Background:Little is known about the effect of modern hip arthroscopy on the natural history of femoroacetabular impingement syndrome (FAIS) with respect to joint preservation.Purpose:To (1) characterize the natural history of FAIS and (2) understand the effect of modern hip arthroscopy by radiographically comparing the hips of patients who underwent only unilateral primary hip arthroscopy with a minimum follow-up of 10 years.Study Design:Cohort study; Level of evidence, 3.Methods:Between 2010 and 2012, 619 consecutive patients were reviewed from the practice of a single fellowship-trained hip arthroscopic surgeon. Inclusion criteria were FAIS, bilateral radiographic findings of femoroacetabular impingement, primary unilateral hip arthroscopy (labral repair, femoroplasty, or capsular closure), and minimum 10-year follow-up. The preoperative and minimum 10-year postoperative radiographs of patients were evaluated at each time point. Both operative and nonoperative hips were graded using the Tönnis classification or the presence of hip arthroplasty by 2 independent reviewers. Subgroup analyses were performed.Results:A total of 200 hips from 100 patients were evaluated at a mean follow-up of 12.0 years. Preoperatively, 98% and 99% of operative and nonoperative hips were evaluated as Tönnis grades 0 and 1, respectively; 5% of nonoperative hips had worse Tönnis grades than operative hips. The nonoperative hip advanced to a worse Tönnis grade in 48% (48/100) of cases compared with 28% (28/100) among operative hips. At follow-up, Tönnis grades between hips were equal in 70% (70/100) of the cases, the operative hip had a better grade 25% (25/100) of the time, and the nonoperative hip had a better grade 5% (5/100) of the time. Modern hip arthroscopy was associated with a relative risk reduction of 42% in osteoarthritis progression. Impingement with borderline dysplasia, age, preoperative Tönnis grade, and alpha angle >65° were key risk factors in the radiographic progression of osteoarthritis.Conclusion:Although the majority of patients (70%) undergoing hip arthroscopy for FAIS did not experience differences between operative and nonoperative hips in terms of the radiographic progression of osteoarthritis, the natural history may be favorably altered for 25% of patients whose Tönnis grade was better after undergoing arthroscopic correction. Modern hip arthroscopy indications and techniques represent a valid joint-preservation procedure conferring a relative risk reduction of 42% in the progression of osteoarthritis. Arthroscopy for mixed patterns of impingement and instability were the fastest to degenerate.

中文翻译：

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用于 FAIS 的现代髋关节镜检查可能会延迟 25% 患者骨关节炎的自然病程：12 年随访分析


背景：关于现代髋关节镜检查对股骨髋臼撞击综合征 (FAIS) 自然史在关节保护方面的影响知之甚少。目的：(1) 描述 FAIS 自然史的特征，(2) 了解现代髋关节镜检查的效果通过放射学比较仅接受单侧初次髋关节镜检查的患者的髋部，并进行至少 10 年的髋关节镜检查。 研究设计：队列研究；证据级别，3。方法：2010 年至 2012 年期间，对一位经过专科培训的髋关节镜外科医生的连续 619 名患者进行了回顾。纳入标准为 FAIS、股骨髋臼撞击的双侧放射学检查结果、初次单侧髋关节镜检查（盂唇修复、股骨成形术或关节囊闭合）以及至少 10 年随访。在每个时间点对患者术前和术后至少 10 年的 X 光片进行评估。手术和非手术髋关节均由 2 名独立评审员使用 Tönnis 分类或髋关节置换术进行分级。进行亚组分析。结果：平均随访 12.0 年，对 100 名患者的总共 200 个髋关节进行了评估。术前，98%和99%的手术和非手术髋关节分别被评估为Tönnis 0级和1级； 5% 的非手术髋关节 Tönnis 等级比手术髋关节差。 48% (48/100) 的非手术髋关节进展至更差的 Tönnis 分级，而手术髋关节的这一比例为 28% (28/100)。随访时，70% (70/100) 的病例中髋部之间的 Tönnis 等级相同，25% (25/100) 的病例中手术髋部的等级更好，非手术髋部的 5 级更好% (5/100) 的时间。 现代髋关节镜检查可使骨关节炎进展的相对风险降低 42%。伴有交界性发育不良的撞击、年龄、术前 Tönnis 分级和 α 角 >65° 是骨关节炎放射学进展的关键危险因素。 结论：尽管大多数接受 FAIS 髋关节镜检查的患者 (70%) 并没有经历术前差异就骨关节炎的放射学进展而言，对于 25% 的 Tönnis 分级较好的患者，在接受关节镜矫正后，其自然病程可能会得到有利的改变。现代髋关节镜检查适应症和技术代表了一种有效的关节保护手术，可将骨关节炎进展的相对风险降低 42%。针对混合型撞击和不稳定性的关节镜检查退化速度最快。