Richter Camilla, Ishøi Lasse, Kraemer Otto, Hölmich Per, Thorborg Kristian
Sports Orthopedic Research Center-Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital - Amager-Hvidovre, Hvidovre, Denmark.
Research and implementation Unit PROgrez, Department of Physiotherapy and occupational Therapy, Naestved-Slagelse-Ringsted Hospitals, Slagelse, Denmark.
Orthop J Sports Med. 2024 Mar 26;12(3):23259671241238742. doi: 10.1177/23259671241238742. eCollection 2024 Mar.
The effects of specific bony hip morphologies, cam and dysplasia, and cartilage damage on mid- and long-term (≥5 years) patient-reported outcomes (PROs) are understudied.
To investigate if changes in PROs from preoperatively to 5 years after hip arthroscopy are associated with preoperative bony hip morphology and cartilage status in patients with femoroacetabular impingement syndrome.
Cohort study; Level of evidence, 3.
Patients were identified in the Danish Hip Arthroscopy Registry. Hip and groin function was assessed from preoperatively to 5 years postoperatively with the Copenhagen Hip and Groin Outcome Score (HAGOS) Activities of Daily Living (ADL) and Sports and Recreation (Sport) subscales. Morphology was defined using the anterior alpha angle (AA) and lateral center-edge angle (LCEA) as follows: mild to moderate cam (55°≤ AA < 78°), severe cam (AA ≥ 78°), pincer (LCEA > 39°), and borderline dysplasia (20°≤ LCEA < 25°). Joint space width (JSW) was defined as slightly reduced (3.1 mm ≤ JSW ≤ 4 mm) or severely reduced (2.1 mm ≤ JSW ≤ 3 mm). Acetabular cartilage status was defined by modified Beck grades 0 to 4 and femoral head cartilage status by International Cartilage Regeneration & Joint Preservation Society grades 0 to 4. Acetabular and femoral cartilage injury areas were categorized as <1, 1 to 2, or >2 cm. Multiple regression analyses assessed adjusted associations between hip morphology and cartilage injuries with improvement in HAGOS-ADL and HAGOS-Sport.
The study included 281 patients (age, 35 ± 10 years; 52.3% female). No cam and mild-to-moderate cam were associated with greater improvement in HAGOS-ADL (16 points [ = .002] and 7 points [ = .038], respectively) compared with severe cam. Normal JSW was associated with greater improvement in HAGOS-ADL (21 points; = .026) compared with severely reduced JSW. Femoral head cartilage injury area <1 cm was associated with greater improvements in HAGOS-ADL (17 points; = .03) and HAGOS-Sport (21 points; = .035) compared with femoral cartilage injury area >2 cm.
Patients having no-to-moderate cam morphology, normal JSW, or femoral head cartilage injury area <1 cm had greater improvement in PROs 5 years after hip arthroscopy compared with patients having severe cam morphology, severely reduced JSW, or femoral cartilage injury area >2 cm.
特定的髋部骨形态、凸轮畸形和发育不良以及软骨损伤对中长期（≥5年）患者报告结局（PROs）的影响研究不足。
探讨髋关节镜检查术前至术后5年PROs的变化是否与股骨髋臼撞击综合征患者术前的髋部骨形态和软骨状态相关。
队列研究；证据等级，3级。
从丹麦髋关节镜登记处识别患者。使用哥本哈根髋部和腹股沟结局评分（HAGOS）的日常生活活动（ADL）和运动与娱乐（Sport）子量表，对患者术前至术后5年的髋部和腹股沟功能进行评估。形态学定义如下：使用前α角（AA）和外侧中心边缘角（LCEA）进行定义，轻度至中度凸轮畸形（55°≤AA<78°）、重度凸轮畸形（AA≥78°）、钳夹型（LCEA>39°）和临界发育不良（20°≤LCEA<25°）。关节间隙宽度（JSW）定义为轻度减小（3.1mm≤JSW≤4mm）或重度减小（2.1mm≤JSW≤3mm）。髋臼软骨状态根据改良的贝克分级为0至4级，股骨头软骨状态根据国际软骨再生与关节保护学会分级为0至4级。髋臼和股骨头软骨损伤面积分为<1cm、1至2cm或>2cm。多元回归分析评估髋部形态和软骨损伤与HAGOS-ADL和HAGOS-Sport改善之间的校正关联。
该研究纳入了281例患者（年龄35±10岁；52.3%为女性）。与重度凸轮畸形相比，无凸轮畸形和轻度至中度凸轮畸形与HAGOS-ADL的更大改善相关（分别为16分[P=.002]和7分[P=.038]）。与重度减小的JSW相比，正常JSW与HAGOS-ADL的更大改善相关（21分；P=.026）。与股骨头软骨损伤面积>2cm相比，股骨头软骨损伤面积<1cm与HAGOS-ADL（17分；P=.03）和HAGOS-Sport（21分；P=.035）的更大改善相关。
与具有重度凸轮畸形、JSW重度减小或股骨头软骨损伤面积>2cm的患者相比，具有无至中度凸轮畸形、正常JSW或股骨头软骨损伤面积<1cm的患者在髋关节镜检查术后5年的PROs改善更大。
