Background:Arthroscopic treatment of femoroacetabular impingement (FAI) and symptomatic labral tears confers short- to midterm benefits, yet further long-term evidence is needed. Moreover, despite the physiological and biomechanical significance of the chondrolabral junction (CLJ), the clinical implications of damage to this transition zone remain understudied.Purpose:To (1) report minimum 8-year survivorship and patient-reported outcome measures after hip arthroscopy for FAI and (2) characterize associations between outcomes and patient characteristics (age, body mass index, sex), pathological parameters (Tönnis angle, alpha angle, type of FAI, CLJ breakdown), and procedures performed (labral management, FAI treatment, microfracture).Study Design:Cohort study; Level of evidence, 3.Methods:This retrospective cohort study included patients who underwent primary hip arthroscopy for symptomatic labral tears secondary to FAI by a single surgeon between 2002 and 2013. All patients were ≥18 years of age with minimum 8-year follow-up and available preoperative radiographs. The primary outcome was conversion to total hip arthroplasty (THA), and secondary outcomes included revision arthroscopy, patient-reported outcome measures, and patient satisfaction. CLJ breakdown was assessed using the Beck classification. Kaplan-Meier estimates and weighted Cox regression were used to estimate 10-year survivorship (no conversion to THA) and identify risk factors associated with THA conversion.Results:In this study of 174 hips (50.6% female; mean age, 37.8 ± 11.2 years) with mean follow-up of 11.1 ± 2.5 years, the 10-year survivorship rate was 81.6% (95% CI, 75.9%-87.7%). Conversion to THA occurred at a mean 4.7 ± 3.8 years postoperatively. Unadjusted analyses revealed several variables significantly associated with THA conversion, including older age; higher body mass index; higher Tönnis grade; labral debridement; and advanced breakdown of the CLJ, labrum, or articular cartilage. Survivorship at 10 years was inferior in patients exhibiting severe (43.6%; 95% CI, 31.9%-59.7%) versus mild (97.9%; 95% CI, 95.1%-100%) breakdown of the CLJ ( P < .001). Multivariable analysis identified worsening CLJ breakdown (weighted hazard ratio per 1-unit increase, 6.41; 95% CI, 3.11-13.24), older age (1.09; 95% CI, 1.04-1.14), and higher Tönnis grade (4.59; 95% CI, 2.13-9.90) as independent negative prognosticators ( P < .001 for all).Conclusion:Although most patients achieved favorable minimum 8-year outcomes, several pre- and intraoperative factors were associated with THA conversion; of these, worse CLJ breakdown, higher Tönnis grade, and older age were the strongest predictors.

中文翻译：

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因症状性盂唇撕裂而进行髋关节镜检查后，软骨盂连接处破坏与全髋关节置换术之间的关系：至少 8 年随访

背景：关节镜治疗股骨髋臼撞击症（FAI）和有症状的盂唇撕裂可带来短期到中期的益处，但还需要进一步的长期证据。此外，尽管软骨唇交界处 (CLJ) 具有生理和生物力学意义，但该过渡区损伤的临床影响仍未得到充分研究。 目的：(1) 报告髋关节镜检查后的最低 8 年生存率和患者报告的结果测量FAI 和 (2) 表征结果与患者特征（年龄、体重指数、性别）、病理参数（Tönnis 角、α 角、FAI 类型、CLJ 破裂）和执行的手术（盂唇管理、FAI 治疗、微骨折）之间的关联).研究设计：队列研究；证据级别，3。方法：这项回顾性队列研究纳入了 2002 年至 2013 年间由一位外科医生因 FAI 继发的症状性盂唇撕裂而接受初次髋关节镜检查的患者。所有患者年龄均≥ 18 岁，且随访时间至少为 8 年。并提供术前 X 光片。主要结局是转为全髋关节置换术（THA），次要结局包括翻修关节镜检查、患者报告的结局指标和患者满意度。使用 Beck 分类评估 CLJ 分解。Kaplan-Meier 估计和加权 Cox 回归用于估计 10 年生存率（未转为 THA）并确定与 THA 转为相关的风险因素。 结果：在这项针对 174 个髋关节的研究中（50.6% 为女性；平均年龄为 37.8 ± 11.2）年），平均随访时间为 11.1 ± 2.5 年，10 年生存率为 81.6%（95% CI，75.9%-87.7%）。术后平均 4.7 ± 3.8 年转为 THA。未经调整的分析揭示了与 THA 转换显着相关的几个变量，包括年龄；较高的体重指数；更高的 Tönnis 等级；盂唇清创术；CLJ、盂唇或关节软骨的严重损坏。严重 (43.6%; 95% CI, 31.9%-59.7%) CLJ 故障患者的 10 年生存率低于轻度 (97.9%; 95% CI, 95.1%-100%) CLJ 故障的患者 ( P < .001) 。多变量分析发现 CLJ 恶化恶化（每增加 1 个单位的加权风险比，6.41；95% CI，3.11-13.24）、年龄较大（1.09；95% CI，1.04-1.14）和较高的 Tönnis 等级（4.59；95%） CI，2.13-9.90）作为独立的阴性预后因素（所有 P < .001）。 结论：虽然大多数患者获得了良好的至少 8 年结局，但一些术前和术中因素与 THA 转换相关；其中，CLJ 崩溃更严重、Tönnis 等级更高和年龄更大是最强的预测因素。