Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, 1200 Main St West, 4E15, Hamilton, ON, L8N 3Z5, Canada.
Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
Knee Surg Sports Traumatol Arthrosc. 2021 May;29(5):1461-1473. doi: 10.1007/s00167-020-06395-6. Epub 2021 Jan 5.
To identify patient factors associated with improved pain scores, functional hip scores, health-related quality of life, and re-operation rates after arthroscopic management of femoroacetabular impingement (FAI).
Using the comprehensive dataset from the multinational Femoroacetabular Impingement Randomized Controlled Trial (FIRST), a total of 13 prognostic factors that were chosen a priori were identified that would be expected to predict post-surgical outcomes. The primary outcome was pain assessed using a Visual Analogue Scale (VAS) and secondary outcomes included hip function (Hip Outcome Score [HOS] and International Hip Outcome Tool [iHOT-12]), health-related quality of life (Short Form-12 [SF-12] and Euro-Qol 5 Dimensions [EQ-5D]), and re-operation rate. A multivariable linear regression was used to analyse the change questionnaire scores from baseline to 12 months post-surgery including all 13 prognostic factors as independent variables. A total of 27 re-operation events were analysed at 24 months using a multivariable logistic regression including only the treatment group variable.
Of the 154 patients that had VAS scores completed at 12 months, a lower BMI (adjusted mean difference [aMD], 4.48 for a 5-unit decrease in BMI; 95% confidence interval [CI] 0.33-8.63; p = 0.035) was significantly associated with less pain. There was a significant negative association between increasing age and 1-year EQ-5D scores (aMD, - 0.04 for every 10-year increase in age; 95% CI - 0.07 to - 0.006; p = 0.020). The degree of impingement, severity of osteoarthritis, type of procedure, and adjudicated quality of surgery were not significantly associated with improvement across all outcomes at 12 months. Furthermore, there was no significant association between the treatment variable and the incidence of re-operation at 24 months.
This study identified that lower BMI and age are predictive of improved pain and health utility scores, respectively, following arthroscopic management of FAI at 12 months post-surgery. These results may be a helpful adjunct in clinical decisions for this patient population when determining candidacy for surgical intervention.
I.
确定与髋关节撞击综合征（FAI）关节镜治疗后疼痛评分、髋关节功能评分、健康相关生活质量和再手术率改善相关的患者因素。
利用多国髋关节撞击症随机对照试验（FIRST）的综合数据集，共确定了 13 个预先选择的预测术后结果的预后因素。主要结局是使用视觉模拟量表（VAS）评估疼痛，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 [iHOT-12]）、健康相关生活质量（SF-12 和 EQ-5D）和再手术率。使用多元线性回归分析从基线到术后 12 个月的问卷评分变化，包括所有 13 个预后因素作为自变量。使用多元逻辑回归分析仅包括治疗组变量的 24 个月时的 27 例再手术事件。
在完成 12 个月 VAS 评分的 154 名患者中，BMI 较低（调整平均差异 [aMD]，BMI 降低 5 个单位时为 4.48；95%置信区间 [CI] 0.33-8.63；p = 0.035）与疼痛减轻显著相关。年龄增加与 1 年 EQ-5D 评分呈显著负相关（aMD，每增加 10 岁，年龄增加 0.04；95%CI -0.07 至 -0.006；p = 0.020）。在 12 个月时，撞击程度、骨关节炎严重程度、手术类型和判定的手术质量与所有结局的改善均无显著相关性。此外，在 24 个月时，治疗变量与再手术发生率之间无显著相关性。
本研究确定 BMI 较低和年龄较大分别是髋关节撞击症关节镜治疗后 12 个月疼痛和健康效用评分改善的预测因素。这些结果可能有助于在确定手术干预候选资格时为该患者群体的临床决策提供参考。
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