Department of Orthopaedic Surgery, Division of Physical Medicine and Rehabilitation, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA.
Department of Surgery, Division of Public Health Sciences, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA.
PM R. 2022 May;14(5):575-586. doi: 10.1002/pmrj.12746. Epub 2022 Feb 7.
Extensive literature has described surgical outcomes for pre-arthritic hip pain, but the proportion of patients who progress to surgery remains unknown.
To determine the proportion of patients who present to a tertiary referral center for pre-arthritic hip pain and progress to surgery at minimum 1-year follow-up.
Retrospective cohort study.
Single tertiary care academic medical center.
Patients ages 13 to 40 years who presented for initial evaluation to a conservative or surgical orthopedic specialist and were diagnosed with pre-arthritic hip pain (n = 713 patients, 830 hips).
Not applicable.
The primary outcome was the rate of progression to surgery at minimum 1-year follow-up for the entire cohort. Predictors of progression to surgery were determined for the entire cohort and for radiographically defined subgroups using multiple logistic regression. Candidate predictors included baseline demographic, radiographic, clinical diagnosis, and patient-reported outcome measures.
In a cohort with a mean age of 25.4 (SD 8.1) years, 72.7% female, and mean follow-up of 2.6 (range 1.0-4.8) years, 429 of 830 hips (51.7%, 95% confidence interval [CI] 48.2% to 55.1%) progressed to surgery. Predictors of surgical progression in the entire cohort included younger age (OR 0.95/year, 95% CI 0.93 to 0.98), pain duration longer than 6 months (ORs 1.87-2.03, p ≤ .027), worse physical function (OR 0.96/Patient-Reported Outcomes Measurement Information System [PROMIS] point, 0.92 to 0.99), and a clinical diagnosis of femoroacetabular impingement (FAI) (OR 3.47, 2.05 to 5.89), acetabular dysplasia (OR 2.75, 1.73 to 4.35), and/or labral tear (OR 10.71, 6.98 to 16.47). Radiographic dysplasia (lateral center edge angle <20 degrees) increased the likelihood of surgery in all subgroups (ORs 2.05-8.47, p ≤ .008). Increasing maximum α angle increased the likelihood of surgery in patients with severe cam FAI (α > 63 degrees) (OR 1.03/degree, 1.00 to 1.06).
Almost half of patients with pre-arthritic hip pain did not progress to surgery at a minimum 1-year follow-up. A trial of conservative management is likely worthwhile in most patients.
大量文献描述了髋关节关节炎前疼痛的手术结果，但进展为手术的患者比例仍不清楚。
确定因髋关节关节炎前疼痛就诊于三级转诊中心并在至少 1 年随访时接受手术的患者比例。
回顾性队列研究。
单一的三级保健学术医疗中心。
年龄在 13 岁至 40 岁之间的患者，他们初次就诊于保守或手术矫形专家，并被诊断为髋关节关节炎前疼痛（n=713 例患者，830 髋）。
无。
整个队列中至少在 1 年随访时进展为手术的比例为主要结局。使用多因素逻辑回归确定整个队列和影像学定义亚组中进展为手术的预测因素。候选预测因素包括基线人口统计学、影像学、临床诊断和患者报告的结局测量指标。
在平均年龄为 25.4（SD 8.1）岁、72.7%为女性、平均随访时间为 2.6（范围为 1.0-4.8）年的队列中，830 髋中有 429 髋（51.7%，95%置信区间[CI]为 48.2%至 55.1%）进展为手术。整个队列中手术进展的预测因素包括年龄较小（OR 0.95/年，95%CI 0.93 至 0.98）、疼痛持续时间超过 6 个月（ORs 1.87-2.03，p≤.027）、物理功能更差（OR 0.96/患者报告的结局测量信息系统[PROMIS]点，0.92 至 0.99）和临床诊断为股骨髋臼撞击症（FAI）（OR 3.47，2.05 至 5.89）、髋臼发育不良（OR 2.75，1.73 至 4.35）和/或盂唇撕裂（OR 10.71，6.98 至 16.47）。影像学发育不良（外侧中心边缘角＜20 度）增加了所有亚组手术的可能性（ORs 2.05-8.47，p≤.008）。最大α角的增加增加了严重凸轮 FAI（α＞63 度）患者手术的可能性（OR 1.03/度，1.00 至 1.06）。
髋关节关节炎前疼痛患者中，近一半在至少 1 年随访时未进展为手术。在大多数患者中，尝试保守治疗可能是值得的。
