Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China.
Am J Sports Med. 2024 Jul;52(9):2306-2313. doi: 10.1177/03635465241260354.
Arthroscopic treatment is recommended for hip synovial chondromatosis. However, evidence regarding long-term clinical outcomes is limited.
To evaluate long-term patient-reported outcomes (PROs) and survival, and to determine the potential effect of residual loose bodies, as evaluated by immediate postoperative computed tomography (CT), on clinical outcomes.
Case series; Level of evidence, 4.
A consecutive cohort of patients undergoing arthroscopic treatment and diagnosed with synovial chondromatosis between March 2010 and May 2015 were included in the study. Preoperative radiography, CT, and magnetic resonance imaging were performed. Preoperative, midterm (minimum of 4 years), and long-term (minimum of 8 years) PROs were collected for visual analog scale for pain, modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), and 12-item international Hip Outcome Tool (iHOT-12). The percentages achieving minimal clinically important difference (MCID) were calculated. PROs and survival were compared between patients with and without residual loose bodies evident on immediate postoperative CT scan.
A total of 28 patients (20% of patients were lost to follow-up) were included in the study with a mean follow-up period of 104.9 months (range, 96-139 months). PROs including visual analog scale for pain (preoperative, 3.8 ± 1.2; midterm, 0.9 ± 1.7; long-term, 0.8 ± 1.4), mHHS (preoperative, 66.4 ± 14.4; midterm, 92.8 ± 12.3; long-term, 93.5 ± 10.5), NAHS (preoperative, 45.2 ± 16.2; midterm, 81.8 ± 15.3; long-term, 83.1 ± 12.9), and iHOT-12 (preoperative, 48.4 ± 15.6; midterm, 69.3 ± 11.7; long-term, 72.7 ± 11.4) were improved at both midterm and long-term follow-up (all with < .001). In total, 27 (96.4%), 28 (100%), and 26 (92.9%) patients achieved MCID for mHHS, NAHS and iHOT-12, respectively, at the long-term follow-up. No significant difference was found in any of the PROs and the rate of achieving MCID between midterm and long-term follow-up (all with > .05). One patient (3.6%) underwent revision surgery. Among the 23 patients who had loose bodies on preoperative CT or radiographs, 14 patients (60.9%) with residual loose bodies evident on immediate postoperative CT demonstrated lower NAHS ( = .045) and iHOT-12 ( = .037) scores but a comparable survival ( > .05) at long-term follow-up compared with those who did not have loose bodies.
Arthroscopic treatment for hip synovial chondromatosis achieved satisfactory long-term clinical outcomes with strong survival. Most patients maintained or improved their overall functional status between midterm and long-term follow-up. Furthermore, patients with residual loose bodies had less favorable clinical outcomes, although the survival rate was comparable.
关节镜治疗被推荐用于髋关节滑膜软骨瘤病。然而，关于长期临床结果的证据有限。
评估长期患者报告的结果（PROs）和生存率，并确定术后即刻 CT 检查评估的残留游离体的潜在影响对临床结果的影响。
病例系列；证据水平，4 级。
研究纳入了 2010 年 3 月至 2015 年 5 月期间接受关节镜治疗并被诊断为滑膜软骨瘤病的连续队列患者。术前进行了 X 线摄影、CT 和磁共振成像检查。收集了术前、中期（至少 4 年）和长期（至少 8 年）的视觉模拟量表疼痛评分、改良 Harris 髋关节评分（mHHS）、非关节炎髋关节评分（NAHS）和 12 项国际髋关节结果工具（iHOT-12）的 PROs。计算了达到最小临床重要差异（MCID）的百分比。比较了术后即刻 CT 扫描有或无残留游离体的患者的 PROs 和生存率。
共有 28 例患者（20%的患者失访）纳入研究，平均随访时间为 104.9 个月（范围 96-139 个月）。PROs 包括疼痛视觉模拟量表评分（术前 3.8 ± 1.2；中期 0.9 ± 1.7；长期 0.8 ± 1.4）、mHHS（术前 66.4 ± 14.4；中期 92.8 ± 12.3；长期 93.5 ± 10.5）、NAHS（术前 45.2 ± 16.2；中期 81.8 ± 15.3；长期 83.1 ± 12.9）和 iHOT-12（术前 48.4 ± 15.6；中期 69.3 ± 11.7；长期 72.7 ± 11.4）在中期和长期随访时均得到改善（均<0.001）。在长期随访时，27 例（96.4%）、28 例（100%）和 26 例（92.9%）患者分别达到了 mHHS、NAHS 和 iHOT-12 的 MCID。中期和长期随访时的任何 PROs 和 MCID 达到率均无显著差异（均>0.05）。1 例（3.6%）患者接受了翻修手术。在 23 例术前 CT 或 X 线片上有游离体的患者中，14 例（60.9%）术后即刻 CT 显示有残留游离体的患者 NAHS（=0.045）和 iHOT-12（=0.037）评分较低，但长期随访时的生存率相似（>0.05）。
关节镜治疗髋关节滑膜软骨瘤病可获得满意的长期临床结果和较高的生存率。大多数患者在中期和长期随访期间保持或改善了整体功能状态。此外，尽管生存率相似，但有残留游离体的患者临床结果较差。
