Department of Orthopaedic Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Korea.
Arthroscopy. 2020 Aug;36(8):2186-2194. doi: 10.1016/j.arthro.2020.04.041. Epub 2020 May 8.
The present study investigated the minimum 2-year outcomes of hip arthroscopy for femoroacetabular impingement (FAI) and concomitant labral tears in Asian patients.
Patients who underwent hip arthroscopy for both FAI and concomitant labral tears between January 2012 and December 2017 were included. Patients with hip osteoarthritis of Tönnis grade ≥2, previous hip surgery, or followed for less than 2 years were excluded. Clinical assessments were performed using the modified Harris Hip Score, Western Ontario and McMaster Universities Osteoarthritis Index, and the rates of achieving threshold values of the minimal clinically important difference and patient acceptable symptomatic state at the latest follow-up. Plain radiographs were acquired pre- and postoperatively for radiologic assessments.
A total of 73 patients (90 hips, 58 male, 15 female; mean age 34.4 years) who underwent hip arthroscopy for FAI and concomitant labral tears were enrolled. Forty-three hips (47.8%) had cam-type, 7 (7.8%) had pincer-type, and 40 (44.4%) had mixed-type FAI. The mean follow-up duration was 5.2 years. In cam- and mixed-type FAI hips, the mean α angle significantly decreased from 66.7 ± 8.28° preoperatively to 44.9 ± 3.78° postoperatively (95% confidence interval [CI] 19.6°-22.8°; P < .001). The mean modified Harris Hip Score and Western Ontario and McMaster Universities Osteoarthritis Index increased from 74.8 ± 13.2 and 75 ± 12.7 preoperatively to 93 ± 8.1 (95% CI 15.4-20.9; P = .001) and 89.4 ± 8.4 postoperatively (95% CI 11.8-17; P = .001), respectively. Seventy-four hips (82.2%) crossed the minimal clinically important difference, and 85 hips (94.4%) had achieved the patient acceptable symptomatic state. There were 2 cases of pudendal nerve palsy and 1 case of sciatic nerve palsy. No additional surgeries were required.
Hip arthroscopy can be an effective treatment for FAI and concomitant labral tears in Asian patients as demonstrated in this study, with improved PRO scores and reoperation rates. Longer-term studies with larger cohorts are necessary.
Level IV, case series.
本研究旨在探讨亚洲患者髋关节镜治疗股骨髋臼撞击症（FAI）和伴发盂唇撕裂的至少 2 年疗效。
纳入 2012 年 1 月至 2017 年 12 月期间行髋关节镜治疗 FAI 和伴发盂唇撕裂的患者。排除髋关节 Tönnis 分级≥2 级、既往髋关节手术或随访时间少于 2 年的患者。采用改良 Harris 髋关节评分、西部安大略省和麦克马斯特大学骨关节炎指数进行临床评估，并在末次随访时评估达到最小临床重要差异和患者可接受的症状状态阈值的比例。术前和术后均行 X 线平片评估影像学结果。
共纳入 73 例（90 髋，58 例男性，15 例女性；平均年龄 34.4 岁）接受髋关节镜治疗 FAI 和伴发盂唇撕裂的患者。43 髋（47.8%）为凸轮型，7 髋（7.8%）为钳夹型，40 髋（44.4%）为混合型 FAI。平均随访时间为 5.2 年。在凸轮型和混合型 FAI 髋关节中，α 角从术前的 66.7±8.28°显著降低至术后的 44.9±3.78°（95%置信区间：19.6°-22.8°；P<0.001）。改良 Harris 髋关节评分和西部安大略省和麦克马斯特大学骨关节炎指数分别从术前的 74.8±13.2 和 75±12.7 增加至术后的 93±8.1（95%置信区间：15.4-20.9；P=0.001）和 89.4±8.4（95%置信区间：11.8-17；P=0.001）。74 髋（82.2%）跨越了最小临床重要差异，85 髋（94.4%）达到了患者可接受的症状状态。有 2 例阴部神经麻痹和 1 例坐骨神经麻痹。无需进一步手术。
本研究表明，髋关节镜治疗亚洲患者 FAI 和伴发盂唇撕裂可取得良好的疗效，改善了患者的 PRO 评分和再手术率。需要进行更长时间、更大样本量的研究。
IV 级，病例系列研究。
