DISC Sports and Spine Center, Marina del Rey, California, U.S.A..
Department of Physical Therapy, Rangos School of Health Sciences, Duquesne University, Pittsburgh, Pennsylvania, U.S.A.
Arthroscopy. 2019 Aug;35(8):2338-2345. doi: 10.1016/j.arthro.2019.01.055.
To report comparative hip arthroscopic outcomes of patients with low (borderline dysplasia), normal, and high (global pincer femoroacetabular impingement [FAI]) lateral acetabular coverage.
A retrospective analysis of prospectively collected data from a multicenter registry was performed. Primary hip arthroscopy patients were assigned to 1 of 3 groups based on preoperative lateral center-edge angle: borderline dysplasia (≤25°), normal (25.1°-38.9°), and pincer (≥39°). Repeated-measures analysis of variance compared preoperative with 2-year minimum postoperative International Hip Outcome Tool (iHOT-12) scores. Subsequent analysis of variance determined the effect of acetabular coverage on magnitude of change in scores.
Of 437 patients, the only statistical difference between groups was a lower prevalence of acetabuloplasty in the borderline dysplasia group (P = .001). A significant improvement in the preoperative to postoperative iHOT-12 scores for patients with normal acetabular coverage, acetabular undercoverage, and acetabular overcoverage was observed: F(1, 339) = 311.06; P <.001, with no statistical differences in preoperative (P = .505) and postoperative (P <.488) iHOT-12 scores when comparing the groups based on acetabular coverage. Mean iHOT-12 scores increased from 37.3 preoperatively to 68.7 postoperatively (P <.001) in the borderline dysplasia group, from 34.4 to 72 (P <.001) in the normal coverage group, and from 35.3 to 69.4 (P <.001) in the pincer group. These preoperative scores increased by 31.4, 37.8, and 34.1, respectively, with no effect for acetabular coverage on the magnitude of change from preoperative to postoperative iHOT-12 scores: F(2,339) = 1.18; P = .310. Ten patients (2.3%) underwent conversion arthroplasty, and 19 patients (4.4%) underwent revision arthroscopy with no significant effect of acetabular coverage on the incidence of revision or conversion surgery: χ (6,433) = 11.535; P = .073.
Lateral acetabular coverage did not influence outcomes from primary hip arthroscopy when performed in patients with low (borderline dysplasia), normal, and high (global pincer FAI) lateral center-edge angle. Borderline dysplasia and moderate global pincer FAI with no or minimal osteoarthritis do not compromise successful 2-year minimum outcomes or survivorship following primary hip arthroscopy when performed by experienced surgeons.
Level III, retrospective therapeutic trial.
报告髋关节镜下治疗髋臼低位（发育不良边缘型）、正常位和高位（整体钳夹型股骨髋臼撞击症）外侧髋臼覆盖患者的比较结果。
对多中心注册处前瞻性收集的数据进行回顾性分析。根据术前外侧中心边缘角，将原发性髋关节镜患者分为 3 组之一：发育不良边缘型（≤25°）、正常型（25.1°-38.9°）和钳夹型（≥39°）。采用重复测量方差分析比较术前和术后 2 年最低国际髋关节结果工具（iHOT-12）评分。随后的方差分析确定髋臼覆盖对评分变化幅度的影响。
在 437 名患者中，各组之间唯一的统计学差异是发育不良边缘型组髋臼成形术的发生率较低（P=0.001）。正常髋臼覆盖、髋臼覆盖不足和髋臼覆盖过度的患者，术前至术后 iHOT-12 评分均有显著改善：F（1,339）=311.06；P<.001，根据髋臼覆盖情况比较各组时，术前（P=0.505）和术后（P<.488）iHOT-12 评分无统计学差异。发育不良边缘型组 iHOT-12 评分从术前的 37.3 增加到术后的 68.7（P<.001），正常覆盖组从 34.4 增加到 72（P<.001），钳夹组从 35.3 增加到 69.4（P<.001）。这些术前评分分别增加了 31.4、37.8 和 34.1，髋臼覆盖对从术前到术后 iHOT-12 评分的变化幅度没有影响：F（2,339）=1.18；P=0.310。10 例患者（2.3%）行转换关节成形术，19 例患者（4.4%）行翻修关节镜手术，髋臼覆盖对翻修或转换手术的发生率无显著影响：χ（6,433）=11.535；P=0.073。
当在髋臼低位（发育不良边缘型）、正常位和高位（整体钳夹型股骨髋臼撞击症）外侧中心边缘角的患者中进行原发性髋关节镜治疗时，外侧髋臼覆盖对治疗结果没有影响。经验丰富的外科医生进行治疗时，边缘性发育不良和中等程度的整体钳夹型股骨髋臼撞击症，无论是否有轻度骨关节炎，均不会影响术后 2 年的最低疗效或生存率。
III 级，回顾性治疗试验。
