Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, U.S.A.
Department of Orthopedic Surgery, Stanford University School of Medicine, Redwood City, California, U.S.A.
Arthroscopy. 2018 Jun;34(6):1998-2004. doi: 10.1016/j.arthro.2018.01.018. Epub 2018 Feb 21.
The purpose of this study was to compare (1) major complication, (2) revision, and (3) conversion to arthroplasty rates following hip arthroscopy between database studies and original research peer-reviewed publications.
A systematic review was performed using PRISMA guidelines. PubMed, SCOPUS, SportDiscus, and Cochrane Central Register of Controlled Trials were searched for studies that investigated major complication (dislocation, femoral neck fracture, avascular necrosis, fluid extravasation, septic arthritis, death), revision, and hip arthroplasty conversion rates following hip arthroscopy. Major complication, revision, and conversion to hip arthroplasty rates were compared between original research (single- or multicenter therapeutic studies) and database (insurance database using ICD-9/10 and/or current procedural terminology coding terminology) publishing studies.
Two hundred seven studies (201 original research publications [15,780 subjects; 54% female] and 6 database studies [20,825 subjects; 60% female]) were analyzed (mean age, 38.2 ± 11.6 years old; mean follow-up, 2.7 ± 2.9 years). The database studies had a significantly higher age (40.6 + 2.8 vs 35.4 ± 11.6), body mass index (27.4 ± 5.6 vs 24.9 ± 3.1), percentage of females (60.1% vs 53.8%), and longer follow-up (3.1 ± 1.6 vs 2.7 ± 3.0) compared with original research (P < .0001 for all). Ninety-seven (0.6%) major complications occurred in the individual studies, and 95 (0.8%) major complications occurred in the database studies (P = .029; relative risk [RR], 1.3). There was a significantly higher rate of femoral neck fracture (0.24% vs 0.03%; P < .0001; RR, 8.0), and hip dislocation (0.17% vs 0.06%; P = .023; RR, 2.2) in the database studies. Reoperations occurred at a significantly higher rate in the database studies (11.1% vs 7.3%; P < .001; RR, 1.5). There was a significantly higher rate of conversion to arthroplasty in the database studies (8.0% vs 3.7%; P < .001; RR, 2.2).
Database studies report significantly increased major complication, revision, and conversion to hip arthroplasty rates compared with original research investigations of hip arthroscopy outcomes.
Level IV, systematic review of Level I-IV studies.
本研究旨在比较髋关节镜术后（1）主要并发症、（2）翻修和（3）关节成形术转换率，分别在数据库研究和原始研究同行评议文献中的差异。
采用 PRISMA 指南进行系统评价。检索 PubMed、SCOPUS、SportDiscus 和 Cochrane 中央对照试验注册中心，以调查髋关节镜术后主要并发症（脱位、股骨颈骨折、股骨头坏死、液体外渗、化脓性关节炎、死亡）、翻修和髋关节成形术转换率的研究。比较了原始研究（单中心或多中心治疗研究）和数据库（使用 ICD-9/10 和/或当前手术程序术语编码术语的保险数据库）出版研究中主要并发症、翻修和髋关节成形术转换率的差异。
共分析了 207 项研究（201 项原始研究出版物[15780 例；54%为女性]和 6 项数据库研究[20825 例；60%为女性]）（平均年龄 38.2±11.6 岁；平均随访 2.7±2.9 年）。数据库研究的年龄（40.6±2.8 岁比 35.4±11.6 岁）、体重指数（27.4±5.6 比 24.9±3.1）、女性比例（60.1%比 53.8%）和随访时间（3.1±1.6 比 2.7±3.0）明显更高（均 P<0.0001）。个体研究中有 97 例（0.6%）发生主要并发症，数据库研究中有 95 例（0.8%）发生主要并发症（P=0.029；相对风险[RR]，1.3）。数据库研究中股骨颈骨折的发生率明显更高（0.24%比 0.03%；P<0.0001；RR，8.0），髋关节脱位的发生率也明显更高（0.17%比 0.06%；P=0.023；RR，2.2）。数据库研究中再次手术的发生率明显更高（11.1%比 7.3%；P<0.001；RR，1.5）。数据库研究中转换为关节成形术的发生率明显更高（8.0%比 3.7%；P<0.001；RR，2.2）。
与髋关节镜术后结果的原始研究相比，数据库研究报告主要并发症、翻修和关节成形术转换率显著增加。
四级，对 I-IV 级研究的系统评价。
