West Hospital and Virginia Commonwealth University, Richmond.
Virginia Commonwealth University, Richmond.
Arthritis Care Res (Hoboken). 2020 Mar;72(3):405-411. doi: 10.1002/acr.23828.
Determining appropriate candidates for hip preservation surgery is challenging because criteria for judging appropriateness are not defined. The American Academy of Orthopaedic Surgeons (AAOS) recently published a hip preservation surgery appropriateness classification system using the RAND/University of California, Los Angeles approach. This study was undertaken to determin the extent and pattern of contribution of each of the variables used to predict the appropriateness of hip preservation surgery.
An AAOS-appointed multidisciplinary expert panel wrote 270 clinical vignettes incorporating all permutations of 5 indication variables derived from an evidence synthesis. A second independent panel of experts rated the appropriateness of each vignette during multiple Delphi surveys. We used logistic regression to determine the relative contribution of each variable to classification. We also used a classification-tree approach to determine which indication variables, in combination, contributed to the final classification.
Odds ratios from the regression indicated that patient age and radiographic hip osteoarthritis (OA) evaluation were the main indications of appropriateness classification (e.g., the odds ratio for age <40 years was >999.99, with age >65 years as the referent group, for "appropriate/may be appropriate" as compared to "rarely appropriate" vignettes). Hip range of motion, risk for negative outcome, and function-limiting pain did not meaningfully contribute to the final classification.
The AAOS appropriateness classification system for hip preservation surgery is driven almost exclusively by age and radiographic hip OA evaluation. Additional research on appropriateness classification for hip preservation surgery is needed to identify important indication variables beyond age and radiographic hip findings.
由于判断适宜性的标准尚未确定，因此为髋关节保留手术选择合适的患者具有一定挑战性。美国骨科医师学会（AAOS）最近采用 RAND/加州大学洛杉矶分校的方法，发布了髋关节保留手术适宜性分类系统。本研究旨在确定用于预测髋关节保留手术适宜性的各个变量的贡献程度和模式。
AAOS 任命的多学科专家小组编写了 270 个临床案例，其中包含了源自证据综合分析的 5 个适应证变量的所有排列组合。第二个独立的专家小组在多次 Delphi 调查中对每个案例的适宜性进行了评估。我们使用逻辑回归来确定每个变量对分类的相对贡献。我们还使用分类树方法来确定哪些适应证变量组合对最终分类有贡献。
回归的优势比表明，患者年龄和影像学髋关节骨关节炎（OA）评估是适宜性分类的主要指标（例如，年龄<40 岁的优势比>999.99，年龄>65 岁为参考组，与“适宜/可能适宜”相比，“很少适宜”的案例）。髋关节活动范围、不良结局风险和功能受限性疼痛对最终分类没有明显贡献。
髋关节保留手术的 AAOS 适宜性分类系统几乎完全由年龄和影像学髋关节 OA 评估驱动。需要进一步研究髋关节保留手术的适宜性分类，以确定年龄和影像学髋关节发现之外的重要适应证变量。
