Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
Department of Orthopedic Surgery, Wake Forest, Winston-Salem, North Carolina, USA.
Am J Sports Med. 2019 Jan;47(1):131-137. doi: 10.1177/0363546518808046. Epub 2018 Nov 28.
Prolonged disease chronicity has been implicated as a cause of suboptimal clinical outcomes after hip arthroscopy for femoroacetabular impingement syndrome (FAIS), possibly due to disease progression, deconditioning, and the development of compensatory pathomechanics.
To evaluate the effect of increasing duration of preoperative symptoms on patient-reported outcomes, reoperation, and clinical failure of hip arthroscopy for FAIS.
Cohort study; Level of evidence, 3.
A retrospective cohort study was performed to identify all patients undergoing primary hip arthroscopy between January 1, 2012, and July 30, 2014, by a single surgeon, with minimum follow-up of 2 years. Patient demographics, comorbid medical conditions, and preoperative outcome scores were compared between patients with preoperative symptoms lasting less than 2 years and those with symptoms lasting 2 years or longer. Multivariate regressions were used to compare Hip Outcome Score Activities of Daily Living (HOS-ADL), Hip Outcome Score Sport-Specific (HOS-SS), and modified Harris Hip Score (mHHS) between the 2 cohorts at 2 years of follow-up.
A total of 624 patients were included, with an average age of 34.0 ± 13.5 years; 235 (37.7%) patients had experienced preoperative symptoms 2 years or longer. Patients with symptoms lasting less than 2 years had statistically significant higher outcome scores than those with symptoms lasting 2 or more years for the HOS-ADL (86.3 ± 16.4 vs 80.3 ± 19.9, respectively), HOS-SS (75.0 ± 25.3 vs 65.1 ± 29.0), and mHHS (79.1 ± 16.6 vs 74.0 ± 18.8), as well as higher satisfaction (82.1 ± 30.7 vs 71.1 ± 31.6) and lower pain scores (2.6 ± 2.3 vs 3.5 ± 2.6). On multivariate analysis, patients with symptoms 2 years or longer had significantly higher visual analog scale-Pain score (β = 0.6, P = .039) and lower HOS-ADL (β = -3.4, P = .033), HOS-SS (β = -6.3, P = .012), and satisfaction (β = -6.7, P = .028) at 2-year follow-up. Patients with longer duration of symptoms also demonstrated less improvement in HOS-SS (β = -10.3, P = .001) at 2 years after surgery. Patients with symptoms for 2 years or longer were significantly less likely to achieve a patient acceptable symptomatic state for HOS-ADL (relative risk [RR] = 0.8, P = .024) and HOS-SS (RR = 0.8, P = .032) at 2 years of follow-up. Patients with symptoms 2 years or longer also demonstrated significantly higher rates of revision arthroscopy (RR = 10.1, P = .046).
Patients with untreated, FAIS-related symptoms lasting 2 years or longer before arthroscopic management had significantly worse patient-reported outcomes and higher rates of reoperation at 2 years after surgery when compared with those patients with a shorter duration of preoperative symptoms.
髋关节镜治疗股骨髋臼撞击综合征（FAIS）后，疾病慢性化时间延长被认为是临床疗效不佳的原因之一，这可能与疾病进展、身体适应能力下降和代偿性病理力学的发展有关。
评估术前症状持续时间的增加对髋关节镜治疗 FAIS 后患者报告的结果、再次手术和临床失败的影响。
队列研究；证据等级，3 级。
对一名外科医生于 2012 年 1 月 1 日至 2014 年 7 月 30 日期间进行的原发性髋关节镜检查患者进行回顾性队列研究，随访时间至少 2 年。比较术前症状持续时间<2 年和≥2 年的患者的患者人口统计学资料、合并症和术前结果评分。使用多元回归比较 2 组患者在 2 年随访时的髋关节结局评分活动量表（HOS-ADL）、髋关节结局评分运动量表（HOS-SS）和改良 Harris 髋关节评分（mHHS）。
共纳入 624 例患者，平均年龄为 34.0±13.5 岁；235（37.7%）例患者术前症状持续≥2 年。与术前症状持续<2 年的患者相比，术前症状持续≥2 年的患者的 HOS-ADL（分别为 86.3±16.4 分和 80.3±19.9 分）、HOS-SS（分别为 75.0±25.3 分和 65.1±29.0 分）和 mHHS（分别为 79.1±16.6 分和 74.0±18.8 分）评分更高，满意度（分别为 82.1±30.7 分和 71.1±31.6 分）更高，疼痛评分（分别为 2.6±2.3 分和 3.5±2.6 分）更低。多元分析显示，术前症状持续≥2 年的患者的视觉模拟评分-疼痛评分（β=0.6，P=0.039）和 HOS-ADL（β=-3.4，P=0.033）、HOS-SS（β=-6.3，P=0.012）和满意度（β=-6.7，P=0.028）在 2 年随访时显著更高。术前症状持续时间较长的患者在术后 2 年 HOS-SS（β=-10.3，P=0.001）的改善程度也较低。术前症状持续≥2 年的患者在术后 2 年达到 HOS-ADL（相对风险 [RR]=0.8，P=0.024）和 HOS-SS（RR=0.8，P=0.032）患者可接受的症状状态的可能性显著较低。术前症状持续≥2 年的患者行翻修关节镜手术的比例也显著更高（RR=10.1，P=0.046）。
与术前症状持续时间较短的患者相比，接受髋关节镜治疗 FAIS 前未经治疗、与 FAIS 相关的症状持续≥2 年的患者，术后 2 年的患者报告结果明显较差，再次手术的比例也更高。
