McCarthy Brendon, Ackerman Ilana N, de Steiger Richard
Department of Surgery, Epworth HealthCare, The University of Melbourne, Melbourne, Victoria, Australia.
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
ANZ J Surg. 2018 May 24. doi: 10.1111/ans.14672.
Hip arthroscopy is a minimally invasive surgical technique increasingly being used to treat hip pathology. There is evidence that a proportion of patients require total hip arthroplasty in the years immediately following arthroscopy, suggesting that these patients have derived only a limited benefit from the procedure. Identification of risk factors for early progression to hip arthroplasty may enable refinement of hip arthroscopy indications and more informed decision making. The aim of this study is to identify the proportion of patients in a hip arthroscopy cohort who progress to total hip arthroplasty within 2 years of arthroscopy, and to analyse risk factors for this early progression.
A retrospective cohort analysis was conducted on all patients who underwent hip arthroscopy at one tertiary institution from 2004 to 2013. Hospital data were linked to the Australian Orthopaedic Association National Joint Replacement Registry in 2016 to identify subsequent hip arthroplasty.
There were 989 arthroscopies performed on 947 patients; 447 were female (48.1%), the mean age was 41.1 years (SD: 14.23) and osteoarthritis was present at arthroscopy in 31.5%. Total hip arthroplasty occurred in 129 patients (13%) within 2 years. Multivariable logistic regression revealed osteoarthritis, age >50 years and previous arthroscopy were significant risk factors for arthroplasty within 2 years (adjusted odds ratios (confidence intervals): 4.6 (2.91-7.16), 3.8 (2.44-5.87), 2.5 (1.16-5.81)).
Osteoarthritis, older age and history of arthroscopy were independent risk factors for early progression to arthroplasty; these factors should be considered within clinical decision-making, and when discussing potential arthroscopy outcomes with patients.
髋关节镜检查是一种越来越多地用于治疗髋关节疾病的微创手术技术。有证据表明，一部分患者在关节镜检查后的几年内需要进行全髋关节置换术，这表明这些患者从该手术中获得的益处有限。识别早期进展为髋关节置换术的风险因素可能有助于完善髋关节镜检查的适应症，并做出更明智的决策。本研究的目的是确定髋关节镜检查队列中在关节镜检查后2年内进展为全髋关节置换术的患者比例，并分析这种早期进展的风险因素。
对2004年至2013年在一家三级医疗机构接受髋关节镜检查的所有患者进行回顾性队列分析。2016年将医院数据与澳大利亚骨科协会国家关节置换登记处相关联，以确定随后的髋关节置换术。
对947例患者进行了989次关节镜检查；447例为女性（48.1%），平均年龄为41.1岁（标准差：14.23），关节镜检查时存在骨关节炎的患者占31.5%。129例患者（13%）在2年内进行了全髋关节置换术。多变量逻辑回归显示，骨关节炎、年龄>50岁和既往关节镜检查是2年内进行关节置换术的显著风险因素（调整后的优势比（置信区间）：4.6（2.91-7.16）、3.8（2.44-5.87）、2.5（1.16-5.81））。
骨关节炎、年龄较大和关节镜检查史是早期进展为关节置换术的独立风险因素；在临床决策以及与患者讨论潜在的关节镜检查结果时，应考虑这些因素。
