From the Division of Orthopaedic Surgery, Department of Surgery, University of Toronto (Hoit, Whelan, Atrey, and Khoshbin), the Department of Orthopaedic Surgery, St. Michael's Hospital (Whelan, Ly, Atrey, and Khoshbin), and the Institute for Clinical Evaluative Sciences, University of Toronto (Saskin), Toronto, ON, Canada .
J Am Acad Orthop Surg. 2021 Oct 15;29(20):885-893. doi: 10.5435/JAAOS-D-20-00748.
The purpose of this study was to determine which patient, provider, and surgical factors influence progression to total hip arthroplasty (THA) after hip arthroscopy (HA) through a large cohort-based registry.
All patients ≥18 years who underwent unilateral HA in Ontario, Canada, between October 1, 2010, and December 31, 2016, were identified with a minimum of 2-year follow-up. The rate of THA after HA was reported using Kaplan-Meier survivorship analyses. A Cox proportional hazard model was used to assess which factors independently influenced survivorship.
A total of 2,545 patients (53.2% female, mean age 37.4 ± 11.8 years) were identified. A total of 237 patients (9.3%) were identified to have undergone THA at a median time of 2 years after HA, with an additional 6.3% requiring a revision arthroplasty at a median time of 1.1 years. Patients who underwent isolated labral resection (hazard ratio [HR]: 2.55, 95% confidence interval [CI]: 1.51 to 4.60) or in combination with osteochondroplasty (OCP) [HR: 2.11, 95% CI: 1.22 to 3.88] were more likely to undergo THA versus patients who underwent isolated labral repair or in combination with an OCP, respectively. Older age increased the risk for THA (HR: 14.0, 95% CI: 5.76 to 39.1), and treatment by the highest-volume HA surgeons was found to be protective (HR: 0.55, 95% CI: 0.33 to 0.89).
Using our methods, the rate of THA after HA was 9.3% at 2 years. The rate of revision arthroplasty was 6.3% at 1 year. Patients who underwent labral resection, isolated OCP, and/or were of increased age were at increased independent risk of conversion to THA. Those treated by the highest-volume HA surgeons were found to be at reduced risk of conversion to THA.
本研究旨在通过大型基于队列的注册研究，确定哪些患者、医生和手术因素会影响髋关节镜检查（HA）后全髋关节置换术（THA）的进展。
在加拿大安大略省，2010 年 10 月 1 日至 2016 年 12 月 31 日期间，对接受单侧 HA 的所有年龄≥18 岁的患者进行了识别，随访时间至少为 2 年。使用 Kaplan-Meier 生存分析报告 HA 后 THA 的发生率。使用 Cox 比例风险模型评估哪些因素独立影响生存。
共确定了 2545 名患者（53.2%为女性，平均年龄 37.4±11.8 岁）。237 名患者（9.3%）在 HA 后 2 年内被确定接受了 THA，另有 6.3%的患者在 1.1 年内需要进行翻修关节置换术。接受单纯的盂唇切除术（HR：2.55，95%置信区间 [CI]：1.51 至 4.60）或与骨软骨成形术（OCP）联合治疗（HR：2.11，95% CI：1.22 至 3.88）的患者比接受单纯盂唇修复或联合 OCP 的患者更有可能接受 THA。年龄越大，THA 的风险越高（HR：14.0，95%CI：5.76 至 39.1），而由 HA 手术量最高的医生进行治疗被发现具有保护作用（HR：0.55，95%CI：0.33 至 0.89）。
使用我们的方法，HA 后 2 年 THA 的发生率为 9.3%。1 年内翻修关节置换术的发生率为 6.3%。接受盂唇切除术、单纯 OCP 治疗和/或年龄较大的患者，独立转为 THA 的风险增加。接受 HA 手术量最高的医生治疗的患者，转为 THA 的风险降低。
