Department of Orthopaedic Surgery, Naval Medical Center, San Diego, California, USA.
Integrated Sports Medicine, The Rockwood Clinic, Spokane, Washington, USA.
Am J Sports Med. 2017 Dec;45(14):3298-3304. doi: 10.1177/0363546517726984. Epub 2017 Sep 22.
BACKGROUND: Femoroacetabular impingement (FAI) can lead to hip pain and early joint degeneration. There have been few reports to date on the outcomes of hip arthroscopy for the treatment of FAI in the military population. Purpose/Hypothesis: The purpose of this study was to compare patient demographics with postoperative outcomes after hip arthroscopy for symptomatic FAI and to identify preoperative risk factors for poor outcomes. The hypothesis was that certain preoperative patient characteristics will be predictive of poorer outcomes and that lower outcomes scores will be associated with a higher likelihood of medical separation from the military. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Retrospective chart review of active-duty and dependent patients older than 18 years who underwent hip arthroscopy for symptomatic FAI from 2009 to 2014 at a single institution. RESULTS: A total of 469 (309 males and 160 females) surgeries were performed on 456 active-duty personnel and 13 dependent civilians, with a mean 2.5-year follow-up. Overall, 39% (n = 179) were able to return to duty (RTD), 18% (n = 82) were medically cleared to return to normal daily activities but did not remain on active duty, and 43% (n = 195) required referral to the Disability Evaluation System (DES). Increasing rank and male sex were positive predictors and Axis 1 psychiatric diagnosis, revision surgery, concomitant psoas tenotomy, multiple medical comorbidities, and complaints of generalized pelvic pain were negative predictors for returning to duty. US Marine Infantry and Special Forces showed improved RTD rates (50%-86%) compared with administrative, more sedentary, occupations (22%). On average, Single Alpha Numeric Evaluation (SANE) and visual analog scale (VAS) scores improved after surgery, with SANE scores improving 37 ± 28 points and VAS scores improving 2.6 ± 2.5 points. The mean postoperative SANE and VAS scores differed significantly between the RTD group and those not returning to duty; 87 and 1.2 points compared with 69 and 3.6 points, respectively ( P < .0001). CONCLUSION: Hip arthroscopy for the treatment of symptomatic FAI effectively improves pain symptoms and self-reported overall function but shows a much lower than expected return to full, unrestricted active duty in the general active-duty military population. Underlying psychiatric diagnoses, female sex, and more sedentary occupations are associated with lower RTD rates. Furthermore, lower postoperative SANE and VAS scores are associated with lower RTD rates. Only the more active and elite components of the military study population showed RTD rates consistent with previously reported outcomes of return to competitive sports after hip arthroscopy for FAI.
背景:股骨髋臼撞击症(FAI)可导致髋关节疼痛和早期关节退变。迄今为止,关于军事人群中髋关节镜治疗 FAI 的结果的报道很少。目的/假设:本研究的目的是比较髋关节镜治疗症状性 FAI 后的患者人口统计学数据与术后结果,并确定术前不良预后的危险因素。假设是某些术前患者特征将预测预后较差,并且较低的结果评分与从军队中获得医疗分离的可能性更高相关。研究设计:病例系列;证据水平,4 级。方法:对 2009 年至 2014 年在一家机构接受髋关节镜治疗症状性 FAI 的现役和依赖患者进行回顾性图表审查,年龄大于 18 岁。结果:共有 469 例(309 名男性和 160 名女性)手术,其中 456 名现役人员和 13 名依赖平民,平均随访 2.5 年。总体而言,39%(n=179)能够返回现役(RTD),18%(n=82)被医学认定可以恢复正常日常活动但未留在现役,43%(n=195)需要转介到残疾评估系统(DES)。职级升高和男性是阳性预测因素,而轴 1 精神科诊断、翻修手术、同时行髂腰肌切开术、多种合并症和全身性骨盆疼痛是不能返回现役的阴性预测因素。美国海军陆战队步兵和特种部队的 RTD 率(50%-86%)高于行政、更久坐的职业(22%)。平均而言,手术后 SANE 和 VAS 评分均有所改善,SANE 评分提高 37±28 分,VAS 评分提高 2.6±2.5 分。RTD 组和未返回现役的组之间的平均术后 SANE 和 VAS 评分差异有统计学意义;分别为 87 分和 1.2 分,而 69 分和 3.6 分(P<0.0001)。结论:髋关节镜治疗症状性 FAI 可有效改善疼痛症状和自我报告的整体功能,但在现役普通现役军人中,预计重返完全不受限制的现役的比例要低得多。潜在的精神科诊断、女性和更久坐的职业与较低的 RTD 率相关。此外,较低的术后 SANE 和 VAS 评分与较低的 RTD 率相关。只有军队研究人群中更活跃和更精锐的部分显示出与髋关节镜治疗 FAI 后重返竞技运动的先前报道结果一致的 RTD 率。
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