Bloom David A, Yu Stephen W, Kingery Matthew T, Chintalapudi Nainisha, Looze Christopher, Youm Thomas
NYU Langone Health Orthopedics, New York, New York, U.S.A.
New York Medical College, Valhalla, New York, U.S.A.
Arthrosc Sports Med Rehabil. 2020 Dec 24;3(1):e65-e72. doi: 10.1016/j.asmr.2020.08.010. eCollection 2021 Feb.
To identify clinical and radiographic factors associated with failure of revision hip arthroscopy (RHA).
A database was used to identify patients who underwent primary hip arthroscopy and revision hip arthroscopy (RHA) from January 2007 to December 2017 for the indication of femoroacetabular impingement and failure of the index procedure, respectively. The primary outcome was defined as the change, or difference, in the preoperative to postoperative alpha angle between patients with successful RHA and those with failed RHA. Failure was defined as reoperation on the operative hip for any indication or a modified Harris Hip Score (mHHS) of less than 70 at the 1-year postoperative time point. All patients had a minimum of 2 years' follow-up from the date of revision hip surgery. Patients with a history of revision were divided into those with failed revisions and those with successful revisions. The inclusion criteria for failed revision included a history of subsequent revision surgery (or arthroplasty) or an mHHS of less than 70 at final follow-up.
The study included 26 patients, comprising 8 (31%) with failed RHA and 18 (69%) with successful revision. The failure group showed a significantly smaller decrease in the alpha angle with surgery, measured on the Dunn view, compared with the success group. When the preoperative alpha angle was held constant, each 1° increase in the difference between the preoperative and postoperative alpha angles achieved during surgery was associated with a 17% decrease in the odds of failure. Patients included in the success group had both a higher preoperative mHHS (44.2 ± 8.6 vs 34.7 ± 9.6) and a higher postoperative mHHS (83.2 ± 8.3 vs 62.3 ± 14.2) than patients with failed RHA. There was a statistically significant difference in the frequency of patients who achieved the patient acceptable symptomatic state of +74.0 between the failure (25%) and success (83%) groups; 88% of patients in the failure group met the minimal clinically important difference, whereas 100% of patients in the success group (n = 18) met it.
Complete resection of cam lesions as determined by changes in the alpha angle, anterior offset, and head-neck ratio when measured on the Dunn 45° view correlates with positive clinical outcomes after RHA.
III, Retrospective Comparative Study.
确定与髋关节翻修关节镜手术（RHA）失败相关的临床和影像学因素。
利用数据库确定2007年1月至2017年12月期间分别因股骨髋臼撞击症和初次手术失败而接受初次髋关节镜检查和髋关节翻修关节镜手术（RHA）的患者。主要结局定义为RHA成功患者与失败患者术前至术后α角的变化或差异。失败定义为因任何指征对手术髋关节进行再次手术，或术后1年改良Harris髋关节评分（mHHS）低于70分。所有患者自髋关节翻修手术之日起至少随访2年。有翻修史的患者分为翻修失败组和翻修成功组。翻修失败的纳入标准包括后续翻修手术（或关节成形术）史或末次随访时mHHS低于70分。
该研究纳入26例患者，其中8例（31%）RHA失败，18例（69%）翻修成功。与成功组相比，失败组在Dunn位片上测量的手术前后α角减小幅度明显更小。当术前α角保持恒定时，手术中术前与术后α角差值每增加1°，失败几率降低17%。成功组患者术前mHHS（44.2±8.6 vs 34.7±9.6）和术后mHHS（83.2±8.3 vs 62.3±14.2）均高于RHA失败的患者。失败组（25%）和成功组（83%）达到患者可接受症状状态+74.0的患者频率存在统计学显著差异；失败组88%的患者达到最小临床重要差异，而成功组100%的患者（n = 18）达到该差异。
在Dunn 45°位片上测量的α角、前偏移和头颈比变化所确定的凸轮病变完全切除与RHA术后良好的临床结局相关。
III级，回顾性比较研究。
