Grammatopoulos George, Laboudie Pierre, Fischman Daniel, Ojaghi Reza, Finless Alexandra, Beaulé Paul E
Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Canada.
Service de Chirurgie Orthopedique et traumatologique, Hospital Cochin, Paris, France.
Bone Jt Open. 2022 Oct;3(10):804-814. doi: 10.1302/2633-1462.310.BJO-2022-0114.R1.
The primary aim of this study was to determine the ten-year outcome following surgical treatment for femoroacetabular impingement (FAI). We assessed whether the evolution of practice from open to arthroscopic techniques influenced outcomes and tested whether any patient, radiological, or surgical factors were associated with outcome.
Prospectively collected data of a consecutive single-surgeon cohort, operated for FAI between January 2005 and January 2015, were retrospectively studied. The cohort comprised 393 hips (365 patients; 71% male (n = 278)), with a mean age of 34.5 years (SD 10.0). Over the study period, techniques evolved from open surgical dislocation (n = 94) to a combined arthroscopy-Hueter technique (HA + Hueter; n = 61) to a pure arthroscopic technique (HA; n = 238). Outcome measures of interest included modes of failures, complications, reoperation, and patient-reported outcome measures (PROMs). Demographic, radiological, and surgical factors were tested for possible association with outcome.
At a mean follow-up of 7.5 years (SD 2.5), there were 43 failures in 38 hips (9.7%), with 35 hips (8.9%) having one failure mode, one hip (0.25%) having two failure modes, and two hips (0.5%) having three failure modes. The five- and ten-year hip joint preservation rates were 94.1% (SD 1.2%; 95% confidence interval (CI) 91.8 to 96.4) and 90.4% (SD 1.7%; 95% CI 87.1 to 93.7), respectively. Inferior survivorship was detected in the surgical dislocation group. Age at surgery, Tönnis grade, cartilage damage, and absence of rim-trimming were associated with improved preservation rates. Only Tönnis grade was an independent predictor of hip preservation. All PROMs improved postoperatively. Factors associated with improvement in PROMs included higher lateral centre-edge and α angles, and lower retroversion index and BMI.
FAI surgery provides lasting improvement in function and a joint preservation rate of 90.4% at ten years. The evolution of practice was not associated with inferior outcome. Since degree of arthritis is the primary predictor of outcome, improved awareness and screening may lead to prompt intervention and better outcomes.Cite this article: 2022;3(10):804-814.
本研究的主要目的是确定股骨髋臼撞击症（FAI）手术治疗后的十年结果。我们评估了从开放手术到关节镜技术的实践演变是否影响结果，并测试了是否有任何患者、影像学或手术因素与结果相关。
对2005年1月至2015年1月期间由同一外科医生连续收治的FAI手术患者的前瞻性收集数据进行回顾性研究。该队列包括393例髋关节（365例患者；71%为男性（n = 278）），平均年龄34.5岁（标准差10.0）。在研究期间，技术从开放手术脱位（n = 94）演变为关节镜-休特联合技术（HA + 休特；n = 61），再到单纯关节镜技术（HA；n = 238）。感兴趣的结果指标包括失败模式、并发症、再次手术以及患者报告的结果指标（PROMs）。测试了人口统计学、影像学和手术因素与结果的可能关联。
平均随访7.5年（标准差2.5），38例髋关节出现43次失败（9.7%），其中35例髋关节（8.9%）有1种失败模式，1例髋关节（0.25%）有2种失败模式，2例髋关节（0.5%）有3种失败模式。五年和十年的髋关节保留率分别为94.1%（标准差1.2%；95%置信区间（CI）91.8至96.4）和90.4%（标准差1.7%；95%CI 87.1至93.7）。在手术脱位组中检测到较低的生存率。手术年龄、托尼斯分级、软骨损伤和未进行髋臼缘修整与更高的保留率相关。只有托尼斯分级是髋关节保留的独立预测因素。所有PROMs术后均有所改善。与PROMs改善相关的因素包括更高的外侧中心边缘角和α角，以及更低的髋臼后倾指数和体重指数。
FAI手术可使功能得到持久改善，十年关节保留率为90.4%。实践的演变与较差的结果无关。由于关节炎程度是结果的主要预测因素，提高认识和筛查可能会导致及时干预并获得更好的结果。引用本文：2022；3(10):804 - 814。
