Department of Orthopedic Surgery, Western University, London, ON, Canada.
Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.
Knee Surg Sports Traumatol Arthrosc. 2021 Dec;29(12):4082-4090. doi: 10.1007/s00167-021-06639-z. Epub 2021 Jun 18.
Hip arthroscopy offers a minimally invasive approach for the treatment of femoroacetabular impingement (FAI). Although osteoarthritis (OA) is a known negative prognostic factor for arthroscopy, it is unclear if patients with FAI and concomitant mild to moderate OA benefit from hip preservation surgery. The goal of this study was to evaluate current practice patterns among surgeons experienced in FAI management in the treatment of patients between 40 and 60 years of age with symptomatic FAI and concomitant OA of varying severity.
A 12-question cross-sectional survey was distributed using a secure electronic survey portal. The survey sought to determine surgical treatment of FAI in patients between the ages of 40 and 60 years old with concomitant OA of various degrees. Surveys were completed electronically and anonymously, with invitations distributed to members of the American Orthopaedic Society for Sports Medicine, International Society for Hip Arthroscopy, Arthroscopy Association of Canada, Canadian Orthopaedic Association, and both current and former Fowler Kennedy sports medicine fellows.
A total of 76 orthopedic surgeons who treat FAI completed the survey. All respondents routinely treat FAI arthroscopically, while only 43.7% have utilized an open surgical approach. Nearly all respondents (96.0%) would consider performing hip arthroscopy in patients over 40 years of age. The respondents ranked an absence of OA (Tönnis 0 or 1) as the most important factor in deciding to move forward with surgery, while a positive response to diagnostic injection was considered the least important factor of the options given. Respondents felt that the role for hip arthroscopy in patients with symptomatic FAI decreased with increasing age and worsening degree of osteoarthritis. In patients 40-50 years old with Tönnis 1, willingness to perform surgery was 89.5%; while with Tönnis 2 this was reduced to 39.5% and with Tönnis 3 it was 5.3%. In patients 50-60 years old with Tönnis 1, 80.3% of respondents found arthroscopy to be beneficial; while with Tönnis 2 this was reduced to 22.4% and with Tönnis 3 it was 2.6%.
Most respondents consider arthroscopy a viable option for patients aged 40-60 years old with mild osteoarthritis (Tönnis 1), while worsening osteoarthritis (Tönnis 3) results in greater rates of non-arthroscopic treatment. The role of arthroscopy with moderate osteoarthritis (Tönnis 2) remains unclear and should be a focus for future studies.
Level V.
髋关节镜检查为治疗股骨髋臼撞击症（FAI）提供了一种微创方法。尽管骨关节炎（OA）是关节镜检查的已知负面预后因素，但尚不清楚患有 FAI 且伴有轻度至中度 OA 的患者是否受益于髋关节保护手术。本研究的目的是评估在 FAI 管理方面经验丰富的外科医生对 40 至 60 岁之间有症状 FAI 和不同严重程度的并发 OA 的患者的治疗方法。
使用安全的电子调查门户分发了一份包含 12 个问题的横断面调查。该调查旨在确定在 40 至 60 岁之间患有不同程度的并发 OA 的 FAI 患者的手术治疗方法。调查以电子方式匿名完成，并向美国运动医学骨科协会、国际髋关节镜协会、加拿大关节镜协会、加拿大骨科协会以及现任和前任 Fowler Kennedy 运动医学研究员的成员分发了邀请。
共有 76 名治疗 FAI 的骨科医生完成了调查。所有受访者均常规行髋关节镜检查治疗 FAI，而只有 43.7%的医生采用了开放式手术方法。几乎所有受访者（96.0%）都认为对 40 岁以上的患者行髋关节镜检查是可行的。受访者将无 OA（Tönnis 0 或 1）列为决定是否进行手术的最重要因素，而对诊断性注射的阳性反应则被认为是给定选项中最不重要的因素。受访者认为，髋关节镜在有症状的 FAI 患者中的作用随着年龄的增长和骨关节炎程度的加重而降低。在 40-50 岁 Tönnis 1 患者中，愿意进行手术的比例为 89.5%；而 Tönnis 2 时降至 39.5%，Tönnis 3 时降至 5.3%。在 50-60 岁 Tönnis 1 患者中，80.3%的受访者认为关节镜检查有益；而 Tönnis 2 时降至 22.4%，Tönnis 3 时降至 2.6%。
大多数受访者认为，对于患有轻度骨关节炎（Tönnis 1）的 40-60 岁患者，关节镜检查是一种可行的选择，而骨关节炎（Tönnis 3）的恶化会导致更多的非关节镜治疗。对于中度骨关节炎（Tönnis 2），关节镜的作用仍不清楚，应成为未来研究的重点。
5 级。
