髋关节镜治疗伴有骨关节炎的股骨髋臼撞击症的十年疗效：功能效益持续，但全髋关节置换术的转换率高。
Ten-year outcomes of hip arthroscopy for femoroacetabular impingement with osteoarthritis: Sustained functional benefits but high conversion to total hip arthroplasty.
作者信息
Nikou Sarantos, Sandlund Carl, Lindman Ida, Johansson Per-Erik, Öhlin Axel, Karlsson Louise, Sansone Mikael
机构信息
Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
General Practice/Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2025 Jul;33(7):2655-2663. doi: 10.1002/ksa.12709. Epub 2025 May 27.
PURPOSE
To evaluate the long-term clinical and radiographic outcomes of hip arthroscopy for femoroacetabular impingement syndrome (FAIS) in patients with mild to moderate osteoarthritis (OA). The hypothesis is that patients with FAIS and mild to moderate OA would experience sustained improvements in iHOT-12 at 10-year follow-up, despite natural OA progression.
METHODS
This prospective cohort study included 75 patients (80 hips) with FAIS and radiographic signs of mild to moderate OA (Tönnis grade 1 or 2) who underwent hip arthroscopy between November 2011 and December 2012. The International Hip Outcome Tool (iHOT-12) was the primary outcome at a minimum of 10-year follow-up. Radiographic progression of OA using Tönnis classification and conversion to THA were recorded. Statistical analysis of patient-reported outcome measures (PROMs) was performed with Wilcoxon signed-rank test. Relative risk assessment (RR) for conversion to THA for Tönnis grade 1 and 2 was reported.
RESULTS
At 10-year follow-up, 26 patients (29 hips) had undergone THA, resulting in a hip survivorship of 59% while 41% of hips progressed to THA by 10 years. The mean time to THA was 7.1 years (±1.5). Patients with Tönnis grade 2 at baseline had a significantly higher risk of THA compared with Tönnis grade 1 (RR = 3.44, 95% CI: 1.81-6.55, p < 0.001). Among non-THA patients, 79% reported satisfaction with surgery. The iHOT-12 score improved from 41.4 (±17.1) preoperatively to 71.0 (±26.7) at follow-up (p < 0.001), with 67% of patients exceeding the minimal important change (MIC) threshold. Radiographic progression of Tönnis grade was observed in four hips.
CONCLUSION
Hip arthroscopy in patients with FAIS and mild to moderate OA provides substantial long-term functional benefits for those patients not having to undergo THA. However, preoperative OA severity is a key predictor of THA conversion with nearly two-fifths of hips requiring THA within 10 years.
LEVEL OF EVIDENCE
Level IV, case series.
目的
评估髋关节镜手术治疗轻度至中度骨关节炎（OA）患者股骨髋臼撞击综合征（FAIS）的长期临床和影像学结果。假设是，尽管存在自然的OA进展，但FAIS和轻度至中度OA患者在10年随访时iHOT-12评分仍会持续改善。
方法
这项前瞻性队列研究纳入了75例（80髋）患有FAIS且有轻度至中度OA影像学表现（Tönnis分级1级或2级）的患者，这些患者于2011年11月至2012年12月期间接受了髋关节镜手术。国际髋关节结局工具（iHOT-12）是至少10年随访的主要结局指标。记录使用Tönnis分类法的OA影像学进展以及转为全髋关节置换术（THA）的情况。采用Wilcoxon符号秩检验对患者报告的结局指标（PROMs）进行统计分析。报告了Tönnis 1级和2级转为THA的相对风险评估（RR）。
结果
在10年随访时，26例患者（29髋）接受了THA，髋关节生存率为59%，而41%的髋关节在10年内进展为THA。转为THA的平均时间为7.1年（±1.5）。基线时Tönnis 2级患者转为THA的风险显著高于Tönnis 1级患者（RR = 3.44，95%CI：1.81 - 6.55，p < 0.001）。在未接受THA的患者中，79%的患者对手术表示满意。iHOT-12评分从术前的41.4（±17.1）提高到随访时的71.0（±26.7）（p < 0.001），67%的患者超过了最小重要变化（MIC）阈值。观察到4髋出现Tönnis分级的影像学进展。
结论
对于不必接受THA的FAIS和轻度至中度OA患者，髋关节镜手术可提供显著的长期功能益处。然而，术前OA严重程度是THA转换的关键预测因素，近五分之二的髋关节在10年内需要进行THA。
证据水平
IV级，病例系列。
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