Maldonado David R, Lee Michael S, Kyin Cynthia, Jimenez Andrew E, Owens Jade S, Perez-Padilla Paulo A, Domb Benjamin G
Department of Orthopaedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA.
American Hip Institute Research Foundation, Chicago, Illinois, USA.
Orthop J Sports Med. 2023 Apr 6;11(4):23259671231154921. doi: 10.1177/23259671231154921. eCollection 2023 Apr.
There is a paucity of literature reporting outcomes after revision hip arthroscopic surgery in obese patients.
To report the minimum 5-year survivorship, patient-reported outcomes (PROs), clinical benefit, and risk factors for conversion to total hip arthroplasty (THA) in obese patients after revision hip arthroscopic surgery.
Case series; Level of evidence, 4.
Data were prospectively collected and retrospectively reviewed for patients who underwent revision hip arthroscopic surgery by a single surgeon between April 2010 and August 2016. Inclusion criteria were a body mass index ≥30 and baseline and minimum 5-year postoperative values for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score-Sport-Specific Subscale (HOS-SSS), and visual analog scale (VAS) for pain. Exclusion criteria were Tönnis grade >1 and hip dysplasia. Survivorship was defined as no conversion to THA. Clinical benefit was measured using the minimal clinically important difference (MCID). Survivors and nonsurvivors underwent further bivariate and regression analyses to determine the predictors of conversion to THA.
Included were 24 hips in 24 patients. The mean patient age was 39.3 ± 12.7 years, and the mean follow-up was 83.9 ± 26.5 months. The survivorship rate was 75.0%, and patients demonstrated a significant improvement in all PROs ( < .01). At 5-year follow-up, the MCID for the mHHS, NAHS, HOS-SSS, and VAS was achieved by 70.6%, 94.1%, 92.9%, and 64.7%, respectively, of the patients. Older age, higher grade ligamentum teres tears, and acetabuloplasty were significant on bivariate analysis for conversion to THA, and increased age was identified as a significant variable for conversion to THA on regression analysis (odds ratio, 1.297 [95% CI, 1.045-1.609]; = .018), with a 29.7% greater risk for every additional year of age at the time of revision.
In this study, 25.0% of obese patients who underwent revision hip arthroscopic surgery required conversion to THA. The study patients who did not need conversion to THA had a significant improvement in all PROs, with >90% achieving MCID for one or more outcome measures. Older age was identified as a significant predictor of conversion to THA.
关于肥胖患者髋关节翻修关节镜手术后结果的文献报道较少。
报告肥胖患者髋关节翻修关节镜手术后至少5年的生存率、患者报告结局（PROs）、临床获益以及转为全髋关节置换术（THA）的危险因素。
病例系列；证据等级，4级。
对2010年4月至2016年8月间由单一外科医生进行髋关节翻修关节镜手术的患者数据进行前瞻性收集和回顾性分析。纳入标准为体重指数≥30，以及改良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）和疼痛视觉模拟量表（VAS）的基线值及术后至少5年的值。排除标准为Tönnis分级>1和髋关节发育不良。生存率定义为未转为THA。使用最小临床重要差异（MCID）衡量临床获益。对生存者和非生存者进行进一步的双变量和回归分析，以确定转为THA的预测因素。
纳入24例患者的24个髋关节。患者平均年龄为39.3±12.7岁，平均随访时间为83.9±26.5个月。生存率为75.0%，患者在所有PROs方面均有显著改善（P<0.01）。在5年随访时，分别有70.6%、94.1%、92.9%和64.7%的患者达到了mHHS、NAHS、HOS-SSS和VAS的MCID。年龄较大、较高等级的圆韧带撕裂和髋臼成形术在转为THA的双变量分析中具有显著性，回归分析确定年龄增加是转为THA的显著变量（优势比，1.297[95%CI，1.045 - 1.609]；P = 0.018），翻修时每增加一岁风险增加29.7%。
在本研究中，接受髋关节翻修关节镜手术的肥胖患者中有25.0%需要转为THA。未需要转为THA的研究患者在所有PROs方面均有显著改善，超过90%的患者在一项或多项结局指标上达到MCID。年龄较大被确定为转为THA的显著预测因素。
