Spencer-Gardner Luke, Dissanayake Ruch, Kalanie Amir, Singh Parminder, O'Donnell John
The Hip Preservation Center, Baylor University Medical Center, 3900 Junius Street, #705, Dallas, TX 75246, USA.
Eastern Health 8 Arnold St, Box Hill, VIC 3128, Australia.
J Hip Preserv Surg. 2017 Jan 10;4(1):39-44. doi: 10.1093/jhps/hnw051. eCollection 2017 Jan.
Hip arthroscopy (HA) is an established treatment option to address intra-articular pathology of the hip. However, some clinicians encourage non-operative management (NOM). Non-operative management may include active measures such as physiotherapy and intra-articular steroid injections, or NOM may involve so called watchful waiting with no active intervention. These approaches, along with surgery have been detailed recently in the Warwick Agreement, a Consensus Statement regarding diagnosis and treatment of Femoroacetabular Impingement Syndrome The aim of this study is to compare the change in clinical outcome scores of waitlisted patients with intra-articular hip pathology who receive no active treatment with matched controls that have undergone HA. Patients less than 60 years of age were identified from a HA waiting list in a single hospital in the Australian public hospital system. Patient reported outcomes (PRO) were collected whilst patients waited for surgery. During this waiting period no specific treatment was offered. A separate group of patients who had previously undergone HA were matched based on age, sex, body mass index and baseline non-arthritic hip scores (NAHS). The groups were compared using the NAHS as the primary outcome measures. Modified Harris Hip Scores were also collected and compared. Thirty-six patients were included in each group, with a mean follow up of 19 months (12-36). There were no significant differences in age, sex, BMI and NAHS between groups at baseline. At final follow up, mean NAHS scores after HA were significantly higher than scores after NOM, 82.1 (36.4-100.0) versus 48.9 (11.3-78.8), respectively ( < 0.001) with a large effect size for mean change in scores between groups ( = 1.77, 95% CI 1.21-2.30). Mean mHHS after HA were significantly higher than scores after NOM, 84.3 (15.4-100.0) versus 48.1 (21.0-66.0) respectively ( < 0.001), with a large effect size for mean change in scores between groups ( = 1.92, 95% CI 1.34-2.46). HA may lead to significant improvements in PRO when compared to non-operative management of waitlisted patients with intra-articular pathology of the hip at 18 months follow-up.
髋关节镜检查（HA）是治疗髋关节关节内病变的一种既定治疗选择。然而，一些临床医生鼓励非手术治疗（NOM）。非手术治疗可能包括物理治疗和关节内注射类固醇等积极措施，或者非手术治疗可能涉及所谓的观察等待，不进行积极干预。这些方法以及手术治疗最近在《沃里克协议》中有详细阐述，该协议是关于股骨髋臼撞击综合征诊断和治疗的共识声明。本研究的目的是比较等待手术的髋关节关节内病变患者在未接受积极治疗时与接受HA治疗的匹配对照组的临床结局评分变化。从澳大利亚公立医院系统的一家单一医院的HA等待名单中识别出年龄小于60岁的患者。在患者等待手术期间收集患者报告结局（PRO）。在此等待期间不提供特定治疗。根据年龄、性别、体重指数和基线非关节炎髋关节评分（NAHS）对另一组先前接受过HA治疗的患者进行匹配。以NAHS作为主要结局指标对两组进行比较。还收集并比较了改良Harris髋关节评分。每组纳入36例患者，平均随访19个月（12 - 36个月）。两组在基线时的年龄、性别、BMI和NAHS无显著差异。在最终随访时，HA治疗后的平均NAHS评分显著高于非手术治疗后的评分，分别为82.1（36.4 - 100.0）和48.9（11.3 - 78.8）（<0.001），两组评分的平均变化效应量较大（=1.77，95%CI 1.21 - 2.30）。HA治疗后的平均mHHS评分显著高于非手术治疗后的评分，分别为84.3（15.4 - 100.0）和48.1（21.0 - 66.0）（<0.001），两组评分的平均变化效应量较大（=1.92，95%CI 1.34 - 2.46）。与等待手术的髋关节关节内病变患者的非手术治疗相比，在18个月随访时，HA可能会使PRO有显著改善。
