Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
Mercy Health Cincinnati Sports Medicine and Orthopaedic Center, Cincinnati, Ohio.
J Bone Joint Surg Am. 2022 Feb 2;104(3):271-283. doi: 10.2106/JBJS.21.00375.
Torsional hip deformities are common among patients undergoing hip arthroscopy. However, recent studies have suggested conflicting outcomes following arthroscopy in the setting of abnormal hip version. The purpose of this study was to systematically evaluate the literature and determine the impact of femoral and acetabular version on patient-reported outcomes following primary arthroscopic hip surgery.
This study was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Studies investigating femoral and acetabular version in primary hip arthroscopy with clinical outcomes were identified, and data were extracted in duplicate.
Overall, 11 studies met inclusion criteria and comprised 1,297 hips (726 femora and 571 acetabulae), with a mean patient age of 29.2 years (range, 14 to 74.7 years). In patients with acetabular retroversion, there was no significant difference, when compared with the normal acetabular version group, in the modified Harris hip score (mHHS), the Hip Outcome Score-Sports Specific Subscale (HOS-SSS), and visual analog scale (VAS) pain scores postoperatively. Among patients with femoral retroversion, in 2 of 3 studies, the authors reported no difference in mHHS postoperatively compared with patients with normal femoral version. In patients with high femoral anteversion, in 2 of 3 studies, the authors reported a significant difference in postoperative mHHS favoring patients with normal femoral version. Studies examining high femoral anteversion included patients with borderline hip dysplasia and patients who underwent concurrent psoas-lengthening procedures.
Although the definition of the normal version of the hip varied within the literature, hip arthroscopy in patients with acetabular retroversion resulted in no difference in functional outcomes compared with patients with normal version. Postoperative functional outcomes in patients with femoral retroversion and high femoral anteversion were mixed, although the procedure was possibly less effective in high femoral anteversion combined with specific clinical scenarios. Further prospective studies based on standardized definitions and version analysis techniques would be useful in identifying the precise surgical indications for safe arthroscopic surgical procedures in patients with version abnormalities of the femur and acetabulum, particularly those with high femoral anteversion and retroversion.
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
髋关节扭转畸形在接受髋关节镜检查的患者中很常见。然而，最近的研究表明，在髋关节发育不良的情况下，髋关节镜检查后的结果存在争议。本研究的目的是系统评估文献，并确定股骨和髋臼版本对初次髋关节镜手术后患者报告的结果的影响。
本研究符合 PRISMA（系统评价和荟萃分析的首选报告项目）声明。确定了研究原发性髋关节镜术中股骨和髋臼版本与临床结果的研究，并进行了重复数据提取。
总体而言，有 11 项研究符合纳入标准，共包括 1297 髋（726 个股骨和 571 个髋臼），平均患者年龄为 29.2 岁（范围 14 至 74.7 岁）。在髋臼后旋的患者中，与正常髋臼版本组相比，改良 Harris 髋关节评分（mHHS）、髋关节结果评分-运动特定亚量表（HOS-SSS）和术后视觉模拟评分（VAS）疼痛评分无显著差异。在股骨后旋的患者中，有 3 项研究中的 2 项报告术后 mHHS 无差异，与正常股骨版本的患者相比。在高股骨前旋的患者中，有 3 项研究中的 2 项报告术后 mHHS 有显著差异，支持正常股骨版本的患者。研究高股骨前旋的患者包括髋关节边缘发育不良的患者和接受同时进行的髂腰肌延长手术的患者。
尽管文献中髋关节正常版本的定义不同，但髋关节镜检查在髋臼后旋的患者中与正常版本的患者相比，在功能结果方面没有差异。股骨后旋和高股骨前旋患者的术后功能结果参差不齐，尽管在高股骨前旋与特定临床情况结合时，该手术可能效果较差。基于标准化定义和版本分析技术的进一步前瞻性研究将有助于确定在股骨和髋臼版本异常的患者中进行安全关节镜手术的精确手术指征，特别是那些具有高股骨前旋和后旋的患者。
预后 IV 级。有关证据水平的完整描述，请参阅作者说明。
