Kraeutler Matthew J, Marder Ryan S, Fasulo Sydney M, Dávila Castrodad Iciar M, Mei-Dan Omer, Scillia Anthony J
Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, U.S.A..
Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, New Jersey, U.S.A.
Arthroscopy. 2025 Mar;41(3):649-656. doi: 10.1016/j.arthro.2024.03.040. Epub 2024 Apr 9.
To prospectively compare the short-term clinical outcomes of patients undergoing hip arthroscopy with versus without the use of a perineal post.
A prospective, single-surgeon cohort study was performed on a subset of patients undergoing hip arthroscopy between 2020 and 2022. A post-free hip distraction system was used at 1 center at which the senior author operates, and a perineal post was used at another surgical location. An electronic survey of patient-reported outcome measures (PROMs) was completed by each patient at a minimum of 1 year postoperatively. PROMs included a visual analog scale for pain; University of California, Los Angeles (UCLA) Activity Scale; modified Harris Hip Score (mHHS); Hip Outcome Score-Sports-Specific Subscale (HOS-SSS); and a Single Assessment Numeric Evaluation. Postoperative scores and clinically significant outcomes, including the minimal clinically important difference, substantial clinical benefit, and patient acceptable symptom state, for each PROM were compared between groups.
Sixty-nine patients were reached for follow-up (41 post, 28 postless) of 87 patients eligible for the study (79%). No significant differences were found between groups in terms of sex (post: 61% female, postless: 54% female, P = .54), age (post: 34 years, postless: 29 years, P = .11), body mass index (post: 26, postless: 24, P = .23), or follow-up duration (post: 24.4 months, postless: 21.3 months, P = .16). There was a significantly higher visual analog scale (3.1 vs 1.4, P = .01), a significantly lower UCLA Activity Scale score (7.0 vs 8.4, P = .02), and a significantly lower mHHS (73.7 vs 82.2, P = .03) in the post-assisted group. A significantly higher proportion of patients in the postless group achieved a patient acceptable symptom state for the UCLA (89.3% vs 68.3%, P = .04), mHHS (84.6% vs 61.0%, P = .04), and HOS-SSS (84.0% vs 61.0%, P = .048) and a substantial clinical benefit for HOS-SSS (72.0% vs 41.5%, P = .02). One patient (2.6%) in the post group underwent revision hip arthroscopy, and another was indicated for total hip arthroplasty by the time of follow-up.
Postless hip arthroscopy may result in better clinical outcomes compared with post-assisted hip arthroscopy.
Level III, retrospective cohort study.
前瞻性比较使用与会阴柱辅助髋关节镜手术患者和未使用会阴柱辅助髋关节镜手术患者的短期临床结果。
对2020年至2022年间接受髋关节镜手术的部分患者进行了一项前瞻性、单术者队列研究。在资深作者所在的1个中心使用了无柱髋关节牵引系统，在另一个手术地点使用了会阴柱。每位患者在术后至少1年完成了一项关于患者报告结局指标（PROMs）的电子问卷调查。PROMs包括疼痛视觉模拟量表；加利福尼亚大学洛杉矶分校（UCLA）活动量表；改良Harris髋关节评分（mHHS）；髋关节结局评分-运动特定子量表（HOS-SSS）；以及单项评估数字评价。比较两组之间每个PROM的术后评分和临床显著结果，包括最小临床重要差异、实质性临床益处和患者可接受症状状态。
87例符合研究条件的患者中有69例获得随访（使用会阴柱组41例，未使用会阴柱组28例）（79%）。两组在性别（使用会阴柱组：61%为女性，未使用会阴柱组：54%为女性，P = 0.54）、年龄（使用会阴柱组：34岁，未使用会阴柱组：29岁，P = 0.11）、体重指数（使用会阴柱组：26，未使用会阴柱组：24，P = 0.23）或随访时间（使用会阴柱组：24.4个月，未使用会阴柱组：21.3个月，P = 0.16）方面均无显著差异。在使用会阴柱辅助组中，视觉模拟量表评分显著更高（3.1对1.4，P = 0.01），UCLA活动量表评分显著更低（7.0对8.4，P = 0.02），mHHS显著更低（73.7对82.2，P = 0.03）。在未使用会阴柱组中，更高比例的患者在UCLA（89.3%对68.3%，P = 0.04）、mHHS（84.6%对61.0%，P = 0.04）和HOS-SSS（84.0%对61.0%，P = 0.048）方面达到了患者可接受症状状态，并且在HOS-SSS方面有实质性临床益处（72.0%对41.5%，P = 0.02）。使用会阴柱组中有1例患者（2.6%）接受了髋关节镜翻修手术，另1例在随访时被建议进行全髋关节置换术。
与使用会阴柱辅助的髋关节镜手术相比，无柱髋关节镜手术可能会带来更好的临床结果。
III级，回顾性队列研究。
