Collis Reid W, McCullough Andrea B, Ng Chris, Prather Heidi, Colditz Graham A, Clohisy John C, Cheng Abby L
Washington University School of Medicine, St. Louis, Missouri, USA.
Division of Physical Medicine and Rehabilitation, Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA.
Orthop J Sports Med. 2020 Nov 24;8(11):2325967120969863. doi: 10.1177/2325967120969863. eCollection 2020 Nov.
Prearthritic hip disorders (PAHD), such as femoroacetabular impingement (FAI), acetabular dysplasia, and acetabular labral tears, are a common cause of pain and dysfunction in adolescent and young adult athletes, and optimal patient-specific treatment has not been defined. Operative management is often recommended, but conservative management may be a reasonable approach for some athletes.
To identify (1) the relative rate of progression to surgery in self-reported competitive athletes versus nonathletes with PAHD and (2) baseline demographic, pain, and functional differences between athletes who proceeded versus those who did not proceed to surgery within 1 year of evaluation.
Cohort study; Level of evidence, 3.
An electronic medical record review was performed of middle school, high school, and college patients who were evaluated for PAHD at a single tertiary-care academic medical center between June 22, 2015, and May 1, 2018. Extracted variables included patients' self-reported athlete status, decision to choose surgery within 1 year of evaluation, and baseline self-reported pain and functional scores on Patient-Reported Outcomes Measurement Information System (PROMIS) domains, the Hip disability and Osteoarthritis Outcome Score (HOOS), and the modified Harris Hip Score.
Of 260 eligible patients (289 hips), 203 patients (78%; 227 hips) were athletes. Athletes were no more likely to choose surgery than nonathletes (130/227 hips [57%] vs 36/62 hips [58%]; relative risk [RR], 0.99 [95% CI, 0.78-1.25]). Among athletes, those who proceeded to surgery over conservative care were more likely to be female (81% vs 69%; RR, 1.34 [95% CI, 0.98-1.83]) and had more known imaging abnormalities (FAI: 82% vs 69%, RR, 1.47 [95% CI, 1.09-1.99]; dysplasia: 48% vs 27%, RR, 1.44 [95% CI, 1.16-1.79]; mixed deformity: 30% vs 10%, RR, 2.91 [95% CI, 1.53-5.54]; known labral tear: 84% vs 40%, RR, 2.79 [95% CI, 2.06-3.76]). Athletes who chose surgery also reported worse baseline hip-specific symptoms on all HOOS subscales (mean difference, 10.8-17.7; < .01 for all).
Similar to nonathletes, just over half of athletes with PAHD chose surgical management within 1 year of evaluation. Many competitive athletes with PAHD continued with conservative management and deferred surgery, but more structural hip pathology and worse hip-related baseline physical impairment were associated with the choice to pursue surgery.
关节炎前期髋关节疾病（PAHD），如股骨髋臼撞击症（FAI）、髋臼发育不良和髋臼盂唇撕裂，是青少年和年轻成年运动员疼痛和功能障碍的常见原因，目前尚未确定针对患者个体的最佳治疗方法。通常建议进行手术治疗，但对于一些运动员来说，保守治疗可能是一种合理的方法。
确定（1）自我报告的竞技运动员与患有PAHD的非运动员进行手术的相对比例，以及（2）在评估后1年内接受手术与未接受手术的运动员之间的基线人口统计学、疼痛和功能差异。
队列研究；证据等级，3级。
对2015年6月22日至2018年5月1日期间在单一三级医疗学术中心接受PAHD评估的初中、高中和大学患者的电子病历进行回顾。提取的变量包括患者自我报告的运动员身份、在评估后1年内选择手术的决定，以及患者报告结局测量信息系统（PROMIS）领域、髋关节残疾和骨关节炎结局评分（HOOS）以及改良Harris髋关节评分的基线自我报告疼痛和功能评分。
在260名符合条件的患者（289个髋关节）中，有203名患者（78%；227个髋关节）是运动员。运动员选择手术的可能性并不比非运动员高（227个髋关节中的130个[57%]对62个髋关节中的36个[58%]；相对风险[RR]，0.99[95%CI，0.78 - 1.25]）。在运动员中，选择手术而非保守治疗的患者更可能为女性（81%对69%；RR，1.34[95%CI，0.98 - 1.83]），并且有更多已知的影像学异常（FAI：82%对69%，RR，1.47[95%CI，1.09 - 1.99]；发育不良：48%对27%，RR，1.44[95%CI，1.16 - 1.79]；混合畸形：30%对10%，RR，2.91[95%CI，1.53 - 5.54]；已知盂唇撕裂：84%对40%，RR，2.79[95%CI，2.06 - 3.76]）。选择手术的运动员在所有HOOS子量表上也报告了更严重的基线髋关节特异性症状（平均差异，10.8 - 17.7；所有P值均<0.01）。
与非运动员类似，略多于一半的患有PAHD的运动员在评估后1年内选择了手术治疗。许多患有PAHD的竞技运动员继续采用保守治疗并推迟手术，但更多的髋关节结构病变和更严重的与髋关节相关的基线身体损伤与选择手术治疗相关。
