Gürsan Onur, Çeltik Mustafa, Aydemir Selahaddin, Aydın Özgür, Tukel Gürhan, Arayıcı Mehmet Emin, Hapa Onur
Department of Orthopedics, Dokuz Eylul University Faculty of Medicine, İzmir, Turkey.
Department of Orthopedics, Ankara Oncology Training and Research Hospital, Ankara, Turkey.
Orthop J Sports Med. 2025 Aug 22;13(8):23259671251366417. doi: 10.1177/23259671251366417. eCollection 2025 Aug.
Hip arthroscopy effectively treats femoroacetabular impingement (FAI) to preserve joint function and alleviate symptoms. Joint space widths (JSWs) and ratios may predict surgical outcomes, especially in older patients.
To assess the relationship between the preoperative lateral-to-medial (L/M) ratio, the central-to-medial (C/M) ratio, and postoperative functional scores following arthroscopic treatment for FAI in patients aged ≥35 years.
Cohort study; Level of evidence, 3.
Patients who had primary hip arthroscopy for FAI between February 5, 2013, and June 1, 2022, with a minimum 2-year follow-up, were included and categorized into 2 age groups (≥35 years and <35 years). Radiographic measurements of JSW on plain anteroposterior pelvic radiographs were used to calculate L/M and C/M ratios. Patient-reported outcomes included the modified Harris Hip Score (mHHS) and visual analog scale for pain. Statistical analysis included chi-square, Mann-Whitney , and Wilcoxon tests to compare categorical and continuous variables. The receiver operating characteristic (ROC) curve and area under the curve (AUC) assessed threshold values for L/M and C/M ratios predicting the Patient Acceptable Symptom State (PASS) for mHHS at 2 years.
A total of 110 patients (114 hips) were identified, comprising 56 hips from the older group (age ≥35 years) and 58 hips from the younger group (age <35 years). The ROC curve for preoperative C/M effectively distinguished between patients who achieved and did not achieve a second-year PASS value, with an AUC of 0.70 in older patients. Older patients, compared with younger, demonstrated lower postoperative mHHS (89 ± 10 vs 94 ± 8; = .01) but similar rates of PASS achievement (75% vs 88%; = .07). The C/M ratio was a significant predictor of functional outcomes in patients aged ≥35. Patients with a preoperative C/M ratio ≥1.08 achieved significantly better outcomes. No significant predictive value was found for L/M ratios in older patients or for L/M and C/M ratios in younger patients.
Our study demonstrated that the central JSW is a sensitive prognostic indicator in older patients undergoing primary hip arthroscopy. A preoperative C/M ratio ≥1.08 correlates with higher rates of achieving PASS. Identifying preoperative predictors, such as the C/M JSW ratio, assists surgeons in determining patients (≥35 years) who are more likely to benefit from hip arthroscopy.
髋关节镜检查能有效治疗股骨髋臼撞击症（FAI），以保留关节功能并缓解症状。关节间隙宽度（JSWs）及其比值可能预测手术效果，尤其是在老年患者中。
评估年龄≥35岁的FAI患者在接受关节镜治疗后，术前外侧与内侧（L/M）比值、中央与内侧（C/M）比值与术后功能评分之间的关系。
队列研究；证据等级，3级。
纳入2013年2月5日至2022年6月1日期间因FAI接受初次髋关节镜检查且随访至少2年的患者，并将其分为2个年龄组（≥35岁和<35岁）。利用骨盆前后位X线平片上JSW的影像学测量值计算L/M和C/M比值。患者报告的结局包括改良Harris髋关节评分（mHHS）和疼痛视觉模拟量表。统计分析包括卡方检验、Mann-Whitney检验和Wilcoxon检验，以比较分类变量和连续变量。采用受试者工作特征（ROC）曲线和曲线下面积（AUC）评估L/M和C/M比值预测2年时mHHS患者可接受症状状态（PASS）的阈值。
共纳入110例患者（114髋），其中老年组（年龄≥35岁）56髋，年轻组（年龄<35岁）58髋。术前C/M的ROC曲线能有效区分达到和未达到第二年PASS值的患者，老年患者的AUC为0.70。与年轻患者相比，老年患者术后mHHS较低（89±10 vs 94±8；P = 0.01），但达到PASS的比例相似（75% vs 88%；P = 0.07）。C/M比值是年龄≥35岁患者功能结局的重要预测指标。术前C/M比值≥1.08的患者结局明显更好。老年患者的L/M比值以及年轻患者的L/M和C/M比值均未发现显著的预测价值。
我们的研究表明，中央JSW是接受初次髋关节镜检查的老年患者的敏感预后指标。术前C/M比值≥1.08与更高的PASS达成率相关。识别术前预测指标，如C/M JSW比值，有助于外科医生确定更可能从髋关节镜检查中获益的患者（≥35岁）。
