Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Phoenix, Arizona, USA.
Am J Sports Med. 2018 Jun;46(7):1674-1684. doi: 10.1177/0363546518767399. Epub 2018 May 3.
Studies assessing dysplasia's effect on hip arthroscopy are often limited to the short term and unable to account for demographic factors that may vary between dysplastic and nondysplastic populations.
To determine the midterm failure rate and patient-reported outcomes of arthroscopic labral repair in the setting of dysplasia and make subsequent failure and outcome comparisons with a rigorously matched nondysplastic control group.
Cohort study; Level of evidence, 3.
Primary arthroscopic labral repair cases at 2 centers from 2008 to 2011 were reviewed. Patients with lateral center edge angle (LCEA) <25° were matched to nondysplastic controls by age, sex, laterality, body mass index (BMI), Tönnis grade, and capsular repair per a 1:2 matching algorithm. Groups were compared with a visual analog scale (VAS) for pain, modified Harris Hip Score (mHHS), and Hip Outcome Score-Sports Specific Subscale (HOS-SSS) to determine predictors of outcome and failure.
Forty-eight patients with dysplasia (mean LCEA, 21.6°; range, 13.0°-24.9°; n = 25 with capsular repair) were matched to 96 controls (mean LCEA, 32.1°; range, 25°-52°; n = 50 with capsular repair) and followed for a mean of 5.7 years (range, 5.0-7.7 years). Patients achieved mean VAS improvements of 3.3 points, mHHS of 19.5, and HOS-SSS of 29.0 points ( P < .01) with no significant differences between the dysplasia and control populations ( P > .05). Five-year failure-free survival was 83.3% for patients with dysplasia and 78.1% for controls ( P = .53). No survival or outcomes difference was observed between patients with dysplasia who did or did not have capsular repair ( P ≥ .45) or when comparing LCEA <20° and LCEA 20° to 25° ( P ≥ .60). BMI ≤30 was associated with increased revision surgery risk ( P < .01). Age >35 years ( P < .05) and Tönnis grade 0 radiographs ( P < .01) predicted failure to reach minimal clinically important differences.
With careful selection and modern techniques, patients with dysplasia can benefit significantly and durably from arthroscopic labral repair. The dysplastic cohort had outcomes and failure rates similar to those of rigorously matched controls at midterm follow-up. Subanalyses comparing LCEA <20° and LCEA 20° to 25° are presented for completeness; however, this study was not designed to detect differences in dysplastic subpopulations. BMI ≤30 was associated with increased revision risk. Age >35 years and Tönnis grade 0 radiographs predicted failure to achieve minimal clinically important differences.
评估髋关节发育不良对髋关节镜检查影响的研究通常仅限于短期，并且无法考虑到可能在发育不良和非发育不良人群之间存在差异的人口统计学因素。
确定在发育不良情况下关节镜下盂唇修复的中期失败率和患者报告的结果，并与严格匹配的非发育不良对照组进行后续失败和结果比较。
队列研究；证据水平，3 级。
对 2008 年至 2011 年 2 个中心的主要关节镜下盂唇修复病例进行了回顾性研究。外侧中心边缘角（LCEA）<25°的患者通过年龄、性别、侧别、体重指数（BMI）、Tönnis 分级和囊修复按照 1:2 的匹配算法与非发育不良对照组进行匹配。使用视觉模拟量表（VAS）评估疼痛、改良 Harris 髋关节评分（mHHS）和髋关节结果评分-运动特异性亚量表（HOS-SSS）对两组进行比较，以确定结局和失败的预测因素。
48 例发育不良患者（平均 LCEA，21.6°；范围，13.0°-24.9°；n = 25 例伴囊修复）与 96 例对照组（平均 LCEA，32.1°；范围，25°-52°；n = 50 例伴囊修复）相匹配，并平均随访 5.7 年（范围，5.0-7.7 年）。患者在 VAS 中平均改善 3.3 分，mHHS 改善 19.5 分，HOS-SSS 改善 29.0 分（P<.01），发育不良组和对照组之间无显著差异（P>.05）。发育不良组和对照组的 5 年无失败生存率分别为 83.3%和 78.1%（P=.53）。无论是否行囊修复（P≥.45）或 LCEA<20°与 LCEA 20°-25°（P≥.60），发育不良患者之间的生存或结局差异均无统计学意义。BMI≤30 与翻修手术风险增加相关（P<.01）。年龄>35 岁（P<.05）和 Tönnis 分级 0 级 X 线片（P<.01）预测无法达到最小临床重要差异。
通过精心选择和现代技术，髋关节发育不良患者可以从关节镜下盂唇修复中显著且持久地获益。在中期随访时，发育不良队列的结果和失败率与严格匹配的对照组相似。为完整性起见，还比较了 LCEA<20°和 LCEA 20°-25°的亚组分析；然而，本研究的设计并非旨在检测发育不良亚群之间的差异。BMI≤30 与翻修风险增加相关。年龄>35 岁和 Tönnis 分级 0 级 X 线片预测无法达到最小临床重要差异。
