Ruzbarsky Joseph J, Comfort Spencer M, Stetzelberger Vera M, Ernat Justin J, Felan Nicholas A, Dornan Grant J, Philippon Marc J
Steadman Philippon Research Institute, Vail, Colorado, U.S.A.
Steadman Clinic and United States Coalition for the Prevention of Illness and Injury in Sport, Vail, Colorado, U.S.A.
Arthrosc Sports Med Rehabil. 2025 May 21;7(4):101166. doi: 10.1016/j.asmr.2025.101166. eCollection 2025 Aug.
To characterize risk factors for patients who underwent multiple-revision hip arthroscopies and report survivorship at a minimum 2 years after hip arthroscopy.
Patients aged 18-65 years who underwent revision hip arthroscopy between January 2011 and September 2018 with ≥2-year follow-up were included. Exclusion criteria were age <18 or >65 years at time of surgery, center-edge angle <20°, previous ipsilateral periacetabular osteotomy, or refusal to participate. Procedures were categorized as first (R1), second (R2), or third or more (R3+) revisions. Demographics, preoperative radiographic measurements, baseline patient-reported outcomes (PROs), intraoperative findings, and survivorship were compared across groups and between those requiring further surgery or total hip arthroplasty (THA) and those who did not. Survivorship was defined as re-revision and arthroplasty-free survival. PROs included modified Harris Hip Score, Hip Outcome Score - Activities Daily Living, HOS-Sport, Western Ontario and McMaster Universities Osteoarthritis Index, and Short Form Physical and Mental Component Scores (12-Item Short Form Physical Component Score/Mental Component Score).
A total of 284 hips (246 patients) met inclusion criteria, with mean follow-up of 4.3 ± 2.1 years. Female sex (52% vs 63% vs 78%, = .03), primary hip arthroscopy at an outside institution (62% vs 78% vs 96%, < .001), smaller alpha angle (64° vs 56° vs 50°, < .001), and worse baseline PROs (modified Harris Hip Score, Hip Outcome Score - Activities Daily Living, HOS-Sport, Western Ontario and McMaster Universities Osteoarthritis Index; = .05, = .01, < .001, = .01) were associated with more previous revisions. Failure incidence did not differ between groups ( = .29), but the hazard ratio for further surgery or THA was greater for R3+ versus R1 (hazard ratio 2.4, 95% confidence interval 1.04-5.38, = .04).
At a minimum 2-year follow-up, more prior revisions were associated with female sex, lower baseline PROs, capsular deficiency, and greater failure risk. Patients with lower nondysplastic lateral center-edge angles, severe acetabular cartilage damage, or ≥3 revisions had elevated risk for re-revision or THA.
Level IV, therapeutic case series.
明确接受多次髋关节镜翻修手术患者的危险因素，并报告髋关节镜检查后至少2年的生存率。
纳入2011年1月至2018年9月期间接受髋关节镜翻修手术且随访时间≥2年的18 - 65岁患者。排除标准为手术时年龄<18岁或>65岁、中心边缘角<20°、既往同侧髋臼周围截骨术或拒绝参与。手术分为首次（R1）、第二次（R2）或第三次及以上（R3 +）翻修。比较各组以及需要进一步手术或全髋关节置换术（THA）的患者与未进行此类手术患者之间的人口统计学资料、术前影像学测量、基线患者报告结局（PROs）、术中发现和生存率。生存率定义为无再次翻修和关节置换的生存。PROs包括改良Harris髋关节评分、髋关节结局评分 - 日常生活活动、HOS - 运动、西安大略和麦克马斯特大学骨关节炎指数以及简短身体和精神成分评分（12项简短身体成分评分/精神成分评分）。
共有284例髋关节（246例患者）符合纳入标准，平均随访时间为4.3±2.1年。女性（52%对63%对78%，P = 0.03）、在外院进行初次髋关节镜检查（62%对78%对96%，P < 0.001）、较小的α角（64°对56°对50°，P < 0.001）以及较差的基线PROs（改良Harris髋关节评分、髋关节结局评分 - 日常生活活动、HOS - 运动、西安大略和麦克马斯特大学骨关节炎指数；P = 0.05，P = 0.01，P < 0.001，P = 0.01）与既往翻修次数较多相关。各组之间的失败发生率无差异（P = 0.29），但R3 +组与R1组相比，进一步手术或THA的风险比更高（风险比2.4，95%置信区间1.04 - 5.38，P = 0.04）。
在至少2年的随访中，既往翻修次数较多与女性、较低的基线PROs、关节囊缺损以及更高的失败风险相关。非发育不良性外侧中心边缘角较低、严重髋臼软骨损伤或翻修次数≥3次的患者再次翻修或行THA的风险升高。
IV级，治疗性病例系列。
