Columbia University Irving Medical Center, New York, New York, USA.
University of Iowa Health Care, Iowa City, Iowa, USA.
Am J Sports Med. 2020 Apr;48(5):1254-1262. doi: 10.1177/0363546519869671. Epub 2019 Sep 10.
While the indications for primary hip arthroscopic surgery in treating femoroacetabular abnormalities continue to be defined, the indications and outcomes for revision hip arthroscopic surgery remain ambiguous. However, revision hip arthroscopic surgery is performed in 5% to 14% of patients after their index procedure. While patient-reported outcomes (PROs) generally improve after revision procedures, the extent of their improvement is not well defined.
To determine the outcomes and efficacy of revision hip arthroscopic surgery in patients who remain symptomatic after their index procedure.
Meta-analysis and systematic review.
The terms "hip arthroscopy,""revisions,""outcomes," and "femoroacetabular impingement" were searched in PubMed, Web of Science, Scopus, Cochrane Library, and Google Scholar. After screening, 15 studies were included for review. In addition to hip-specific metrics, functional outcome measures were included. Pooled estimates and 95% CIs were calculated using inverse variance methods.
A total of 4765 hips in 4316 patients were identified. The most common indication for revision surgery was inadequate bony resection during the index procedure. Meta-analysis showed that all PROs improved significantly from baseline to final follow-up after revision hip arthroscopic surgery. Notably, the modified Harris Hip Score (mHHS) increased a mean of 17.20 points after revision hip arthroscopic surgery, the Hip Outcome Score-Activities of Daily Living (HOS-ADL) improved by 13.98, and the visual analog scale (VAS) for pain decreased by 3.16. However, when compared with primary hip arthroscopic surgery, the mean PRO scores after revision hip arthroscopic surgery were lower. After revision hip arthroscopic surgery, the rates of conversion to total hip arthroplasty ranged from 0% to 14.3%, and the rates of further arthroscopic revision ranged from 2% to 14%.
Inadequate bony resection represents the most common indication for revision hip arthroscopic surgery. PROs improve significantly after revision hip arthroscopic surgery but remain lower than those of patients undergoing primary hip arthroscopic surgery.
虽然髋关节镜初次手术治疗股骨髋臼异常的适应证仍在不断明确，但髋关节镜翻修手术的适应证和疗效仍不明确。然而，初次手术后仍有 5%至 14%的患者需要接受髋关节镜翻修手术。虽然翻修手术后患者报告的结局（PROs）通常会改善，但改善的程度尚不清楚。
确定初次手术后仍有症状的患者接受髋关节镜翻修手术的结局和疗效。
荟萃分析和系统评价。
在 PubMed、Web of Science、Scopus、Cochrane Library 和 Google Scholar 中检索了“髋关节镜”、“翻修”、“结局”和“股骨髋臼撞击症”等术语。筛选后，共纳入 15 项研究进行综述。除了髋关节特定指标外，还纳入了功能结局测量指标。使用逆方差法计算汇总估计值和 95%置信区间。
共纳入 4316 例患者的 4765 髋。翻修手术最常见的适应证是初次手术时骨切除不充分。荟萃分析显示，所有 PROs 在翻修髋关节镜手术后从基线到最终随访均显著改善。值得注意的是，翻修髋关节镜手术后改良 Harris 髋关节评分（mHHS）平均增加 17.20 分，髋关节功能评分-日常活动（HOS-ADL）增加 13.98 分，疼痛视觉模拟量表（VAS）评分降低 3.16 分。然而，与初次髋关节镜手术相比，翻修髋关节镜手术后的平均 PRO 评分较低。翻修髋关节镜手术后，转为全髋关节置换术的比例为 0%至 14.3%，进一步接受髋关节镜翻修的比例为 2%至 14%。
骨切除不充分是髋关节镜翻修手术最常见的适应证。翻修髋关节镜手术后 PROs 显著改善，但仍低于初次髋关节镜手术患者。
