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Hip Arthroscopy for the Treatment of Femoroacetabular Impingement Syndrome in Hips With Mild Osteoarthritis (Tönnis Grade 1): A Matched Comparative Cohort Analysis at Minimum 5-Year Follow-up
The American Journal of Sports Medicine ( IF 4.8 ) Pub Date : 2022-07-22 , DOI: 10.1177/03635465221107354
Lakshmanan Sivasundaram 1 , Morgan W Rice 1 , Nolan S Horner 1 , Thomas D Alter 1 , Christopher G Ephron 1 , Shane J Nho 1
Affiliation  

Background:

There is a paucity of information in the literature on midterm outcomes from the arthroscopic treatment of femoroacetabular impingement syndrome (FAIS) with concomitant labral treatment in patients with mild osteoarthritis (OA) using modern surgical techniques.

Purpose:

To compare outcomes of hip arthroscopy for the treatment of FAIS between patients with mild OA (Tönnis grade 1) and patients without OA (Tönnis grade 0) at minimum 5-year follow-up.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

Patients were identified who underwent primary hip arthroscopy for FAIS with routine capsular closure between January 2012 and December 2015. Patients with Tönnis grade 1 were matched 1:3 by age, sex, and body mass index to patients without OA. The Hip Outcome Score–Activities of Daily Living (HOS-ADL), HOS–Sports Subscale (HOS-SS), modified Harris Hip Score, and 12-item International Hip Outcome Tool were collected preoperatively and at 5 years postoperatively and compared between groups using an independent t test. Survivorship rate and percentage achievement of a Patient Acceptable Symptom State (PASS) or minimal clinically important difference (MCID) were compared using a Fisher exact test.

Results:

A total of 50 patients (54 hips) with Tönnis grade 1 were matched to 162 patients (162 hips) with Tönnis grade 0. The mean ± SD age and body mass index of the Tönnis grade 1 group were 44.5 ± 9.6 years and 28.5 ± 5.5, respectively. Patient-reported outcome (PRO) scores improved significantly for both groups from presurgery to 5 years postoperatively for all PROs (P≤ .03). There were no significant differences in preoperative PROs between the groups. Patients with Tönnis grade 1 had significantly lower postoperative scores on the HOS-ADL (74.7 ± 22.6 vs 83.0 ± 20.1; P = .04) and HOS-SS (58.8 ± 33.7 vs 71.8 ± 29.3; P = .03) than patients with grade 0. Patients with Tönnis grade 1 also had significantly lower rates of achievement of the MCID (57.1% vs 80.2%; P < .01) and PASS (34.1% vs 53.4%; P = .03) for any PRO when compared with patients with Tönnis grade 0. Gross survivorship was significantly lower for Tönnis grade 1 versus grade 0 (77.8% vs 96.9%; P < .001).

Conclusion:

Patients with Tönnis grade 1 arthritis experienced significant improvement in PROs after hip arthroscopy for the treatment of FAIS. However, they had significantly lower postoperative HOS-ADL and HOS-SS scores with significantly lower rates of achievement on the MCID and PASS, with a significantly lower gross survivorship rate at a minimum 5 years postoperatively in comparison with those with Tönnis grade 0 changes.



中文翻译:

髋关节镜治疗轻度骨关节炎髋关节髋臼撞击综合征(Tönnis 1 级):至少 5 年随访的匹配比较队列分析

背景:

文献中缺乏关于使用现代手术技术对轻度骨关节炎 (OA) 患者进行关节镜治疗股骨髋臼撞击综合征 (FAIS) 的中期结果的中期结果的信息。

目的:

比较轻度 OA 患者(Tönnis 1 级)和非 OA 患者(Tönnis 0 级)在至少 5 年的随访中髋关节镜治疗 FAIS 的结果。

学习规划:

队列研究;证据水平,3。

方法:

确定了在 2012 年 1 月至 2015 年 12 月期间因 FAIS 接受初次髋关节镜检查并常规闭合关节囊的患者。Tönnis 1 级患者按年龄、性别和体重指数与没有 OA 的患者按 1:3 匹配。在术前和术后 5 年收集髋关节结果评分-日常生活活动 (HOS-ADL)、HOS-运动分量表 (HOS-SS)、改良 Harris 髋关节评分和 12 项国际髋关节结果工具,并在组间进行比较使用独立t检验。使用 Fisher 精确检验比较患者可接受症状状态 (PASS) 或最小临床重要差异 (MCID) 的存活率和百分比实现。

结果:

共有 50 名 Tönnis 1 级患者(54 髋)与 162 名 Tönnis 0 级患者(162 髋)匹配。Tönnis 1 级组的平均 ± SD 年龄和体重指数分别为 44.5 ± 9.6 岁和 28.5 ± 5.5,分别。从术前到术后 5 年,两组的患者报告结果 (PRO) 评分均显着提高(P ≤ .03)。组间术前PROs无显着差异。Tönnis 1 级患者的 HOS-ADL(74.7 ± 22.6 vs 83.0 ± 20.1;P = .04)和 HOS-SS(58.8 ± 33.7 vs 71.8 ± 29.3;P = .03)的术后评分显着低于0 级。Tönnis 1 级患者的 MCID 完成率也显着降低(57.1% vs 80.2%;与 Tönnis 0 级患者相比,任何 PRO 的P < .01)和通过(34.1% 对 53.4%;P = .03)。Tönnis 1 级与 0 级患者的总生存率显着降低(77.8% 对 96.9%;P < .001)。

结论:

Tönnis 1 级关节炎患者在髋关节镜检查治疗 FAIS 后 PROs 有显着改善。然而,与 Tönnis 0 级变化的患者相比,他们的术后 HOS-ADL 和 HOS-SS 评分显着降低,MCID 和 PASS 的成功率显着降低,术后至少 5 年的总生存率显着降低。

更新日期:2022-07-22
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