From the Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA.
J Am Acad Orthop Surg Glob Res Rev. 2021 Jun 8;5(6):e21.00100. doi: 10.5435/JAAOSGlobal-D-21-00100.
Individuals with hip dysplasia report significant functional disability that improves with periacetabular osteotomy (PAO). Four physical performance measures (PPMs) have been recently validated for use with nonarthritic hip conditions; however, their ability to detect functional improvement and correlate with improvements in popular hip-specific patient-reported outcome (PRO) instruments after PAO is unknown. The purpose of this study was to evaluate the responsiveness of four PPMs up to 1 year after PAO, compare PPMs with established PRO measures at these time points, and report the acceptability and utility of PPMs for assessing outcomes after PAO.
Twenty-two participants aged 15 to 39 years completed the timed stair ascent (TSA), sit-to-stand five times (STS5), self-selected walking speed, four-square-step test, and seven hip-specific PRO measures before surgery and at approximately 6 months and 1 year after PAO. They completed questions regarding acceptability and utility of both types of testing. Wilcoxon rank sum test and unpaired Student t-tests were used to assess differences between time points; Spearman correlation and generalized linear modeling were used to determine the relationship between PPMs and PRO measures.
Six months after PAO, participants showed significant improvements on all seven PRO instruments (P < 0.001) and on the STS5 (P = 0.01). At one year, these improvements were maintained and TSA also improved (P = 0.03). Improvement in other PPMs did not reach significance (P = 0.07 and 0.08). The STS5 test demonstrated moderate to strong correlation (|r| = 0.43 to 0.76, P < 0.05) with all PRO measures, and the TSA test demonstrated moderate to strong correlation with almost all measures (|r| = 0.43 to 0.58, P < 0.05). Correlations strengthened on subanalysis of participants with unilateral disease (n = 11) (|r| = 0.56 to 0.94, P < 0.05). All participants (100%) found PPM testing acceptable despite disability; 25% preferred PPMs to PRO measures, whereas 75% of participants found them equal in usefulness.
The STS5 and TSA tests demonstrated moderate to very strong correlation with PRO measures at six and 12 months after PAO for dysplasia. These tests could be used as a functional outcome to supplement PRO instruments after PAO.
患有髋关节发育不良的个体报告存在显著的功能障碍，而髋臼周围截骨术（PAO）可改善这种功能障碍。最近已经有四项身体机能测量（PPM）经过验证可用于非关节炎性髋关节疾病，但这些方法检测 PAO 后功能改善的能力以及与流行的髋关节特异性患者报告结局（PRO）指标改善的相关性仍不清楚。本研究的目的是评估四项 PPM 在 PAO 后 1 年内的反应能力，比较这些 PPM 与在这些时间点的既定 PRO 测量的相关性，并报告 PPM 在评估 PAO 后结局的可接受性和实用性。
22 名年龄在 15 至 39 岁之间的参与者在手术前和 PAO 后约 6 个月和 1 年时完成了计时登梯（TSA）、5 次坐立（STS5）、自我选择的步行速度、四方步测试以及 7 项髋关节特异性 PRO 测量，并回答了有关两种类型测试的可接受性和实用性的问题。Wilcoxon 秩和检验和独立样本 t 检验用于评估时间点之间的差异；Spearman 相关和广义线性模型用于确定 PPM 和 PRO 测量之间的关系。
PAO 后 6 个月，所有 7 项 PRO 指标（P < 0.001）和 STS5（P = 0.01）均有显著改善。在 1 年时，这些改善得以维持，TSA 也得到了改善（P = 0.03）。其他 PPM 的改善未达到统计学意义（P = 0.07 和 0.08）。STS5 测试与所有 PRO 测量指标均具有中度至高度相关性（|r| = 0.43 至 0.76，P < 0.05），而 TSA 测试与几乎所有测量指标均具有中度至高度相关性（|r| = 0.43 至 0.58，P < 0.05）。在单侧疾病（n = 11）参与者的亚分析中，相关性增强（|r| = 0.56 至 0.94，P < 0.05）。尽管参与者存在残疾，但所有参与者（100%）都认为 PPM 测试是可以接受的；25%的参与者更喜欢 PPM 而不是 PRO 测量，而 75%的参与者认为它们具有同等的实用性。
STS5 和 TSA 测试在 PAO 后 6 个月和 12 个月时与髋关节发育不良患者的 PRO 测量具有中度至非常高的相关性。这些测试可作为 PAO 后补充 PRO 仪器的功能结局。
