Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.
Department of Orthopaedic Surgery, University of Nebraska, Omaha, Nebraska, USA.
Am J Sports Med. 2024 Apr;52(5):1153-1164. doi: 10.1177/03635465241234258. Epub 2024 Mar 12.
Arthroscopic treatment of femoroacetabular impingement (FAI) and symptomatic labral tears confers short- to midterm benefits, yet further long-term evidence is needed. Moreover, despite the physiological and biomechanical significance of the chondrolabral junction (CLJ), the clinical implications of damage to this transition zone remain understudied.
To (1) report minimum 8-year survivorship and patient-reported outcome measures after hip arthroscopy for FAI and (2) characterize associations between outcomes and patient characteristics (age, body mass index, sex), pathological parameters (Tönnis angle, alpha angle, type of FAI, CLJ breakdown), and procedures performed (labral management, FAI treatment, microfracture).
Cohort study; Level of evidence, 3.
This retrospective cohort study included patients who underwent primary hip arthroscopy for symptomatic labral tears secondary to FAI by a single surgeon between 2002 and 2013. All patients were ≥18 years of age with minimum 8-year follow-up and available preoperative radiographs. The primary outcome was conversion to total hip arthroplasty (THA), and secondary outcomes included revision arthroscopy, patient-reported outcome measures, and patient satisfaction. CLJ breakdown was assessed using the Beck classification. Kaplan-Meier estimates and weighted Cox regression were used to estimate 10-year survivorship (no conversion to THA) and identify risk factors associated with THA conversion.
In this study of 174 hips (50.6% female; mean age, 37.8 ± 11.2 years) with mean follow-up of 11.1 ± 2.5 years, the 10-year survivorship rate was 81.6% (95% CI, 75.9%-87.7%). Conversion to THA occurred at a mean 4.7 ± 3.8 years postoperatively. Unadjusted analyses revealed several variables significantly associated with THA conversion, including older age; higher body mass index; higher Tönnis grade; labral debridement; and advanced breakdown of the CLJ, labrum, or articular cartilage. Survivorship at 10 years was inferior in patients exhibiting severe (43.6%; 95% CI, 31.9%-59.7%) versus mild (97.9%; 95% CI, 95.1%-100%) breakdown of the CLJ ( < .001). Multivariable analysis identified worsening CLJ breakdown (weighted hazard ratio per 1-unit increase, 6.41; 95% CI, 3.11-13.24), older age (1.09; 95% CI, 1.04-1.14), and higher Tönnis grade (4.59; 95% CI, 2.13-9.90) as independent negative prognosticators ( < .001 for all).
Although most patients achieved favorable minimum 8-year outcomes, several pre- and intraoperative factors were associated with THA conversion; of these, worse CLJ breakdown, higher Tönnis grade, and older age were the strongest predictors.
髋关节镜治疗股骨髋臼撞击症（FAI）和有症状的盂唇撕裂可带来短期至中期获益，但仍需要进一步的长期证据。此外，尽管软骨盂唇交界处（CLJ）具有生理和生物力学意义，但该过渡区损伤的临床意义仍研究不足。
（1）报告髋关节镜治疗 FAI 后至少 8 年的生存率和患者报告的结局测量指标，（2）描述结局与患者特征（年龄、体重指数、性别）、病理参数（Tönnis 角、α角、FAI 类型、CLJ 破裂）和手术操作（盂唇处理、FAI 治疗、微骨折）之间的相关性。
队列研究；证据等级，3 级。
本回顾性队列研究纳入了由同一位外科医生于 2002 年至 2013 年期间行髋关节镜治疗因 FAI 导致有症状的盂唇撕裂的患者。所有患者年龄均≥18 岁，随访时间至少 8 年，且均有术前 X 线片。主要结局为全髋关节置换术（THA）转换，次要结局包括翻修关节镜检查、患者报告的结局测量和患者满意度。使用 Beck 分类评估 CLJ 破裂情况。Kaplan-Meier 估计和加权 Cox 回归用于估计 10 年生存率（无 THA 转换）并确定与 THA 转换相关的风险因素。
在这项研究中，174 髋（50.6%女性；平均年龄 37.8±11.2 岁）的平均随访时间为 11.1±2.5 年，10 年生存率为 81.6%（95%CI，75.9%-87.7%）。THA 转换的平均时间为术后 4.7±3.8 年。未调整的分析显示，有几个变量与 THA 转换显著相关，包括年龄较大、体重指数较高、Tönnis 分级较高、盂唇清创术以及 CLJ、盂唇或关节软骨的高级别破裂。CLJ 破裂严重（43.6%；95%CI，31.9%-59.7%）患者的 10 年生存率明显低于破裂轻微（97.9%；95%CI，95.1%-100%）的患者（<0.001）。多变量分析确定 CLJ 破裂恶化（每增加 1 单位的加权危害比，6.41；95%CI，3.11-13.24）、年龄较大（1.09；95%CI，1.04-1.14）和 Tönnis 分级较高（4.59；95%CI，2.13-9.90）是独立的负面预后因素（均<0.001）。
尽管大多数患者获得了至少 8 年的良好结局，但术前和术中的几个因素与 THA 转换相关；其中，CLJ 破裂恶化、Tönnis 分级较高和年龄较大是最强的预测因素。
