Department of Orthopedics, Sports Medicine, Mayo Clinic Arizona, Phoenix, Arizona, U.S.A.
Department of Orthopedics, Mayo Clinic Rochester, Rochester, Minnesota, U.S.A.
Arthroscopy. 2019 Jun;35(6):1837-1844. doi: 10.1016/j.arthro.2018.12.033. Epub 2019 Apr 9.
To determine the degree of correlation of radiographic measurements, degree of correlation of intraoperative pathology, and difference in outcomes between sides of patients requiring staged bilateral hip arthroscopy.
Two high-volume hip preservation centers retrospectively reviewed hip preservation databases for staged bilateral hip arthroscopies conducted between 2008 and 2015. Patients were separated into those who presented with bilateral hip pain and those that presented with unilateral pain and developed contralateral pain >2 years later. Patients were analyzed for radiographic correlation (alpha angle, lateral center edge angle, anterior center edge angle, magnetic resonance imaging alpha angle, Tönnis grade) and correlation of intraoperative pathology (acetabular labrum articular disruption grade, Outerbridge grade/location, Villar class ligamentum teres tears, labral tear location, symmetry of Seldes tear types, and the differences between operative procedures). Patient-reported outcomes were analyzed (modified Harris Hip Score, Non-Arthritic Hip Score, International Hip Outcome Tool-12, hip outcome score-sport specific subscale, visual analog scale, patient satisfaction). Correlative tests included Pearson and Spearman; univariate and multivariate analysis for differences included χ-square test and Student t tests for ordinal and continuous variables respectively.
A total of 133 of 2,705 patients (4.6%) underwent bilateral hip arthroscopy. Radiographic alpha angle, magnetic resonance imaging alpha angle, lateral center edge angle, and anterior center edge angle demonstrated strong correlation (Pearson's coefficients 0.651, 0.648, 0.644, 0.667, respectively, P < .0001). Tönnis grade was weakly correlated (Pearson's coefficient 0.286, P = .001). Intraoperative pathology was moderately correlated (Pearson's coefficients for acetabular Outerbridge location, 0.300, P = .0170; acetabular labrum articular disruption, 0.490, P < .0001; acetabular Outerbridge; 0.530; P < .0001; femoral head Outerbridge, 0.459, P < .0001; Villar class, 0.393, P < .0001; and labral tear location, 0.468, P < .0001). Labral tear Seldes type was compared with Bowker's symmetry test and there was no significant difference between sides. There were no significant differences in surgical interventions performed between sides. Patients with bilateral hip arthroscopies significantly improved in all measured patient-reported outcomes and had a high patient satisfaction after both procedures. Final patient-reported outcomes and change in patient-reported outcomes were not different between procedures; follow up ranged from 3 months to 8 years.
This study demonstrated an incidence of 4.6% of patients who require bilateral hip arthroscopy. These patients can expect significant improvement after surgical intervention. Patients that had 1 side done gained similar improvement when the contralateral side was performed. Preoperative radiographic, intraoperative pathology, and procedures performed were similar between hips.
Level III, retrospective cohort study.
确定需要分期双侧髋关节镜检查的患者的放射学测量值的相关性程度、术中病理学的相关性程度以及两侧结果的差异。
两个大容量髋关节保护中心回顾性地审查了 2008 年至 2015 年间进行的分期双侧髋关节镜检查的髋关节保护数据库。患者分为双侧髋关节疼痛和单侧疼痛并在 2 年以上出现对侧疼痛的患者。对患者进行放射学相关性（α角、外侧中心边缘角、前中心边缘角、磁共振成像α角、Tönnis 分级）和术中病理学相关性（髋臼唇关节破坏分级、外侧壁骨关节炎分级/位置、Villar 级韧带撕裂、唇撕裂位置、Seldes 撕裂类型的对称性、手术程序之间的差异）分析。分析患者报告的结果（改良 Harris 髋关节评分、非关节炎髋关节评分、国际髋关节结果工具-12、髋关节结果评分-运动特定亚量表、视觉模拟评分、患者满意度）。相关检验包括 Pearson 和 Spearman；单变量和多变量分析差异包括 χ2 检验和学生 t 检验用于有序和连续变量。
共有 133 名/2705 名患者（4.6%）接受了双侧髋关节镜检查。放射学α角、磁共振成像α角、外侧中心边缘角和前中心边缘角显示出很强的相关性（Pearson 系数分别为 0.651、0.648、0.644、0.667，P<.0001）。Tönnis 分级相关性较弱（Pearson 系数 0.286，P=0.001）。术中病理学中度相关（髋臼外侧壁骨关节炎的 Pearson 系数为 0.300，P=0.0170；髋臼唇关节破坏的 Pearson 系数为 0.490，P<0.0001；髋臼外侧壁骨关节炎的 Pearson 系数为 0.530；P<0.0001；股骨头外侧壁骨关节炎的 Pearson 系数为 0.459，P<0.0001；Villar 级的 Pearson 系数为 0.393，P<0.0001；和唇撕裂位置的 Pearson 系数为 0.468，P<0.0001）。比较了唇撕裂 Seldes 类型与 Bowker 对称性检验，两侧无显著差异。两侧手术干预之间无显著差异。接受双侧髋关节镜检查的患者在所有测量的患者报告结果中均有显著改善，并且在两次手术后均有很高的患者满意度。最终的患者报告结果和患者报告结果的变化在程序之间没有差异；随访时间为 3 个月至 8 年。
本研究表明，需要双侧髋关节镜检查的患者发生率为 4.6%。这些患者可以预期手术干预后会有显著改善。接受一侧手术的患者在对侧手术时也会获得类似的改善。术前放射学、术中病理学和手术程序在两侧相似。
III 级，回顾性队列研究。
