Investigation performed at McMaster University, Hamilton, Ontario, Canada.
Am J Sports Med. 2021 Jan;49(1):25-34. doi: 10.1177/0363546520952804. Epub 2020 Sep 24.
Femoroacetabular impingement (FAI) is a condition known to cause hip pain in young adults.
To evaluate the efficacy of the surgical correction of FAI via arthroscopic osteochondroplasty with or without labral repair compared with arthroscopic lavage of the hip joint with or without labral repair.
Randomized controlled trial; Level of evidence, 1.
A total of 220 male and female participants aged 18 to 50 years with nonarthritic FAI suitable for surgical treatment were recruited for the trial at 10 clinical centers in Canada, Finland, and Denmark between October 2012 and November 2017, of whom 214 were included in the final analysis. In the osteochondroplasty group, cam- and/or pincer-type lesions were resected using fluoroscopic guidance. In the lavage group, the joint was washed out with 3 L of normal saline. Surgeons were instructed to repair the labrum in both groups if it was mechanically unstable once probed, showing visible displacement or chondrolabral separation. The primary outcome was patient-reported pain (using the 100-point visual analog scale [VAS]) at 12 months. Secondary outcomes included hip function (Hip Outcome Score [HOS] and International Hip Outcome Tool), physical and mental health (12-Item Short Form Health Survey), and health utility (EuroQol-5 Dimensions) at 12 months as well as any reoperations and other hip-related adverse events at 24 months.
At 12 months, there was no difference in pain (VAS) between the groups (mean difference [MD], 0.11 [95% CI, -7.22 to 7.45]; = .98). Also, 88.3% (189/214) of participants had a labral tear, of which 60.3% were repaired. For the secondary outcomes, there were no significant differences between treatment groups, with the exception of the HOS activities of daily living domain in which lavage showed significant improvement compared with osteochondroplasty (MD, -5.03 [95% CI, -10.40 to -0.03]; = .049). By 24 months, there were significantly fewer reoperations reported in the osteochondroplasty group (8/105) than the lavage group (19/104) (odds ratio, 0.37 [95% CI, 0.15-0.89]; = .026). The primary reasons for a reoperation included hip pain (15/27; 55.6%) and a reinjury of the labrum (11/27; 40.7%).
Both the osteochondroplasty and the lavage groups with or without labral repair for FAI had significantly improved pain or function significantly at 1 year. By 2 years, the reoperation rate was significantly lower in the osteochondroplasty group.
NCT01623843 (ClinicalTrials.gov identifier).
股骨髋臼撞击症（FAI）是一种已知会导致年轻成年人髋关节疼痛的病症。
评估通过关节镜下骨软骨成形术治疗 FAI 的疗效，与关节镜下髋关节灌洗术相比，无论是否同时进行盂唇修复。
随机对照试验；证据水平，1 级。
2012 年 10 月至 2017 年 11 月期间，在加拿大、芬兰和丹麦的 10 个临床中心招募了 220 名年龄在 18 至 50 岁之间的非关节炎 FAI 适合手术治疗的男性和女性参与者，其中 214 名参与者纳入最终分析。在骨软骨成形术组中，使用透视引导切除凸轮型和/或钳夹型病变。在灌洗组中，用 3 升生理盐水冲洗关节。如果盂唇在探查时表现出机械不稳定，出现可见移位或软骨盂唇分离，外科医生被指示在两组中进行修复。主要结局是患者在 12 个月时报告的疼痛（使用 100 点视觉模拟量表 [VAS]）。次要结局包括髋关节功能（髋关节结局评分 [HOS]和国际髋关节结局工具）、身体和心理健康（12 项简短健康调查）和健康效用（EuroQol-5 维度）在 12 个月以及任何再手术和其他与髋关节相关的不良事件在 24 个月。
在 12 个月时，两组之间的疼痛（VAS）没有差异（平均差异 [MD]，0.11 [95%CI，-7.22 至 7.45]； =.98）。此外，88.3%（189/214）的参与者有盂唇撕裂，其中 60.3%进行了修复。对于次要结局，治疗组之间没有显著差异，除了关节镜下灌洗组的日常生活活动域 HOS 显著改善（MD，-5.03 [95%CI，-10.40 至 -0.03]； =.049）。到 24 个月时，骨软骨成形术组的再手术报告明显少于灌洗组（8/105 比 19/104）（比值比，0.37 [95%CI，0.15-0.89]； =.026）。再次手术的主要原因包括髋关节疼痛（15/27；55.6%）和盂唇再损伤（11/27；40.7%）。
FAI 的骨软骨成形术和灌洗术联合或不联合盂唇修复均在 1 年内显著改善了疼痛或功能。到 2 年时，骨软骨成形术组的再手术率显著降低。
NCT01623843（ClinicalTrials.gov 标识符）。
