Cabell Grant H, Kwon Nicholas F, Shultz Christopher, Hutyra Carolyn A, Lewis Brian D, Olson Steven A, Salata Michael J, Nho Shane J, Mather Iii Richard C
Department of Orthopaedic Surgery, Duke University Medical Center, 3475 Erwin Rd, Durham, NC 27705, USA.
Department of Orthopaedic Surgery, Stanford Medicine, 450 Broadway, Redwood City, CA 94063, USA.
J Hip Preserv Surg. 2024 Feb 1;11(3):167-175. doi: 10.1093/jhps/hnae002. eCollection 2024 Jul.
Decision-making regarding surgical treatment of patients showing radiographic evidence of femoroacetabular impingement syndrome (FAIS) in the setting of borderline hip dysplasia (BHD) remains a challenge as there is no consensus on treatment in current literature. When medical evidence is unclear, understanding patient preferences becomes particularly important in deciding the optimal treatment for each patient. The purpose of this study was to measure the patient-determined importance of factors surrounding surgical treatment of FAIS in BHD. Patients aged 18-65 with hip pain and BHD (defined as lateral center edge angle 18-25 or Tonnis angle 10-15) morphology were given a discrete-choice experiment (DCE) focusing on attributes that differ between treatment options: Length of Hospital Stay, Major Complication Rate, Chance of Needing Reoperation within 2 Years and Time to Return to Regular Exercise. This DCE was used to calculate treatment preferences, relative attribute importance and preference weights. A total of 101 patients fully completed the DCE. The most important attribute (average importance weight, 95% CI) was Chance of Reoperation (60.16, 56.99-63.34), while the least important was Hospital Stay (6.57, 5.73-7.41). Only 6 Months to Resume Regular Exercise and 2% Chance of Reoperation ( < 0.05) significantly impacted treatment choice. When presented with fixed choice parameters, 50.5% of subjects preferred PAO and arthroscopy while 49.5% opted for arthroscopy alone. When no clear surgical treatment is indicated, patient preferences have an amplified role in patient decision-making. Our results confirm variation in attribute importance within treatments as well as treatment choice, highlighting the importance in understanding patient preferences in decision-making for FAIS in BHD. More patient-specific generalizable outcomes of surgical treatment options are needed in the literature.
对于在临界性髋关节发育不良（BHD）情况下出现股骨髋臼撞击综合征（FAIS）影像学证据的患者，手术治疗的决策仍然是一项挑战，因为目前文献中对于治疗方法尚无共识。当医学证据不明确时，了解患者偏好对于为每位患者确定最佳治疗方案尤为重要。本研究的目的是衡量患者确定的与BHD中FAIS手术治疗相关因素的重要性。对年龄在18 - 65岁、有髋关节疼痛且具有BHD形态（定义为外侧中心边缘角18 - 25度或Tonnis角10 - 15度）的患者进行了一项离散选择实验（DCE），该实验聚焦于不同治疗方案之间存在差异的属性：住院时间、主要并发症发生率、2年内需要再次手术的几率以及恢复常规锻炼的时间。此DCE用于计算治疗偏好、相对属性重要性和偏好权重。共有101名患者完整完成了DCE。最重要的属性（平均重要性权重，95%可信区间）是再次手术的几率（60.16，56.99 - 63.34），而最不重要的是住院时间（6.57，5.73 - 7.41）。仅恢复常规锻炼6个月和再次手术几率为2%（P < 0.05）对治疗选择有显著影响。当呈现固定的选择参数时，50.5%的受试者倾向于骨盆髋臼截骨术（PAO）和关节镜检查，而49.5%的受试者仅选择关节镜检查。当未指明明确的手术治疗方法时，患者偏好在患者决策中具有更大作用。我们的结果证实了不同治疗方法以及治疗选择中属性重要性的差异，凸显了在BHD中FAIS决策过程中了解患者偏好的重要性。文献中需要更多针对患者的手术治疗方案的可推广结果。
