Background:

Bilateral hip symptoms from femoroacetabular impingement syndrome (FAIS) are a common finding in patients regardless of athletic involvement. Oftentimes, patients and surgeons choose to stage bilateral hip arthroscopic surgery.

Purpose/Hypothesis:

The purpose of this study was (1) to compare minimum 2-year outcomes between patients who underwent staged bilateral hip arthroscopic surgery for FAIS to a propensity score–matched control group that underwent unilateral hip arthroscopic surgery and (2) to investigate the effect of time between bilateral procedures on patient-reported outcomes (PROs). We hypothesized that, after bilateral hip arthroscopic surgery, the improvement in outcomes would be similar to that after unilateral hip arthroscopic surgery and the time duration between bilateral procedures would not affect the final outcome.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

Data were retrospectively reviewed on a consecutive series of patients who underwent primary hip arthroscopic surgery at our institution between June 2008 and November 2017. Patients who underwent bilateral hip arthroscopic surgery with minimum 2-year PROs for the modified Harris Hip Score (mHHS), the Nonarthritic Hip Score (NAHS), the Hip Outcome Score–Sports Specific Subscale (HOS-SSS), patient satisfaction, and a visual analog scale (VAS) for pain were included. The study group was matched 1:1 based on age, sex, and body mass index to a control group that only required unilateral hip arthroscopic surgery. Additionally, a subanalysis was performed on the study group to determine the effect of time between arthroscopic procedures. Rates of achieving the minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) for the mHHS and HOS-SSS were determined. The P value was set at <.05.

Results:

A total of 205 patients (410 hips) were included. The mean age and body mass index of the study group were 32.3 ± 13.2 years and 25.0 ± 5.1, respectively. All 410 hips that met the inclusion criteria were matched. There were no significant differences in patient, radiographic, or procedural data. A significant and comparable improvement was reported for all PRO measures and the VAS (P < .0001) in both groups. Similarly, rates of achieving the MCID and PASS were comparable. After dividing the study group based on whether the contralateral procedure was performed <3 months or >3 months after the first procedure, it was determined that patients had a significant improvement and favorable outcomes regardless of time between bilateral procedures.

Conclusion:

Patients who underwent unilateral and bilateral hip arthroscopic surgery for FAIS had a significant and comparable improvement in PROs at a minimum 2-year follow-up. A time interval of <3 months or >3 months between bilateral procedures did not affect PROs.

中文翻译：

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股骨髋臼撞击综合征背景下分期双侧髋关节镜手术的结果：一项针对手术间隔时间影响的嵌套配对对照研究

背景：

股髋臼撞击综合征 (FAIS) 引起的双侧髋关节症状在患者中很常见，无论是否参与运动。通常，患者和外科医生会选择进行双侧髋关节镜手术。

目的/假设：

本研究的目的是（1）比较接受分期双侧髋关节镜手术治疗 FAIS 的患者与倾向评分匹配的对照组接受单侧髋关节镜手术的患者之间的至少 2 年结果，以及（2）研究患者报告结果 (PROs) 的双边程序之间的时间。我们假设，在双侧髋关节镜手术后，结果的改善将与单侧髋关节镜手术后的相似，并且双侧手术之间的持续时间不会影响最终结果。

学习规划：

队列研究；证据水平，3。

方法：

回顾性分析了 2008 年 6 月至 2017 年 11 月期间在我们机构接受初次髋关节镜手术的连续系列患者的数据。接受双侧髋关节镜手术且改良 Harris 髋关节评分 (mHHS) 至少 2 年 PRO 的患者，包括非关节炎髋关节评分 (NAHS)、髋关节结果评分-运动特定分量表 (HOS-SSS)、患者满意度和疼痛视觉模拟量表 (VAS)。根据年龄、性别和体重指数，研究组与仅需要单侧髋关节镜手术的对照组进行 1:1 匹配。此外，对研究组进行了子分析，以确定关节镜手术之间时间的影响。确定了 mHHS 和 HOS-SSS 实现最小临床重要差异 (MCID) 和患者可接受症状状态 (PASS) 的比率。这P值设定为 <.05。

结果：

共纳入 205 名患者（410 髋）。研究组的平均年龄和体重指数分别为 32.3 ± 13.2 岁和 25.0 ± 5.1。符合纳入标准的所有 410 个髋关节均匹配。患者、影像学或程序数据没有显着差异。两组的所有 PRO 测量和 VAS ( P < .0001) 均报告了显着且可比的改善。同样，达到 MCID 和 PASS 的比率是可比的。根据对侧手术是否在第一次手术后<3个月或>3个月进行划分研究组后，确定无论双侧手术之间的时间长短，患者都有显着的改善和良好的结果。

结论：

接受单侧和双侧髋关节镜手术治疗 FAIS 的患者在至少 2 年的随访中获得了显着且相当的 PROs 改善。双边程序之间<3 个月或>3 个月的时间间隔不影响PROs。