Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
Am J Sports Med. 2019 Apr;47(5):1138-1144. doi: 10.1177/0363546519832545.
There is literature on the association between smoking in patients undergoing orthopaedic procedures and poor short-term outcomes. However, there are few data on smoking as an independent predictor of midterm outcomes in patients undergoing hip arthroscopic surgery for femoroacetabular impingement (FAI).
To evaluate 2-year postoperative outcomes in patients undergoing hip arthroscopic surgery for FAI in current smokers compared with an age- and body mass index (BMI)-matched group with no smoking history.
Cohort study; Level of evidence, 3.
Consecutive patients undergoing primary hip arthroscopic surgery for FAI between June 2012 and January 2016 were screened for smoking habits. Exclusion criteria included revision or bilateral surgery, dysplasia, and less than 2-year follow-up. Forty current smokers at the time of surgery were matched 1:2 by age and BMI to patients with no smoking history. Outcome measures included the Hip Outcome Score (HOS)-Activities of Daily Living (ADL), HOS-Sports-Specific Subscale (SSS), modified Harris Hip Score (mHHS), and visual analog scale (VAS) for pain and satisfaction. Minimal clinically important difference (MCID) and patient acceptable symptom state rates were calculated for all patients.
All patients demonstrated significant improvements in all outcome measures ( P < .001). Current smokers experienced inferior postoperative HOS-ADL (80.4 vs 89.1, respectively; P = .013) and HOS-SSS (65.8 vs 75.6, respectively; P = .046) scores and greater VAS pain scores (3.2 vs 1.8, respectively; P = .011) than nonsmokers. Current smoking was correlated with inferior HOS-ADL ( r = -0.27, P = .003) and HOS-SSS ( r = -0.18, P = .046) scores and greater VAS pain scores ( r = 0.26, P = .005). Controlling for age, sex, and BMI, smoking was a significant independent predictor of postoperative HOS-ADL (β = -8.7 [95% CI, -14.3 to -3.0]; P = .003), HOS-SSS (β = -9.8 [95% CI, -19.5 to -0.2]; P = .046), and VAS pain (β = 14.6 [95% CI, 4.4 to 23.7]; P = .005) scores. Current smokers had lower odds of achieving the MCID for the HOS-ADL (odds ratio, 0.31 [95% CI, 0.12-0.83]; P = .019) and mHHS (odds ratio, 0.31 [95% CI, 0.10-0.88]; P = .028).
Current smokers had inferior postoperative HOS-ADL and HOS-SSS scores, increased pain, and lower odds of achieving the MCID for the HOS-ADL and mHHS at 2 years postoperatively than patients without any smoking history.
有文献表明，接受骨科手术的患者吸烟与短期预后不良有关。然而，在接受髋关节镜手术治疗股骨髋臼撞击症（FAI）的患者中，吸烟作为中期预后的独立预测因素的数据较少。
评估当前吸烟者与无吸烟史的年龄和体重指数（BMI）匹配组相比，在接受髋关节镜手术治疗 FAI 后的 2 年术后结果。
队列研究；证据水平，3 级。
对 2012 年 6 月至 2016 年 1 月期间接受原发性髋关节镜手术治疗 FAI 的连续患者进行吸烟习惯筛查。排除标准包括翻修或双侧手术、发育不良和随访时间少于 2 年。在手术时为当前吸烟者的 40 名患者按年龄和 BMI 1:2 匹配无吸烟史的患者。评估指标包括髋关节结局评分（HOS）-日常生活活动（ADL）、HOS-运动特异性亚量表（SSS）、改良 Harris 髋关节评分（mHHS）和疼痛及满意度的视觉模拟量表（VAS）。所有患者均计算了最小临床重要差异（MCID）和患者可接受的症状状态发生率。
所有患者在所有评估指标上均表现出显著改善（P<0.001）。与非吸烟者相比，当前吸烟者的术后 HOS-ADL（分别为 80.4 分和 89.1 分；P=0.013）和 HOS-SSS（分别为 65.8 分和 75.6 分；P=0.046）评分以及更大的 VAS 疼痛评分（分别为 3.2 分和 1.8 分；P=0.011）较低。当前吸烟与 HOS-ADL（r=-0.27，P=0.003）和 HOS-SSS（r=-0.18，P=0.046）评分以及更大的 VAS 疼痛评分（r=0.26，P=0.005）呈负相关。在控制年龄、性别和 BMI 后，吸烟是术后 HOS-ADL（β=-8.7[95%CI，-14.3 至-3.0]；P=0.003）、HOS-SSS（β=-9.8[95%CI，-19.5 至-0.2]；P=0.046）和 VAS 疼痛评分（β=14.6[95%CI，4.4 至 23.7]；P=0.005）的显著独立预测因素。当前吸烟者达到 HOS-ADL 的 MCID 的可能性较小（比值比，0.31[95%CI，0.12-0.83]；P=0.019）和 mHHS（比值比，0.31[95%CI，0.10-0.88]；P=0.028）。
与无吸烟史的患者相比，当前吸烟者在术后 2 年时 HOS-ADL 和 HOS-SSS 评分较低，疼痛增加，且达到 HOS-ADL 和 mHHS 的 MCID 的可能性较低。
