Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.
Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.
Arthroscopy. 2020 Jan;36(1):127-136. doi: 10.1016/j.arthro.2019.07.026.
To determine clinical outcomes of patients undergoing revision hip arthroscopy for failure to improve with magnetic resonance imaging (MRI) and intraoperative evidence of a capsular incompetency as compared with (1) patients undergoing revision hip arthroscopy without evidence of a capsular incompetency and (2) patients undergoing primary surgery for femoroacetabular impingement syndrome (FAIS) at a minimum follow up of 2 years.
Data from consecutive patients undergoing revision hip arthroscopy with MRI/arthrogram-confirmed capsular incompetency between January 2012 and June 2016 were analyzed. All revision patients with capsular incompetency was matched 1:1 by age and body mass index to FAIS revision patients without capsular incompetency and primary FAIS patients. Outcomes included the Hip Outcome Score (HOS)-Activities of Daily Living (ADL), HOS-Sports Subscale (SS), Modified Harris Hip Score (mHHS), pain, and satisfaction. The minimal clinically important difference was calculated for HOS-ADL, HOS-SS, and mHHS.
In total, 49 patients (54.4%) of 90 undergoing revision hip arthroscopy had MRI evidence of a capsular incompetency. Most patients were female (79.6%), with a mean age of 30 ± 10.5 years and body mass index of 25.7 ± 5.5. The difference among pre- and postoperative HOS-ADL, HOS-SS, mHHS, and visual analog scale score for pain were all statistically significant (P < .05). Analysis of reported outcomes among matched groups demonstrated statistically significant differences, with the group undergoing primary surgery having the greatest 2-year outcomes. Only 66.7% of patients undergoing revision surgery with capsular incompetency achieved a minimal clinically important difference; however, there was no significant difference when compared with revision patients without capsular incompetency. When compared with patients undergoing primary surgery, the difference in frequency was statistically significant (66.7% vs 91.3%; P < .001).
More than one half of patients undergoing revision hip arthroscopy had MRI and intraoperative evidence of capsular incompetency. Revision arthroscopy for capsular incompetency results in significantly improved 2-year outcomes. However, patients undergoing revision for capsular incompetency and intact capsule revision patients reported significantly lower outcomes compared with primary patients.
Level III, Retrospective Comparative Study.
与（1）无囊袋功能不全的髋关节镜翻修患者和（2）接受股骨髋臼撞击综合征（FAIS）初次手术的患者相比，确定接受髋关节镜翻修治疗、磁共振成像（MRI）和术中囊袋功能不全证据显示治疗无效的患者的临床结果。
分析了 2012 年 1 月至 2016 年 6 月期间连续接受 MRI/关节造影证实囊袋功能不全髋关节镜翻修手术的患者数据。所有具有囊袋功能不全的翻修患者，均通过年龄和体重指数与无囊袋功能不全的 FAIS 翻修患者和 FAIS 初次手术患者进行 1:1 匹配。结果包括髋关节评分（HOS）-日常生活活动（ADL）、HOS-运动亚量表（SS）、改良 Harris 髋关节评分（mHHS）、疼痛和满意度。计算了 HOS-ADL、HOS-SS 和 mHHS 的最小临床重要差异。
90 例行髋关节镜翻修术的患者中，有 49 例（54.4%）的 MRI 显示有囊袋功能不全。大多数患者为女性（79.6%），平均年龄为 30±10.5 岁，体重指数为 25.7±5.5。术前和术后 HOS-ADL、HOS-SS、mHHS 和疼痛视觉模拟评分之间的差异均具有统计学意义（P<0.05）。对匹配组的报告结果进行分析显示，差异具有统计学意义，初次手术组的 2 年结果最大。仅 66.7%接受有囊袋功能不全的髋关节镜翻修术的患者达到了最小临床重要差异；然而，与无囊袋功能不全的髋关节镜翻修术患者相比，差异无统计学意义。与初次手术患者相比，频率差异具有统计学意义（66.7% vs 91.3%；P<0.001）。
超过一半的髋关节镜翻修术患者有囊袋功能不全的 MRI 和术中证据。髋关节镜翻修治疗囊袋功能不全可显著改善 2 年结果。然而，接受囊袋功能不全翻修和完整囊袋翻修的患者报告的结果明显低于初次手术患者。
III 级，回顾性比较研究。
