University Lille, MABLab-Unité Labellisée de Recherche, ULR4490, 59000 Lille, France; CHU Lille, Service d'Orthopédie, Hôpital Salengro, Place de Verdun, 59000 Lille, France.
University Lille, MABLab-Unité Labellisée de Recherche, ULR4490, 59000 Lille, France; CHU Lille, Service d'Orthopédie, Hôpital Salengro, Place de Verdun, 59000 Lille, France.
Orthop Traumatol Surg Res. 2021 Feb;107(1):102767. doi: 10.1016/j.otsr.2020.102767. Epub 2020 Dec 29.
Hip arthroscopy is a surgical procedure that is becoming more and more prevalent in France. Even though indications are now well-established little is still known about patient outcomes. Therefore, the purpose of our retrospective study was to: (1) describe the circumstances in which hip arthroscopies are being performed; (2) study arthroscopy and arthroplasty reoperation rates; (3) assess the incidence of readmissions for complications.
Hip arthroscopy in France produced similar results to those observed in other countries.
We conducted a cohort study from January 2008 to December 2014 in the French population using the national hospital discharge database called "Programme de médicalisation des systèmes d'information (PMSI)." We included all admissions that had a hip arthroscopy code and analyzed readmissions for conversion to hip arthroplasty, revision hip arthroscopy and complications (without being able to provide detailed descriptions). Risk factors associated with conversion, revision and readmission for complications were studied after performing a population analysis.
A total of 3,699 patients were included over a period of seven years. The mean age was 40 years, with women being significantly older (mean age of 43 years) than men (38 years) (p<0.05). The number of procedures increased from 240 in 2008 to 702 in 2014. Synovectomies (67.9%; 2514/3699) and surgical bone procedures (acetabuloplasty or femoroplasty) (47.3%; 1751/3699) were the main procedures performed during the primary arthroscopy. In total, 410 patients underwent a conversion to arthroplasty, 231 patients had a revision arthroscopy, and 126 patients suffered a complication. Five years after the index procedure, the conversion rate was 16.3%, revision rate was 8.2%, and readmission rate for a postoperative complication was 5%. The main risk factor associated with conversions was [Hazard ratio (HR) and 95% Confidence Index (CI)] an age between 40 and 79 years during the first arthroscopy [3.04 (2.40; 3.87) compared with the reference class of 25-39 years]. Patients between ages 16 to 24 years during the first arthroscopy (0.35 [0.20; 0.61] compared with the reference class of 25-39 years) had a decreased risk of conversion (HR and 95% CI). The main risk factors associated with revisions were: synovectomies [1.90 (1.34; 2.70)] and surgical bone procedures on the femoral neck and/or the acetabulum [1.82 (1.36; 2.4)]. The risk factor associated with complication-related readmissions was an age greater than 40 years [2.23 (1.43; 3.49)].
Unlike the international literature, our study population was largely male. The rates of revision (8.2% after five years) and conversion to arthroplasty (16.3% after five years) were relatively low and comparable to the different international studies. This procedure, which is not widely performed, is growing in popularity, has low morbidity and remains an interesting approach given the revision and conversion rates after five years. The implementation of specific coding for arthroscopic hip procedures and the pathologies to be treated seems warranted.
IV; descriptive epidemiological study.
髋关节镜检查在法国越来越普遍。尽管目前已经确定了适应证，但对于患者的治疗结果仍知之甚少。因此，我们的回顾性研究目的是：（1）描述进行髋关节镜检查的情况；（2）研究关节镜和关节置换翻修率；（3）评估因并发症再次入院的发生率。
法国的髋关节镜检查结果与其他国家观察到的结果相似。
我们使用名为“Programme de médicalisation des systèmes d'information (PMSI)”的国家医院出院数据库，对 2008 年 1 月至 2014 年 12 月期间的法国人群进行了队列研究。我们纳入了所有有髋关节镜检查代码的住院患者，并分析了因转换为髋关节置换术、髋关节镜翻修术和并发症（但无法提供详细描述）而再次入院的情况。在进行人群分析后，研究了与转换、翻修和并发症相关的再次入院的相关风险因素。
在 7 年的时间里，共纳入 3699 例患者。平均年龄为 40 岁，女性明显比男性（平均年龄 43 岁）年长（p<0.05）。手术数量从 2008 年的 240 例增加到 2014 年的 702 例。初次关节镜检查中主要的手术方式是滑膜切除术（67.9%；2514/3699）和手术骨处理（髋臼成形术或股骨成形术）（47.3%；1751/3699）。共有 410 例患者转为关节置换术，231 例患者进行了关节镜翻修术，126 例患者发生了并发症。初次关节镜检查后 5 年，转化率为 16.3%，翻修率为 8.2%，术后并发症再次入院率为 5%。与转换相关的主要风险因素是[风险比（HR）和 95%置信区间（CI）]初次关节镜检查时年龄在 40 至 79 岁之间[3.04（2.40；3.87）与 25-39 岁参考组相比]。初次关节镜检查时年龄在 16 至 24 岁的患者（0.35 [0.20；0.61]与 25-39 岁参考组相比），转换风险降低。与翻修相关的主要风险因素是：滑膜切除术[1.90（1.34；2.70）]和股骨颈和/或髋臼的手术骨处理[1.82（1.36；2.4）]。与并发症相关的再次入院的风险因素是年龄大于 40 岁[2.23（1.43；3.49）]。
与国际文献不同，我们的研究人群主要为男性。翻修率（5 年后 8.2%）和转换为关节置换术的比率（5 年后 16.3%）相对较低，与不同的国际研究结果相似。该手术在法国虽不广泛开展，但却越来越受欢迎，发病率较低，考虑到 5 年后的翻修和转换率，该手术仍然是一种很有前途的治疗方法。为了更好地对髋关节镜手术的编码和治疗的疾病进行管理，有必要制定具体的编码。
IV；描述性流行病学研究。
