髋臼周围截骨术和髋关节镜下关节囊紧缩术治疗髋关节发育不良边缘患者的患者报告结局无差异：一项倾向性匹配多中心研究，随访时间至少 5 年。

No Difference in Patient-Reported Outcomes for Periacetabular Osteotomy and Hip Arthroscopy With Capsular Plication in the Setting of Borderline Hip Dysplasia: A Propensity-Matched Multicenter Study With Minimum 5-Year Follow-Up.

机构信息

Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.

American Hip Institute Research Foundation, Chicago, Illinois, U.S.A.

出版信息

Arthroscopy. 2024 Mar;40(3):754-762. doi: 10.1016/j.arthro.2023.06.045. Epub 2023 Jul 6.

DOI:10.1016/j.arthro.2023.06.045

PMID:37422025

Abstract

PURPOSE

To compare minimum 5-year patient-reported outcome measures after hip arthroscopy (HA) and periacetabular osteotomy (PAO) for borderline hip dysplasia.

METHODS

Hips with a lateral center-edge angle (LCEA) between 18° and less than 25° that underwent either PAO or HA were selected from 2 institutions. The exclusion criteria were as follows: LCEA less than 18°, Tönnis osteoarthritis grade greater than 1, prior hip surgical procedures, active inflammatory disease, Workers' Compensation, and concomitant surgery. Patients underwent propensity matching based on age, sex, body mass index, and Tönnis osteoarthritis grade. Patient-reported outcome measures included the modified Harris Hip Score, as well as calculation of the minimal clinically important difference, patient acceptable symptom state, and maximum outcome improvement satisfaction threshold. Preoperative radiographic predictors included comparison of the Femoro-epiphyseal Acetabular Roof index and ligamentum teres lesions.

RESULTS

A total of 28 PAO patients underwent propensity matching to 49 HA patients. The 2 groups were similar in terms of mean age, sex, preoperative body mass index, and LCEA. The PAO group had a longer mean follow-up period (95.8 months vs 81.3 months, P = .001). The mean Femoro-epiphyseal Acetabular Roof index was significantly lower preoperatively in the HA group (P < .001). The 2 groups showed similar and significant improvements in the mean modified Harris Hip Score from preoperatively to latest follow-up (P < .001). The relative risk of subsequent surgery in the PAO group was 3.49 (P = .024), mostly attributed to hardware removal (25%). The revision rate was 3.6% in the PAO group and 8.2% in the HA group (P = .65). One patient in the PAO group required revision HA for intra-articular adhesions. Three of the patients requiring revision in the HA group underwent PAO because of persistent pain, and one underwent revision HA alone. Conversion to total hip arthroplasty was required in 1 patient in the HA group and no patients in the PAO group.

CONCLUSIONS

Both PAO and HA with capsular plication provide borderline hip dysplasia patients with clinically significant improvements and low revision rates at a minimum of 5 years postoperatively.

LEVEL OF EVIDENCE

Level III, retrospective, comparative therapeutic trial.

摘要

目的

比较髋关节镜（HA）和髋臼周围截骨术（PAO）治疗边缘型髋关节发育不良患者术后至少 5 年的患者报告结局指标。

方法

从 2 家机构中选择外侧中心边缘角（LCEA）在 18°到小于 25°之间且接受过 PAO 或 HA 的髋关节。排除标准如下：LCEA 小于 18°、Tönnis 骨关节炎分级大于 1、先前髋关节手术、活动性炎症性疾病、工人赔偿和同时进行的手术。根据年龄、性别、体重指数和 Tönnis 骨关节炎分级进行倾向匹配。患者报告的结局指标包括改良 Harris 髋关节评分，以及计算最小临床重要差异、患者可接受的症状状态和最大结局改善满意度阈值。术前影像学预测指标包括比较股骨骺髋臼顶指数和圆韧带病变。

结果

共 28 例 PAO 患者接受倾向匹配，与 49 例 HA 患者匹配。2 组在平均年龄、性别、术前体重指数和 LCEA 方面相似。PAO 组的平均随访时间较长（95.8 个月比 81.3 个月，P =.001）。HA 组术前股骨骨骺髋臼顶指数明显较低（P <.001）。2 组的改良 Harris 髋关节评分从术前到最新随访均有显著改善（P <.001）。PAO 组随后手术的相对风险为 3.49（P =.024），主要归因于内固定取出（25%）。PAO 组的翻修率为 3.6%，HA 组为 8.2%（P =.65）。1 例 PAO 组患者因关节内粘连行再次 HA 手术。HA 组中需要翻修的 3 例患者因持续性疼痛而行 PAO，1 例单独行 HA 翻修。HA 组中有 1 例患者需要转换为全髋关节置换术，PAO 组无患者需要转换。