American Hip Institute Research Foundation, Chicago, Illinois, USA.
American Hip Institute, Chicago, Illinois, USA.
Am J Sports Med. 2021 Jul;49(8):2090-2101. doi: 10.1177/03635465211013006. Epub 2021 May 17.
There is a paucity of midterm outcome data on hip revision arthroscopic surgery.
(1) To report minimum 5-year patient-reported outcome measurement scores (PROMSs) in patients who underwent revision hip arthroscopy, (2) to compare minimum 5-year PROMSs with a propensity-matched control group that underwent primary hip arthroscopy, and (3) to compare the rate of achieving the minimal clinically important difference (MCID) at minimum 5-year follow-up between the revision group and the propensity-matched control primary group.
Cohort study; Level of evidence, 3.
Data were prospectively collected between June 2008 and April 2014. Patients were included who underwent revision hip arthroscopy with preoperative and minimum 5-year follow-up scores for the modified Harris Hip Score (mHHS), Non-arthritic Hip Score (NAHS), Hip Outcome Score-Sports Specific Subscale (HOS-SSS), and visual analog scale (VAS) for pain. Patients with Tönnis grade >1 or with hip conditions such as avascular necrosis, Legg-Calve-Perthes disease, Ehlers-Danlos syndrome, and pigmented villonodular synovitis were excluded. A subanalysis was performed against a propensity-matched control group that underwent primary surgery. Groups were propensity matched in a 1:2 ratio for sex, age, body mass index, and follow-up time.
A total of 127 revision arthroscopies (113 patients) were included, and the mean ± SD follow-up time was 72.8 ± 23.3 months. The revision group was 74.0% female, and the average age and body mass index were 34.9 ± 12.4 years and 24.8 ± 4.2, respectively. The revision group demonstrated improvement for all PROMSs and reached the MCID for the mHHS (66.1%), HOS-SSS (68.4%), NAHS (66.9%), and VAS (80.0%). All revision cases were propensity matched to 254 primary arthroscopy cases. PROMSs in the revision group were lower than those of the control group before and after surgery. Delta values were similar between groups for all PROMSs. There were no differences in rates of achieving the MCID. The relative risk of arthroplasty conversion was 2.6 (95% CI, 1.5-4.6) for the revision group as compared with the primary group.
Significant improvement in all PROMSs, including the VAS, and high patient satisfaction at minimum 5-year follow-up were reported after revision hip arthroscopy. A high proportion of patients in the revision cohort reached the MCID for the mHHS, HOS-SSS, NAHS, and VAS, with similar rates and magnitudes of improvement relative to the control group. As expected, these data indicate that patients undergoing primary hip arthroscopy have higher PROMSs before and after surgery and lower rates of conversion to arthroplasty.
髋关节翻修关节镜手术的中期结果数据较少。
(1)报告接受髋关节翻修关节镜手术患者的至少 5 年患者报告结局测量评分（PROMs），(2)将至少 5 年的 PROMs 与接受初次髋关节关节镜手术的倾向匹配对照组进行比较，以及(3)比较翻修组和倾向匹配的原发性组在至少 5 年随访时达到最小临床重要差异（MCID）的比例。
队列研究；证据水平，3 级。
数据于 2008 年 6 月至 2014 年 4 月期间前瞻性收集。纳入接受髋关节翻修关节镜手术的患者，术前和至少 5 年随访时进行改良 Harris 髋关节评分（mHHS）、非关节炎髋关节评分（NAHS）、髋关节结局评分-运动特定分量表（HOS-SSS）和疼痛视觉模拟评分（VAS）。排除 Tönnis 分级>1 或存在髋关节疾病（如股骨头坏死、Legg-Calve-Perthes 病、埃勒斯-当洛斯综合征和色素沉着绒毛结节性滑膜炎）的患者。针对接受初次手术的倾向匹配对照组进行了亚分析。性别、年龄、体重指数和随访时间以 1:2 的比例进行倾向匹配。
共纳入 127 例髋关节翻修关节镜手术（113 例患者），平均随访时间为 72.8 ± 23.3 个月。翻修组女性占 74.0%，平均年龄和体重指数分别为 34.9 ± 12.4 岁和 24.8 ± 4.2。翻修组所有 PROMs 均得到改善，且 mHHS（66.1%）、HOS-SSS（68.4%）、NAHS（66.9%）和 VAS（80.0%）达到 MCID。所有翻修病例均与 254 例初次关节镜手术病例进行倾向匹配。翻修组术前和术后的 PROMs 均低于对照组。所有 PROMs 的组间差值均相似。达到 MCID 的比例无差异。与初次组相比，翻修组关节置换的相对风险为 2.6（95%CI，1.5-4.6）。
髋关节翻修关节镜手术后，所有 PROMs 均显著改善，包括 VAS，且至少 5 年随访时患者满意度高。翻修组中有相当比例的患者 mHHS、HOS-SSS、NAHS 和 VAS 达到 MCID，与对照组相比，改善程度和幅度相似。正如预期的那样，这些数据表明，接受初次髋关节关节镜手术的患者术前和术后的 PROMs 更高，关节置换的转化率更低。
