Weber Patrick, Gollwitzer Hans
ECOM - Praxis für Orthopädie, Unfallchirurgie und Sportmedizin, Arabellastr. 17, 81925, München, Deutschland.
ATOS Klinik München, München, Deutschland.
Orthopadie (Heidelb). 2022 Jun;51(6):472-482. doi: 10.1007/s00132-022-04254-5. Epub 2022 May 23.
Femoroacetabular impingement syndrome (FAIS) is a prearthritic deformity. Many patients with FAIS show signs of osteoarthritis at the time of initial presentation. Ideally, surgical correction of FAIS should stop the progression of osteoarthritis. However, biological changes in the joint, inflammatory processes, and patient-specific factors, which are not influenced by surgery, show a role in the progression of joint degeneration. Thus, it is not surprising that the results of joint-preserving surgery in FAIS and osteoarthritis Tönnis grade 2 and higher are bad, and patients often need to undergo total hip replacement (THR).Even in patients with initial osteoarthritis (Tönnis grade 1) the results of joint-preserving surgery are significantly worse in comparison to in patients without osteoarthritis. As this pathology occurs mainly in young patients, efforts should be made to avoid THR, as the risk of loosening and revision surgery is increased. Analysis of risk factors that lead to worse outcome in joint-preserving surgery can be helpful. Age > 45 years, adiposity, high alpha angle, CE angle < 25° and female sex are risk factors that lead to worse outcome in patients with risk factors and osteoarthritis Tönnis grade 1, the success rate of joint-preserving surgery after 5 years is below 50%. Therefore, we recommend non-surgical treatment. Promising is the use of mesenchymal progenitor cells (MPCs), even if their routine use has not been established. If conservative therapy is not successful, THR is indicated. With the use of modern bearings, a survival rate of THR of more than 90% after 15 years is reported in patients < 50 years. Patient satisfaction after THR is higher than after joint-preserving surgery.The combination of treatment modalities like joint-preserving surgery in combination with the application of MPCs to both correct the mechanical conflict and also influence progression of osteoarthritis is promising the from a biological point of view.
股骨髋臼撞击综合征（FAIS）是一种关节炎前期畸形。许多FAIS患者在初次就诊时就表现出骨关节炎的症状。理想情况下，FAIS的手术矫正应能阻止骨关节炎的进展。然而，关节的生物学变化、炎症过程以及不受手术影响的患者个体因素在关节退变的进展中也起作用。因此，对于FAIS以及骨关节炎Tönnis分级为2级及以上的患者，保关节手术效果不佳并不奇怪，患者通常需要接受全髋关节置换术（THR）。即使是初始骨关节炎（Tönnis 1级）的患者，与无骨关节炎的患者相比，保关节手术的效果也明显更差。由于这种病理情况主要发生在年轻患者中，应努力避免进行THR，因为松动和翻修手术的风险会增加。分析导致保关节手术效果较差的风险因素可能会有所帮助。年龄>45岁、肥胖、阿尔法角较大、CE角<25°以及女性是导致有这些风险因素且骨关节炎Tönnis 1级患者手术效果较差的风险因素，5年后保关节手术的成功率低于50%。因此，我们建议采用非手术治疗。使用间充质祖细胞（MPC）是有前景的，即便其常规应用尚未确立。如果保守治疗不成功，则需进行THR。使用现代关节轴承，据报道<50岁的患者15年后THR的生存率超过90%。THR后的患者满意度高于保关节手术后。从生物学角度来看，保关节手术与MPC应用相结合以纠正机械冲突并影响骨关节炎进展等治疗方式的联合应用很有前景。
