Department of Orthopedic Surgery, Division of Sports Medicine, Rush University Medical Center, Chicago, Illinois, USA.
Arcadia University, Glenside, Pennsylvania, USA.
Am J Sports Med. 2021 Oct;49(12):3250-3260. doi: 10.1177/03635465211034511. Epub 2021 Sep 8.
A paucity of literature exists regarding trajectories of functional and sports-specific recovery after hip arthroscopy for femoroacetabular impingement syndrome (FAIS).
To determine if subgroups of patients exist based on the recovery trajectory of patient-reported outcomes (PROs) after hip arthroscopy for FAIS in the short-term period and to determine clinical predictors for these subgroups of patients.
Case-control study; Level of evidence, 3.
A prospectively maintained repository was queried for patients who had undergone primary hip arthroscopy for the treatment of FAIS between January 2012 and May 2018. Patients who completed the preoperative, 1-year, and 2-year International Hip Outcome Tool-12 (iHOT-12) or the Hip Outcome Score Sports Subscale (HOS-SS) were included. The latent class growth analysis (LCGA) and growth mixture models (GMMs) were used to identify subgroups of patients based on trajectories of recovery for the iHOT-12 and the HOS-SS utilizing preoperative, 1-year, and 2-year follow-ups. LCGA and GMM models using 1 to 6 classes for each PRO were performed, and the best-fit model for each PRO was selected. After final model selection, a multivariable multinomial logistic regression was performed, with the largest class being the reference group to determine clinical predictors of subgroup membership.
A total of 443 and 556 patients were included in the iHOT-12 and HOS-SS analyses, respectively. For the iHOT-12, we identified the following 3 subgroups: early progressors (70%), late regressors (22.3%), and late progressors (7.7%). Predictors of late regression were workers' compensation status, psychiatric history, preoperative chronic pain, and lower preoperative iHOT-12 scores; and late progressors were less likely to participate in sports. For the HOS-SS, we identified the following 4 subgroups: early progressors (47.7%), late regressors (17.4%), late progressors (6.8%), and steady progressors (28.1%). Predictors of less favorable recovery trajectories (late regressors and late progessors) were older age, male sex, back pain, psychiatric history, preoperative chronic pain, greater alpha angle, and lower preoperative HOS-SS scores.
Using the growth mixture modeling, 3 natural courses of health-related quality of life (early progression, late regression, and late progression) and 4 natural courses of recovery of athletic function (steady progression, late regression, late progression, and early progression) were identified. Preoperative psychiatric conditions, chronic pain, workers' compensation status, and lower iHOT-12 scores were predictive of less than favorable trajectories of recovery according to the iHOT-12, and male sex, older age, back pain, preoperative narcotic use, and lower preoperative HOS-SS were predictors of less favorable recovery trajectories according to the HOS-SS.
关于髋关节镜治疗股骨髋臼撞击综合征（FAIS）后功能和运动特异性恢复的轨迹，文献资料很少。
确定髋关节镜治疗 FAIS 后，患者报告的结局（PROs）的短期恢复轨迹是否存在亚组，并确定这些亚组患者的临床预测因素。
病例对照研究；证据水平，3 级。
前瞻性维护的存储库中查询了 2012 年 1 月至 2018 年 5 月期间接受原发性髋关节镜治疗 FAIS 的患者。纳入完成术前、1 年和 2 年国际髋关节结果工具-12（iHOT-12）或髋关节结果评分运动亚量表（HOS-SS）的患者。使用术前、1 年和 2 年随访，使用潜在类别增长分析（LCGA）和增长混合模型（GMM），根据 iHOT-12 和 HOS-SS 的恢复轨迹识别患者亚组。对每个 PRO 进行 1 到 6 个类别的 LCGA 和 GMM 模型，并选择每个 PRO 的最佳拟合模型。在最终模型选择后，进行多变量多项逻辑回归，以最大类作为参考组，确定亚组归属的临床预测因素。
分别有 443 例和 556 例患者纳入 iHOT-12 和 HOS-SS 分析。对于 iHOT-12，我们确定了以下 3 个亚组：早期进展者（70%）、晚期倒退者（22.3%）和晚期进展者（7.7%）。晚期回归的预测因素是工人赔偿状况、精神病史、术前慢性疼痛和较低的术前 iHOT-12 评分；而晚期进展者不太可能参加运动。对于 HOS-SS，我们确定了以下 4 个亚组：早期进展者（47.7%）、晚期倒退者（17.4%）、晚期进展者（6.8%）和稳定进展者（28.1%）。恢复轨迹较差（晚期倒退者和晚期进展者）的预测因素是年龄较大、男性、腰痛、精神病史、术前慢性疼痛、较大的 alpha 角和较低的术前 HOS-SS 评分。
使用增长混合模型，确定了 3 种健康相关生活质量的自然恢复轨迹（早期进展、晚期倒退和晚期进展）和 4 种运动功能恢复的自然轨迹（稳定进展、晚期倒退、晚期进展和早期进展）。根据 iHOT-12，术前精神状况、慢性疼痛、工人赔偿状况和较低的 iHOT-12 评分是恢复轨迹不佳的预测因素，而根据 HOS-SS，男性、年龄较大、腰痛、术前使用麻醉药物和较低的术前 HOS-SS 评分是恢复轨迹不佳的预测因素。
