Moore Michael, Mongomery Samuel R, Perez Jose, Savage-Elliott Ian, Sundaram Vishal, Kaplan Daniel, Youm Thomas
NYU Langone Orthopedics, 334 East 26th Street, New York, NY, 10003, USA.
Arch Orthop Trauma Surg. 2024 Jul;144(7):3175-3184. doi: 10.1007/s00402-024-05367-6. Epub 2024 Jun 28.
To investigate the patient reported outcomes (PROs) of patients undergoing hip arthroscopy (HA) for femeroacetabular impingement syndrome (FAIS), a condition where irregular bone growth in the hip joint leads to friction and pain during movement, who have worker's compensation (WC) or no-fault insurance (NF) versus commercial insurance (CI) at both 2 year and 5 year follow-up.
This was a single center, single surgeon, retrospective analysis performed between August 2007 and May 2023 of consecutive patients that underwent HA, a minimally invasive surgical procedure used to diagnose and treat problems inside the hip joint through small incisions, for FAIS. Patients were divided into two cohorts-those with WC/NF and those with commercial insurance (CI). Patient reported outcomes (PROs), which included modified Harris Hip Score (mHHS) and Non-Arthritic Hip Score (NAHS), were collected preoperatively, as well as at least 2-year postoperatively. Additionally, other clinically relevant outcomes variables including prevalence of revision surgery and conversion to total hip arthroplasty were recorded.
Three hundred and forty three patients met inclusion criteria. There were 32 patients in the WC/NF cohort and 311 patients in the commercial cohort. When controlling for age, sex, and Body Mass Index (BMI), WC/NF status was associated with lower mHHS at both 2 year (β = - 8.190, p < 0.01, R = 0.092) and 5 year follow-up (β = - 16.60, p < 0.01, R = 0.179) and NAHS at 5 year follow up (β = - 13.462, p = 0.03, R = 0.148). The WC/NF cohort had a lower rate of achieving Substantial Clinical Benefit (SCB) for mHHS at 2-years follow-up (66.7% vs. 84.1%, p = 0.02).The rate of revision hip arthroscopy was significantly higher in the worker's compensation/no fault cohort than the commercial insurance cohort (15.6% vs. 3.5%, p < 0.01). The rate of conversion to total hip arthroplasty (THA) in the WC/NF cohort was not significantly different than the rate of conversion to THA in the commercial insurance cohort (0.0% vs. 3.2%, p = 0.30).
Patients with WC/NF insurance may expect a significant improvement from baseline mHHS and NAHS following HA for FAIS at short-term follow-up. However, this improvement may not be as durable as those experienced by patients with CI. Additionally, WC/NF patients should be counseled that they have a higher risk of undergoing revision hip arthroscopy than similar CI patients.
III, Retrospective Comparative Prognostic Investigation.
研究因股骨髋臼撞击综合征（FAIS，一种髋关节不规则骨生长导致运动时摩擦和疼痛的病症）接受髋关节镜检查（HA）的患者的患者报告结局（PROs），这些患者在2年和5年随访时分别拥有工伤赔偿（WC）或无过错保险（NF）以及商业保险（CI）。
这是一项单中心、由单一外科医生进行的回顾性分析，于2007年8月至2023年5月对因FAIS接受HA（一种通过小切口诊断和治疗髋关节内部问题的微创手术）的连续患者进行。患者被分为两个队列——有WC/NF的患者和有商业保险（CI）的患者。术前以及术后至少2年收集患者报告结局（PROs），包括改良Harris髋关节评分（mHHS）和非关节炎髋关节评分（NAHS）。此外，记录其他临床相关结局变量，包括翻修手术的发生率和转为全髋关节置换术的情况。
343名患者符合纳入标准。WC/NF队列中有32名患者，商业保险队列中有311名患者。在控制年龄、性别和体重指数（BMI）后，WC/NF状态在2年随访时（β = - 8.190，p < 0.01，R = 0.092）和5年随访时（β = - 十六点六零，p < 0.01，R = 0.179）与较低的mHHS相关，在5年随访时与较低的NAHS相关（β = - 13.462，p = 0.03，R = 0.148）。WC/NF队列在2年随访时达到mHHS显著临床获益（SCB）的比例较低（66.7%对84.1%，p = 0.02）。工伤赔偿/无过错队列的髋关节镜翻修率显著高于商业保险队列（15.6%对3.5%，p < 0.01）。WC/NF队列转为全髋关节置换术（THA）的发生率与商业保险队列转为THA 的发生率无显著差异（0.0%对3.2%，p = 0.30）。
有WC/NF保险的患者在短期随访时，接受HA治疗FAIS后，其mHHS和NAHS可能会较基线有显著改善。然而，这种改善可能不如有CI的患者持久。此外，应告知WC/NF患者，他们接受髋关节镜翻修手术的风险高于类似的有CI的患者。
III，回顾性比较预后研究。
