Gillinov Stephen M, Lee Jonathan S, Siddiq Bilal S, Dowley Kieran S, Cherian Nathan J, Eberlin Christopher T, Kucharik Michael P, Martin Scott D
Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.
Department of Orthopaedic Surgery, University of Nebraska, Omaha, Nebraska, USA.
Orthop J Sports Med. 2025 Jul 8;13(7):23259671251352195. doi: 10.1177/23259671251352195. eCollection 2025 Jul.
Despite the increasing utilization of hip arthroscopy and identification of predictors of poor outcomes, the effect of short-term improvement on long-term functional outcomes has been understudied.
To determine whether improvements in patient-reported outcomes (PROs) 6 months after hip arthroscopy predict 5-year outcomes.
Case-control study.
A retrospective review of prospectively collected data identified patients ≥18 years who underwent primary hip arthroscopy by a single surgeon for the treatment of symptomatic labral tears. Included patients had a Tönnis grade <2 and completed PROs at baseline, 6-month, and minimum 2-year follow-up, and annually thereafter. The minimal clinically important difference (MCID) for the modified Harris Hip Score (mHHS), 8 points, was used to stratify patients into cohorts based on high improvement (HI) versus low improvement (LI) at 6 months. PROs were compared at 1, 2, 3, 4, and 5 years postoperatively by rates of MCID achievement and linear mixed-effects modeling. Subsequent surgery rates were compared by chi-square or Fisher exact tests, as appropriate.
Overall, 175 patients (age, 37.2 ± 11.4 years; 52.0% female) met inclusion criteria. Of these, 131 HI patients were compared with 44 LI patients. At 5 years, 88.3% of HI patients reached MCID, versus 42.1% of LI patients ( < .001). By multivariable logistic regression, achievement of 6-month MCID (adjusted odds ratio [AOR], 17.43; < .001) and labral management (augmentation, relative to debridement: AOR, 14.5; = .01) predicted achievement of 5-year MCID. mHHS scores were greater for HI versus LI patients through 3-year follow-up ( < .05) but were not significantly different at 4 and 5 years. Subsequent surgery rates were 9.9% and 11.4% in HI versus LI patients, respectively ( > .05).
The study demonstrates that early functional improvements after hip arthroscopy, assessed by 6-month MCID, predicted clinically meaningful outcomes at 5-year follow-up, underscoring the importance of early cautious recovery to prioritize labral healing while also meeting appropriate, stepwise rehabilitation milestones to advance functionally during these 6 months. Despite this, LI patients continued improving for 5 years, demonstrating that late functional improvements are still possible for certain patients in the event of a poor 6-month rehabilitation period.
尽管髋关节镜检查的应用日益增多，且已确定了预后不良的预测因素，但短期改善对长期功能预后的影响尚未得到充分研究。
确定髋关节镜检查6个月后患者报告结局（PROs）的改善是否能预测5年结局。
病例对照研究。
对前瞻性收集的数据进行回顾性分析，确定年龄≥18岁、由单一外科医生进行初次髋关节镜检查以治疗有症状的盂唇撕裂的患者。纳入患者的Tönnis分级<2，并在基线、6个月、至少2年随访时以及此后每年完成PROs评估。改良Harris髋关节评分（mHHS）的最小临床重要差异（MCID）为8分，用于根据6个月时的高改善（HI）与低改善（LI）将患者分层为队列。通过MCID达成率和线性混合效应模型比较术后1、2、3、4和5年的PROs。根据情况，通过卡方检验或Fisher精确检验比较后续手术率。
总体而言，175例患者（年龄37.2±11.4岁；52.0%为女性）符合纳入标准。其中，131例HI患者与44例LI患者进行了比较。在5年时，88.3%的HI患者达到MCID，而LI患者为42.1%（P<.001）。通过多变量逻辑回归分析，6个月时达到MCID（调整优势比[AOR]，17.43；P<.001）和盂唇处理方式（相对于清创，增强：AOR，14.5；P=.01）可预测5年时达到MCID。在3年随访期间，HI患者的mHHS评分高于LI患者（P<.05），但在4年和5年时无显著差异。HI患者和LI患者的后续手术率分别为9.9%和11.4%（P>.05）。
该研究表明，通过6个月MCID评估的髋关节镜检查后早期功能改善可预测5年随访时具有临床意义的结局，强调了早期谨慎康复的重要性，即在优先促进盂唇愈合的同时，也要在这6个月内达到适当的、逐步的康复里程碑以实现功能进展。尽管如此，LI患者在5年内仍持续改善，表明对于某些在6个月康复期不佳的患者，后期功能改善仍然是可能的。
