Ramadanov Nikolai, Lettner Jonathan, Voss Maximilan, Prill Robert, Hable Robert, Dimitrov Dobromir, Becker Roland
Center of Orthopaedics and Traumatology, Brandenburg Medical School, University Hospital Brandenburg an der Havel, Brandenburg an der Havel, Germany.
Faculty of Health Science Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany.
Orthop Surg. 2025 Sep;17(9):2514-2528. doi: 10.1111/os.70097. Epub 2025 Jul 5.
Several meta-analyses of surgical versus non-operative treatment of femoroacetabular impingement syndrome (FAIS) have been published, but reliable evidence is still lacking. The aim of this meta-analysis of randomized controlled trials (RCTs) was to assess the outcomes of FAIS patients treated conservatively compared with those treated with hip arthroscopy (HAS). PubMed, CENTRAL of the Cochrane Library, Epistemonikos, and Embase databases were searched up to March 31, 2025. Quality was assessed using the Cochrane Risk of Bias 2 tool, the level of evidence for each outcome parameter was determined using the GRADE system, and publication bias was presented in funnel plots. In a common effect and random effects meta-analysis, mean differences (MDs) between the conservative treatment group and the HAS group were calculated with 95% confidence intervals (CIs) using the Hartung-Knapp-Sidik-Jonkman heterogeneity estimator. A total of 7 RCTs with a total of 489 patients in the conservative treatment group and 484 patients in the HAS group met the inclusion criteria. Of the 7 RCTs included, four were assessed as having a low risk of bias, one as having a moderate risk of bias, and two as having a high risk of bias. The outcomes "post-intervention functional MCID" and "iHOT at ≤ 12 months post-intervention" had a high level of evidence, and the outcome "HOS-ADL at ≤ 8 months post-intervention" had a moderate level of evidence. No significant publication bias was detected for any outcome. The HAS group had a statistically significant 0.85 higher post-intervention functional MCID (common effect model: MD: 0.85 CIs 0.53-1.17; random effects model: MD: 0.85 CIs 0.64-1.06; I = 0%; τ = 0.02; p = 0.96) and a statistically significant 10.74 higher iHOT at ≤ 12 months post-intervention than the conservative treatment group (common effect model: MD: 10.74 CIs 7.06 to 14.42; random effects model: MD: 10.98 CIs 6.62 to 15.34; I = 0%; τ = 7.52; p = 0.62). There was no difference between the HAS group and the conservative treatment group in HOS-ADL at ≤ 8 months post-intervention (common effect model: MD: 5.62 CIs 1.76 to 9.48; random effects model: MD: 4.10 CIs -12.31 to 20.50; I = 69%; τ = 29.88; p = 0.04). This meta-analysis using high-quality statistical methods showed a statistically significant higher post-intervention functional MCID and iHOT at ≤ 12 months post-intervention in favor of the HAS group compared to the conservative treatment group. HOS-ADL at ≤ 8 months post-intervention showed no differences.
已经发表了几项关于股骨髋臼撞击综合征（FAIS）手术治疗与非手术治疗的荟萃分析，但仍缺乏可靠证据。这项随机对照试验（RCT）的荟萃分析旨在评估保守治疗的FAIS患者与接受髋关节镜检查（HAS）的患者的治疗结果。检索了截至2025年3月31日的PubMed、Cochrane图书馆的CENTRAL、Epistemonikos和Embase数据库。使用Cochrane偏倚风险2工具评估质量，使用GRADE系统确定每个结果参数的证据水平，并在漏斗图中呈现发表偏倚。在固定效应和随机效应荟萃分析中，使用Hartung-Knapp-Sidik-Jonkman异质性估计器计算保守治疗组和HAS组之间的平均差异（MD）及其95%置信区间（CI）。共有7项RCT符合纳入标准，其中保守治疗组共有489例患者，HAS组有484例患者。在纳入的7项RCT中，4项被评估为低偏倚风险，1项为中度偏倚风险，2项为高偏倚风险。“干预后功能最小临床重要差异（MCID）”和“干预后≤12个月时的iHOT”结果具有高证据水平，“干预后≤8个月时的HOS-ADL”结果具有中等证据水平。未检测到任何结果存在显著的发表偏倚。与保守治疗组相比，HAS组干预后功能MCID在统计学上显著高0.85（固定效应模型：MD：0.85，CI 0.53 - 1.17；随机效应模型：MD：0.85，CI 0.64 - 1.06；I² = 0%；τ² = 0.02；p = 0.96），干预后≤12个月时iHOT在统计学上显著高10.74（固定效应模型：MD：10.74，CI 7.06至14.42；随机效应模型：MD：10.98，CI 6.62至15.34；I² = 0%；τ² = 7.52；p = 0.62）。干预后≤8个月时，HAS组与保守治疗组在HOS-ADL方面无差异（固定效应模型：MD：5.62，CI 1.76至9.48；随机效应模型：MD：4.10，CI -12.31至20.50；I² = 69%；τ² = 29.88；p = 0.04）。这项使用高质量统计方法的荟萃分析表明，与保守治疗组相比，HAS组干预后功能MCID和干预后≤12个月时的iHOT在统计学上显著更高。干预后≤8个月时的HOS-ADL无差异。
