Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois.
Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, U.S.A.
Arthroscopy. 2020 Apr;36(4):1022-1029. doi: 10.1016/j.arthro.2019.08.032. Epub 2019 Dec 31.
To determine the effect of the preoperative duration of femoroacetabular impingement syndrome (FAIS)-associated symptoms on clinical outcomes at a minimum of 5 years after hip arthroscopy.
We identified FAIS patients who underwent primary hip arthroscopy between January 2012 and January 2014 with a minimum of 5 years' follow-up. Patient demographic characteristics and clinical outcomes, comprising the Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sports Subscale (HOS-SS), modified Harris Hip Score (mHHS), pain score, and satisfaction score, were analyzed. The minimal clinically important difference, patient acceptable symptomatic state, and substantial clinical benefit were calculated. Patients were stratified based on the preoperative duration of symptoms: less than 2 years versus 2 years or longer. Multivariate regressions were constructed to determine the association between the preoperative symptom duration and clinical outcomes at 5 years after hip arthroscopy.
A total of 310 patients were included with a mean age (±standard deviation) of 34.1 ± 11.9 years and body mass index of 25.3 ± 5.1. The study group showed statistically significant improvements in the HOS-ADL, HOS-SS, mHHS, pain score, and satisfaction score (P < .001 for all). A preoperative duration of symptoms of 2 or more years was an independent predictor of worse HOS-ADL, HOS-SS, mHHS, and pain score (P < .05 for all). Furthermore, a longer duration of symptoms was associated with a lower likelihood of achieving the minimal clinically important difference for the HOS-ADL (odds ratio [OR], 0.53; P = .037), HOS-SS (OR, 0.38; P = .003), and mHHS (OR, 0.43; P = .009); the patient acceptable symptomatic state for the HOS-SS (OR, 0.44; P = .006) and mHHS (OR, 0.46; P = .006) but not the HOS-ADL despite trending toward significance (OR, 0.59; P = .098); and substantial clinical benefit for the HOS-ADL (OR, 0.50; P = .011), HOS-SS (OR, 0.52; P = .020), and mHHS (OR, 0.47; P = .007).
Patients with a preoperative duration of FAIS-associated symptoms of 2 or more years prior to hip arthroscopy experience inferior outcomes and a lower frequency of clinically significant outcome improvement than patients with a shorter duration of symptoms at medium-to long-term follow-up.
Level III, retrospective comparative trial.
确定髋关节镜检查术前股骨髋臼撞击综合征（FAIS）相关症状持续时间对术后至少 5 年临床结果的影响。
我们确定了 2012 年 1 月至 2014 年 1 月期间接受初次髋关节镜检查的 FAIS 患者，随访时间至少 5 年。分析患者的人口统计学特征和临床结果，包括髋关节结局评分-日常生活活动（HOS-ADL）、髋关节结局评分-运动亚量表（HOS-SS）、改良 Harris 髋关节评分（mHHS）、疼痛评分和满意度评分。计算最小临床重要差异、患者可接受的症状状态和明显临床获益。根据术前症状持续时间将患者分层：少于 2 年与 2 年或更长。构建多元回归模型以确定髋关节镜检查术前症状持续时间与术后 5 年临床结果之间的关联。
共纳入 310 例患者，平均年龄（±标准差）为 34.1±11.9 岁，体重指数为 25.3±5.1。研究组在 HOS-ADL、HOS-SS、mHHS、疼痛评分和满意度评分方面均显示出统计学显著改善（所有 P<.001）。术前症状持续时间 2 年或更长是 HOS-ADL、HOS-SS、mHHS 和疼痛评分较差的独立预测因素（所有 P<.05）。此外，较长的症状持续时间与获得 HOS-ADL（优势比[OR]，0.53；P=.037）、HOS-SS（OR，0.38；P=.003）和 mHHS（OR，0.43；P=.009）的最小临床重要差异的可能性降低相关；HOS-SS（OR，0.44；P=.006）和 mHHS（OR，0.46；P=.006）的患者可接受症状状态，但 HOS-ADL 则无显著意义（OR，0.59；P=.098）；以及 HOS-ADL（OR，0.50；P=.011）、HOS-SS（OR，0.52；P=.020）和 mHHS（OR，0.47；P=.007）的明显临床获益。
在髋关节镜检查前 FAIS 相关症状持续时间为 2 年或更长的患者在中至长期随访中经历了较差的结果和较低的临床显著改善的频率。
III 级，回顾性比较试验。
