Tiao Justin, Ranson William, Ren Renee, Wang Kevin C, Rosenberg Ashley M, Herrera Michael, Zubizarreta Nicole, Anthony Shawn G
Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Orthop J Sports Med. 2024 Feb 12;12(2):23259671231217494. doi: 10.1177/23259671231217494. eCollection 2024 Feb.
The conversion rate of hip arthroscopy (HA) to total hip arthroplasty (THA) has been reported to be as high as 10%. Despite identifying factors that increase the risk of conversion, current studies do not stratify patients by type of arthroscopic procedure.
PURPOSE/HYPOTHESIS: To analyze the rate and predictors of conversion to THA within 2 years after HA. It was hypothesized that osteoarthritis (OA) and increased patient age would negatively affect the survivorship of HA.
Cohort study; Evidence level, 3.
The IBM MarketScan database was utilized to identify patients who underwent HA and converted to THA within 2 years at inpatient and outpatient facilities between 2013 and 2017. Patients were split into 3 procedure cohorts as follows: (1) femoroacetabular osteoplasty (FAO), which included treatment for femoroacetabular impingement; (2) isolated debridement; and (3) isolated labral repair. Cohort characteristics were compared using standardized differences. Conversion rates between the 3 cohorts were compared using chi-square tests. The relationship between age and conversion was assessed using linear regression. Predictors of conversion were analyzed using multivariable logistic regression. The median time to conversion was estimated using Kaplan-Meier tests.
A total of 5048 patients were identified, and the rates of conversion to THA were 12.86% for isolated debridement, 8.67% for isolated labral repair, and 6.76% for FAO (standardized difference, 0.138). The isolated labral repair cohort had the shortest median time to conversion (isolated labral repair, 10.88 months; isolated debridement, 10.98 months; and FAO, 11.9 months [ = .034). For patients >50 years, isolated debridement had the highest rate of conversion at 18.8%. The conversion rate increased linearly with age. Factors that increased the odds of conversion to THA were OA, having an isolated debridement procedure, and older patient age ( < .05).
Older patients and those with preexisting OA of the hip were at a significantly increased risk of failing HA and requiring a total hip replacement within 2 years of the index procedure. Younger patients were at low risk of requiring a conversion procedure no matter which arthroscopic procedure was performed.
据报道，髋关节镜检查（HA）转为全髋关节置换术（THA）的转化率高达10%。尽管已确定了增加转换风险的因素，但目前的研究并未根据关节镜手术类型对患者进行分层。
目的/假设：分析HA后2年内转为THA的发生率及预测因素。假设骨关节炎（OA）和患者年龄增加会对HA的存留率产生负面影响。
队列研究；证据等级，3级。
利用IBM MarketScan数据库，确定2013年至2017年间在住院和门诊机构接受HA并在2年内转为THA的患者。患者被分为3个手术队列，如下：（1）股骨髋臼截骨术（FAO），包括治疗股骨髋臼撞击症；（2）单纯清创术；（3）单纯盂唇修复术。使用标准化差异比较队列特征。使用卡方检验比较3个队列之间的转化率。使用线性回归评估年龄与转换之间的关系。使用多变量逻辑回归分析转换的预测因素。使用Kaplan-Meier检验估计转换的中位时间。
共确定5048例患者，单纯清创术转为THA的发生率为12.86%，单纯盂唇修复术为8.67%，FAO为6.76%（标准化差异，0.138）。单纯盂唇修复队列的转换中位时间最短（单纯盂唇修复术，10.88个月；单纯清创术，10.98个月；FAO，11.9个月[ = 0.034]）。对于年龄>50岁的患者，单纯清创术的转化率最高，为18.8%。转化率随年龄呈线性增加。增加转为THA几率的因素包括OA、接受单纯清创手术以及患者年龄较大（ < 0.05）。
老年患者以及术前存在髋关节OA的患者在初次手术后2年内HA失败并需要进行全髋关节置换的风险显著增加。无论进行哪种关节镜手术，年轻患者需要转换手术的风险较低。
