Abstract：
Hip arthroscopy has become the mainstay surgical intervention for the treatment of femoroacetabular impingement syndrome (FAIS). However, postoperative outcomes and rates of secondary surgery are mixed in patients with differing levels of preoperative osteoarthritis (OA). Furthermore, there is a paucity of literature comparing patients with and without OA at long-term follow-up.
To compare outcomes and rates of secondary surgery at minimum 10-year follow-up, including revision hip arthroscopy and conversion to total hip arthroplasty (THA), in patients with Tönnis grade 1 undergoing hip arthroscopy for FAIS compared with a propensity-matched control group of patients with Tönnis grade 0.
Cohort study; Level of evidence, 3.
Patients who underwent primary hip arthroscopy for FAIS between January 2012 and February 2013 were identified. Patients with Tönnis grade 1 were propensity matched in a 1:2 ratio by age, sex, and body mass index (BMI) to patients with Tönnis grade 0. Patient-reported outcomes (PROs) were collected at varying timepoints including preoperatively and 1, 2, 5, and 10 years postoperatively and compared between the 2 cohorts. Rates of minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) achievement at 10 years were evaluated and compared between groups. Rates of secondary surgery including revision hip arthroscopy and conversion to total hip arthroplasty (THA) were evaluated. Gross survivorship between cohorts was evaluated using a Kaplan-Meier gross survivorship curve. A subanalysis was performed comparing patients with Tönnis grade 1 who converted to THA and those who did not.
A total of 31 patients with Tönnis grade 1 (age, 42.6 ± 9.0 years; BMI, 28.0 ± 6.3) were successfully matched to 62 patients with Tönnis grade 0 (age, 42.1 ± 8.5, P = .805; BMI, 26.1 ± 3.9, P = .117). Both the Tönnis grade 1 and Tönnis grade 0 groups demonstrated significant improvements regarding all PROs at minimum 10 years (P < .05 for all), except for the Hip Outcome Score Activities of Daily Living subscale (HOS-ADL) (P = .066) in the Tönnis grade 1 cohort. No significant difference (P > .05 for all) was noted between cohorts regarding any 10-year PRO. When the authors evaluated comparisons between preoperative and 1-, 2-, 5-, and 10-year PRO measures, significant differences were noted between cohorts regarding 2-year HOS-ADL (P = .021), Hip Outcome Score Sports-Specific subscale (P = .016), and modified Harris Hip Score (P = .026); otherwise, differences did not reach significance. High rates of 10-year MCID and PASS achievement were seen, with no significant differences between groups. Patients with Tönnis grade 1 had significantly higher rates of conversion to THA compared with patients who had Tönnis grade 0 (25.8% vs 4.8%; P = .006). Patients with Tönnis grade 1 had significantly lower gross survivorship compared with those who had Tönnis grade 0 (71.0% vs 85.5%, respectively; P = .04).
Hip arthroscopy confers comparable postoperative clinical improvements to patients who have FAIS with and without mild OA; however, the benefits among patients with mild OA may be less durable. Patients with Tönnis grade 1 had significantly higher conversion to THA and reduced gross survivorship compared with patients with no evidence of preoperative OA, suggesting that patients with evidence of OA may need to be cautioned on the higher rate of conversion surgery.
To compare outcomes and rates of secondary surgery at minimum 10-year follow-up, including revision hip arthroscopy and conversion to total hip arthroplasty (THA), in patients with Tönnis grade 1 undergoing hip arthroscopy for FAIS compared with a propensity-matched control group of patients with Tönnis grade 0.
Cohort study; Level of evidence, 3.
Patients who underwent primary hip arthroscopy for FAIS between January 2012 and February 2013 were identified. Patients with Tönnis grade 1 were propensity matched in a 1:2 ratio by age, sex, and body mass index (BMI) to patients with Tönnis grade 0. Patient-reported outcomes (PROs) were collected at varying timepoints including preoperatively and 1, 2, 5, and 10 years postoperatively and compared between the 2 cohorts. Rates of minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) achievement at 10 years were evaluated and compared between groups. Rates of secondary surgery including revision hip arthroscopy and conversion to total hip arthroplasty (THA) were evaluated. Gross survivorship between cohorts was evaluated using a Kaplan-Meier gross survivorship curve. A subanalysis was performed comparing patients with Tönnis grade 1 who converted to THA and those who did not.
A total of 31 patients with Tönnis grade 1 (age, 42.6 ± 9.0 years; BMI, 28.0 ± 6.3) were successfully matched to 62 patients with Tönnis grade 0 (age, 42.1 ± 8.5, P = .805; BMI, 26.1 ± 3.9, P = .117). Both the Tönnis grade 1 and Tönnis grade 0 groups demonstrated significant improvements regarding all PROs at minimum 10 years (P < .05 for all), except for the Hip Outcome Score Activities of Daily Living subscale (HOS-ADL) (P = .066) in the Tönnis grade 1 cohort. No significant difference (P > .05 for all) was noted between cohorts regarding any 10-year PRO. When the authors evaluated comparisons between preoperative and 1-, 2-, 5-, and 10-year PRO measures, significant differences were noted between cohorts regarding 2-year HOS-ADL (P = .021), Hip Outcome Score Sports-Specific subscale (P = .016), and modified Harris Hip Score (P = .026); otherwise, differences did not reach significance. High rates of 10-year MCID and PASS achievement were seen, with no significant differences between groups. Patients with Tönnis grade 1 had significantly higher rates of conversion to THA compared with patients who had Tönnis grade 0 (25.8% vs 4.8%; P = .006). Patients with Tönnis grade 1 had significantly lower gross survivorship compared with those who had Tönnis grade 0 (71.0% vs 85.5%, respectively; P = .04).
Hip arthroscopy confers comparable postoperative clinical improvements to patients who have FAIS with and without mild OA; however, the benefits among patients with mild OA may be less durable. Patients with Tönnis grade 1 had significantly higher conversion to THA and reduced gross survivorship compared with patients with no evidence of preoperative OA, suggesting that patients with evidence of OA may need to be cautioned on the higher rate of conversion surgery.
摘要：
■髋关节镜已成为治疗股骨髋臼撞击综合征（FAIS）的主要手术方法。然而,术前骨关节炎(OA)程度不同的患者的术后结局和二次手术率参差不齐.此外，缺乏在长期随访中比较有和无OA患者的文献.
■为了比较至少10年随访的二次手术的结果和率，包括修订髋关节镜和转换为全髋关节置换术（THA），在接受FAIS髋关节镜检查的Tönnis1级患者中，与Tönnis0级患者的倾向匹配对照组进行比较。
■队列研究；证据水平，3.
■在2012年1月至2013年2月期间接受过FAIS初次髋关节镜检查的患者。Tönnis1级患者的倾向匹配为1：2的年龄比例，性别,和体重指数（BMI）为Tönis等级为0的患者。在不同的时间点收集患者报告的结果（PRO），包括术前和术后1、2、5和10年，并在两个队列之间进行比较。评估并比较两组之间在10年时的最小临床重要差异（MCID）和患者可接受症状状态（PASS）成就率。评估了二次手术的发生率，包括髋关节镜翻修术和转换为全髋关节置换术（THA）。使用Kaplan-Meier总体生存率曲线评估队列之间的总体生存率。进行了亚分析，比较了Tönnnis1级转换为THA的患者和未转换为THA的患者。
■共有31名Tönis1级患者（年龄，42.6±9.0岁；BMI，28.0±6.3)与62例Tönis0级患者(年龄,42.1±8.5，P=.805；BMI，26.1±3.9，P=.117）。Tönnnis1级和Tönnis0级组均显示出至少10年所有专业人员的显着改善（所有P<0.05），除了Tönnis1级队列中的髋关节结果评分日常生活活动量表（HOS-ADL）（P=.066）。关于任何10年PRO，队列之间没有显着差异（全部P>0.05）。当作者评估术前与1-之间的比较时，2-,5-,和10年的PRO措施，在2年HOS-ADL方面，队列之间存在显着差异（P=.021），髋关节结果评分运动特定分量表（P=.016），并修改哈里斯髋关节评分(P=.026)；否则，差异没有达到显著性。看到了10年MCID和PASS成就的高比率，组间无显著差异。与Tönis等级为0的患者相比，Tönis等级为1的患者转换为THA的比率明显更高（25.8％vs4.8％；P=.006）。与Tönis等级为0的患者相比，Tönnis等级为1的患者的总体生存率显着降低（71.0％vs85.5％，分别为；P=.04）。
■髋关节镜检查可为患有和不患有轻度OA的FAIS患者提供相当的术后临床改善；然而，轻度OA患者的获益可能不那么持久.与没有术前OA证据的患者相比，Tönnis1级患者向THA的转化率明显更高，总体生存率降低。提示有OA证据的患者可能需要注意更高的转换手术率。
■为了比较至少10年随访的二次手术的结果和率，包括修订髋关节镜和转换为全髋关节置换术（THA），在接受FAIS髋关节镜检查的Tönnis1级患者中，与Tönnis0级患者的倾向匹配对照组进行比较。
■队列研究；证据水平，3.
■在2012年1月至2013年2月期间接受过FAIS初次髋关节镜检查的患者。Tönnis1级患者的倾向匹配为1：2的年龄比例，性别,和体重指数（BMI）为Tönis等级为0的患者。在不同的时间点收集患者报告的结果（PRO），包括术前和术后1、2、5和10年，并在两个队列之间进行比较。评估并比较两组之间在10年时的最小临床重要差异（MCID）和患者可接受症状状态（PASS）成就率。评估了二次手术的发生率，包括髋关节镜翻修术和转换为全髋关节置换术（THA）。使用Kaplan-Meier总体生存率曲线评估队列之间的总体生存率。进行了亚分析，比较了Tönnnis1级转换为THA的患者和未转换为THA的患者。
■共有31名Tönis1级患者（年龄，42.6±9.0岁；BMI，28.0±6.3)与62例Tönis0级患者(年龄,42.1±8.5，P=.805；BMI，26.1±3.9，P=.117）。Tönnnis1级和Tönnis0级组均显示出至少10年所有专业人员的显着改善（所有P<0.05），除了Tönnis1级队列中的髋关节结果评分日常生活活动量表（HOS-ADL）（P=.066）。关于任何10年PRO，队列之间没有显着差异（全部P>0.05）。当作者评估术前与1-之间的比较时，2-,5-,和10年的PRO措施，在2年HOS-ADL方面，队列之间存在显着差异（P=.021），髋关节结果评分运动特定分量表（P=.016），并修改哈里斯髋关节评分(P=.026)；否则，差异没有达到显著性。看到了10年MCID和PASS成就的高比率，组间无显著差异。与Tönis等级为0的患者相比，Tönis等级为1的患者转换为THA的比率明显更高（25.8％vs4.8％；P=.006）。与Tönis等级为0的患者相比，Tönnis等级为1的患者的总体生存率显着降低（71.0％vs85.5％，分别为；P=.04）。
■髋关节镜检查可为患有和不患有轻度OA的FAIS患者提供相当的术后临床改善；然而，轻度OA患者的获益可能不那么持久.与没有术前OA证据的患者相比，Tönnis1级患者向THA的转化率明显更高，总体生存率降低。提示有OA证据的患者可能需要注意更高的转换手术率。
