Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
Department of Orthopaedics and Traumatology, Istanbul Medipol University, Istanbul, Turkey.
J Bone Joint Surg Am. 2020 Jun 17;102(12):e59. doi: 10.2106/JBJS.19.00456.
Surgical treatment of femoroacetabular impingement (FAI) has been increasing over the past decade with reports of favorable results in alleviating patient symptoms. However, progression of osteoarthritis in these patients may necessitate total hip arthroplasty (THA) for the treatment of unresolved or recurrent hip pain and accompanying disability. Identifying the risk factors for disease progression and treatment failure can help orthopaedic surgeons to select the appropriate patients for joint-preservation procedures and allow more informative discussions.
With use of the prospective database of hip-preservation surgery at our institution, 652 patients (324 men and 328 women) with FAI who had undergone femoroacetabular osteoplasty (FAO) between December 2004 and April 2016 were identified. Treatment failure was defined as the need for THA. At the latest follow-up, 68 (9.08%)of 749 hips had undergone THA because of the recurrence of symptoms and the development of osteoarthritis. The groups of patients who had or had not undergone conversion to THA were compared with respect to age, sex, body mass index (BMI), surgeon experience, duration of preoperative symptoms, preoperative and postoperative alpha angles, radiographic parameters of hip dysplasia, a perioperative chondral lesion, labral abnormalities and interventions, acetabular retroversion, and severity of osteoarthritis (Tönnis grade).
The mean age (and standard deviation) at the time of the index FAO was 41.9 ± 10.5 years for patients who had had a failure of FAO, compared with 33.4 ± 11.1 years for those who had not. Risk factors for treatment failure included a longer mean symptomatic period before the FAO procedure, older age, higher mean BMI, the presence of hip dysplasia, acetabular retroversion, higher preoperative alpha angle, a full-thickness acetabular chondral lesion, Tönnis grade-1 and 2 osteoarthritis, labral hypertrophy, and total labral resection during FAO. The rate of failure was related to the experience of the surgeon, with fewer failures occurring in the later years of surgery as compared with the earlier years.
The present study identified a number of variables that influence the outcome of FAO. Surgeons performing hip-preservation procedures should be aware of these risk factors for failure, and a more cautious approach is recommended for patients with these risk factors.
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
在过去十年中，髋关节撞击综合征（FAI）的手术治疗一直在增加，有报道称该治疗方法可以缓解患者的症状。然而，对于这些患者，骨关节炎的进展可能需要全髋关节置换术（THA）来治疗未解决或复发的髋关节疼痛和伴随的残疾。确定疾病进展和治疗失败的风险因素可以帮助矫形外科医生选择合适的患者进行关节保留手术，并进行更具信息量的讨论。
使用我们机构的髋关节保留手术前瞻性数据库，确定了 2004 年 12 月至 2016 年 4 月期间接受股骨髋臼成形术（FAO）的 652 例（324 名男性和 328 名女性）FAI 患者。治疗失败定义为需要 THA。在末次随访时，由于症状复发和骨关节炎的发展，749 髋中有 68 髋（9.08%）需要进行 THA。比较了行与不行 THA 转换的两组患者的年龄、性别、体重指数（BMI）、外科医生经验、术前症状持续时间、术前和术后α角、髋关节发育不良的影像学参数、围手术期软骨损伤、盂唇异常和干预措施、髋臼后倾和骨关节炎严重程度（Tönnis 分级）。
行 FAO 失败的患者 FAO 时的平均年龄（及标准差）为 41.9 ± 10.5 岁，而行 FAO 未失败的患者为 33.4 ± 11.1 岁。治疗失败的危险因素包括 FAO 术前症状持续时间较长、年龄较大、BMI 较高、髋关节发育不良、髋臼后倾、术前α角较高、全层髋臼软骨损伤、Tönnis 分级 1 级和 2 级骨关节炎、盂唇肥大和 FAO 时全层盂唇切除术。失败的发生率与外科医生的经验有关，与手术早期相比，手术后期失败的发生率较低。
本研究确定了一些影响 FAO 结果的变量。进行髋关节保留手术的外科医生应该意识到这些失败的风险因素，并建议对具有这些风险因素的患者采取更为谨慎的方法。
预后 IV 级。请参阅作者说明，以获取完整的证据水平描述。
