Sabetian Payam W, Monahan Peter F, Fox James D, Jimenez Andrew E, Maldonado David R, Saks Benjamin R, Ankem Hari K, Lall Ajay C, Domb Benjamin G
American Hip Institute Research Foundation, Chicago, Illinois, USA.
American Hip Institute, Chicago, Illinois, USA.
Am J Sports Med. 2022 Apr;50(5):1281-1290. doi: 10.1177/03635465221078620. Epub 2022 Mar 14.
The workers' compensation (WC) status has been associated with inferior outcomes in orthopaedic procedures and is usually excluded from clinical outcome studies. Therefore, comparative studies based on WC status are scarce.
(1) To determine outcomes of patients with WC claims treated with hip arthroscopy for labral tears at a minimum 5-year follow-up and (2) to compare these findings with a propensity score-matched control group without WC claims.
Cohort study; Level of evidence, 3.
Patients were propensity score matched to a control group without WC claims. Data were prospectively collected for all patients undergoing hip arthroscopy. Patients were included if they received primary hip arthroscopy for labral tears in the setting of femoroacetabular impingement, had a WC claim, and had preoperative and minimum 5-year follow-up patient-reported outcomes ([PROs]; modified Harris Hip Score [mHHS], Non-Arthritic Hip Score [NAHS], Hip Outcome Score-Sports Specific Subscale [HOS-SSS], and visual analog scale [VAS] for pain). Clinical outcomes were measured using the Patient Acceptable Symptom State (PASS), minimal clinically important difference (MCID), and maximum outcome improvement satisfaction threshold (MOI).
A total of 111 from 132 (84.1%) eligible WC patients met the inclusion criteria with an average follow-up time of 80.3 ± 37.3 months. WC cases demonstrated significant improvement from preoperatively to a minimum 5-year follow-up for mHHS, NAHS, HOS-SSS, and VAS for pain ( < .05). WC patients returned to work at a 66% rate, with an average clearance time of 4.7 months to light duty and 9.5 months to heavy duty. When compared with the control group, the WC group demonstrated lower pre- and postoperative PROs ( < .05); however, WC cases had a greater magnitude of improvement (ΔmHHS [ = .0012], ΔNAHS [ < .001], and ΔHOS-SSS [ = .012]). Rates of achieving MCID and MOI were similar in both groups ( > .05). The WC group went on to receive a future arthroscopy in 19 cases (17.1%), while 10 cases (4.5%) in the control group required revision arthroscopy ( < .001). Patients in both the WC and the control groups converted to total hip arthroplasty at similar rates (13.3% and 15.4%, respectively; > .05).
Patients with WC claims treated with hip arthroscopic surgery showed significant improvement and high rates of returning to work at a minimum 5-year follow-up. Although having lower scores in PROs and achieving PASS rates, no differences were found in MCID and MOI rates. Furthermore, WC patients had a greater magnitude of improvement from preoperatively to a minimum 5-year follow-up after hip arthroscopy. Therefore, even though more studies are needed to determine the causes of inconsistent outcomes in the WC population, hip arthroscopy can effectively treat labral tears in the setting of femoroacetabular impingement, regardless of the WC status.
工伤赔偿（WC）状态与骨科手术的较差预后相关，并且通常被排除在临床结局研究之外。因此，基于WC状态的比较研究很少。
（1）确定接受髋关节镜检查治疗盂唇撕裂的WC索赔患者在至少5年随访后的结局，以及（2）将这些结果与无WC索赔的倾向评分匹配对照组进行比较。
队列研究；证据等级，3级。
将患者按倾向评分与无WC索赔的对照组进行匹配。前瞻性收集所有接受髋关节镜检查患者的数据。纳入标准为：因股骨髋臼撞击症接受初次髋关节镜检查治疗盂唇撕裂、有WC索赔，且有术前及至少5年随访的患者报告结局（[PROs]；改良Harris髋关节评分[mHHS]、非关节炎髋关节评分[NAHS]、髋关节结局评分-运动特定子量表[HOS-SSS]以及疼痛视觉模拟量表[VAS]）。使用患者可接受症状状态（PASS）、最小临床重要差异（MCID）和最大结局改善满意度阈值（MOI）来衡量临床结局。
132例符合条件的WC患者中有111例（84.1%）符合纳入标准，平均随访时间为80.3±37.3个月。WC病例从术前到至少5年随访时，mHHS、NAHS、HOS-SSS和疼痛VAS均有显著改善（P<0.05）。WC患者的复工率为66%，平均轻体力工作恢复时间为4.7个月，重体力工作恢复时间为9.5个月。与对照组相比，WC组术前和术后的PROs较低（P<0.05）；然而，WC病例的改善幅度更大（ΔmHHS[P = 0.0012]，ΔNAHS[P<0.001]，ΔHOS-SSS[P = 0.012]）。两组达到MCID和MOI的比率相似（P>0.05）。WC组有19例（17.1%）患者随后接受了再次关节镜检查，而对照组有10例（4.5%）患者需要翻修关节镜检查（P<0.001）。WC组和对照组患者转换为全髋关节置换术的比率相似（分别为13.3%和15.4%；P>0.05）。
接受髋关节镜手术治疗的WC索赔患者在至少5年随访时显示出显著改善和较高的复工率。尽管PROs评分较低且达到PASS率，但在MCID和MOI率方面未发现差异。此外，WC患者在髋关节镜检查后从术前到至少5年随访时有更大的改善幅度。因此，尽管需要更多研究来确定WC人群结局不一致的原因，但无论WC状态如何，髋关节镜检查都能有效治疗股骨髋臼撞击症中的盂唇撕裂。
