Hartig-Andreasen Charlotte, Nielsen Torsten G, Lund Bent, Søballe Kjeld, Lind Martin
1. Division of Sports Traumatology, Orthopedic Department, Aarhus University Hospital, Tage-Hansens Gade 2b, Aarhus C 8000, Denmark.
2. Department of Orthopedic Surgery, Regionshospitalet Horsens, Sundvej 30, Horsens 8700, Denmark and.
J Hip Preserv Surg. 2017 Mar 27;4(1):67-73. doi: 10.1093/jhps/hnx002. eCollection 2017 Jan.
To identify factors predicting failure after hip arthroscopy in patients with previous periacetabular osteotomy (PAO) defined as a conversion to total hip replacement (THR) and to evaluate the patient reported outcome scores. Of 55 hips treated with hip arthroscopy after PAO from Aug 2008 to 2012 at Aarhus University Hospital, 43 hips were included (median age: 36.1 yrs, range 16.3-56.9 yrs). Indications were unacceptable pain, a positive FABER and impingement test and signs of labral damage on MR-arthrography. Outcomes were evaluated with mHHS and HOS. Failure was defined as conversion to a THR. Nine hips were converted to a THR. Kaplan-Meier survival rate was 52.8% (95% CI, 10%-83.8%) at 6.5 years follow-up. Statistically significant predictors of failure: joint space width after PAO <3.0 mm and Tönnis grade of 2. Fourteen hips needed revision hip arthroscopy. Labral damage was present in 84% of the hips. In 42% of the hips cartilage lesions of Becks grade >3 were found. Mean mHHS and HOS were 65.7 and 68.8 respectively at follow-up. A NRS pain score of >3 in rest and during activity were present in respectively, 43% and 62% of the patients. Hip arthroscopy after PAO demonstrated limited clinical benefit with no decrease in pain levels and 21% of patients needing reoperation to THR. Radiographic signs of joint degeneration after PAO are predictors of faiElure. Further studies are needed to clarify what role hip arthroscopy should play in this patient group.
确定既往接受过髋臼周围截骨术（PAO）的患者行髋关节镜检查后预测失败的因素，失败定义为转为全髋关节置换术（THR），并评估患者报告的结局评分。2008年8月至2012年在奥胡斯大学医院接受PAO术后髋关节镜检查的55例髋关节中，纳入43例（中位年龄：36.1岁，范围16.3 - 56.9岁）。指征为不可接受的疼痛、FABER试验和撞击试验阳性以及磁共振关节造影显示盂唇损伤迹象。采用改良Harris髋关节评分（mHHS）和髋关节 outcome评分（HOS）评估结局。失败定义为转为THR。9例髋关节转为THR。随访6.5年时，Kaplan-Meier生存率为52.8%（95%CI，10% - 83.8%）。失败的统计学显著预测因素：PAO术后关节间隙宽度<3.0 mm和Tönnis分级为2级。14例髋关节需要翻修髋关节镜检查。84%的髋关节存在盂唇损伤。42%的髋关节发现Becks分级>3级的软骨损伤。随访时mHHS和HOS的平均值分别为65.7和68.8。分别有43%和62%的患者静息和活动时数字评分法（NRS）疼痛评分>3。PAO术后髋关节镜检查显示临床益处有限，疼痛水平无下降，21%的患者需要再次手术转为THR。PAO术后关节退变的影像学征象是失败的预测因素。需要进一步研究以阐明髋关节镜检查在该患者群体中应发挥的作用。
