysplasia). Patients with minimum 5-year outcomes were eligible for matching on a 1:1 ratio (Tönnis grade 0 vs 1) based on age ±5 years, body mass index ±5 kg/m, sex, labral treatment, and capsular treatment.
Of 356 eligible hips, 292 hips had minimum 5-year outcomes (82%). Eighty-five hips with Tönnis grade 1 were evaluated. At 5-year follow-up, patients with Tönnis grade 1 had significant improvements in all PRO and VAS scores ( P < .0001). The overall satisfaction score was 8.2. The survivorship rate with respect to conversion to total hip arthroplasty for the Tönnis grade 1 group was 69.4% at 5 years, while in the Tönnis grade 0 group, it was 88.4% ( P = .0002). Sixty-two hips with Tönnis grade 0 were matched to 62 hips with Tönnis grade 1. Both groups demonstrated improvements in all PRO and VAS scores from preoperatively to postoperatively ( P < .0001). No significant differences existed between preoperative or postoperative scores or survivorship between the groups.
The arthroscopic treatment of FAI and labral tears in patients with Tönnis grade 1 had good results at 5-year follow-up. After controlling for other variables using a matched-pair comparison, patients with Tönnis grade 1 had similar, durable improvements to those with Tönnis grade 0. While strict surgical indications and appropriate expectations are recommended for patients with mild OA, Tönnis grade 1 alone should not be considered a contraindication to hip arthroscopic surgery.
关于关节镜治疗伴有轻度骨关节炎（OA）的股骨髋臼撞击症（FAI）和盂唇撕裂的中期疗效研究有限。
评估术前轻度OA（Tönnis 1级）患者关节镜治疗FAI和盂唇撕裂至少5年的随访结果，并与Tönnis 0级对照组进行配对比较。
队列研究；证据等级，3级。
前瞻性收集2008年2月至2011年4月接受髋关节镜手术患者的数据。纳入标准为关节镜治疗FAI和盂唇撕裂，且有术前患者报告结局（PRO）评分，包括改良Harris髋关节评分（mHHS）、非关节炎髋关节评分（NAHS）、髋关节结局评分-运动特定子量表（HOS-SSS）以及疼痛视觉模拟量表（VAS）评分。排除标准为工伤赔偿申请、术前Tönnis分级≥2级以及既往髋关节疾病（同侧手术、股骨头骨骺滑脱、缺血性坏死和发育异常）。至少有5年随访结果的患者有资格根据年龄±5岁、体重指数±5 kg/m²、性别、盂唇治疗和关节囊治疗进行1:1比例配对（Tönnis 0级与1级）。
356例符合条件的髋关节中，292例有至少5年的随访结果（82%）。对85例Tönnis 1级髋关节进行了评估。在5年随访时，Tönnis 1级患者的所有PRO和VAS评分均有显著改善（P < .0001）。总体满意度评分为8.2。Tönnis 1级组转换为全髋关节置换术的5年生存率为69.4%，而Tönnis 0级组为88.4%（P = .0002）。62例Tönnis 0级髋关节与62例Tönnis 1级髋关节配对。两组从术前到术后所有PRO和VAS评分均有改善（P < .0001）。两组术前或术后评分及生存率无显著差异。
Tönnis 1级患者关节镜治疗FAI和盂唇撕裂在5年随访时有良好结果。通过配对比较控制其他变量后，Tönnis 1级患者与Tönnis 0级患者有相似且持久的改善。虽然建议对轻度OA患者严格掌握手术指征并设定适当预期，但单纯Tönnis 1级不应被视为髋关节镜手术的禁忌证。
