PDF(Pubmed)
Abstract：
UNASSIGNED: 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.
UNASSIGNED: 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).
UNASSIGNED: Cohort study; Level of evidence, 3.
UNASSIGNED: 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.
UNASSIGNED: 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).
UNASSIGNED: 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.
UNASSIGNED: 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).
UNASSIGNED: Cohort study; Level of evidence, 3.
UNASSIGNED: 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.
UNASSIGNED: 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).
UNASSIGNED: 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.
摘要：
■股骨髋臼撞击（FAI）和症状性唇撕裂的关节镜治疗可带来短期至中期的益处，但需要进一步的长期证据.此外，尽管软骨室连接处（CLJ）具有生理和生物力学意义，该过渡区受损的临床意义仍未得到充分研究。
■为了(1)报告FAI髋关节镜检查后的8年生存率和患者报告的结局指标，以及(2)表征结局与患者特征之间的关联（年龄，身体质量指数,sex),病理参数(Tönnis角度，α角,FAI类型,CLJ击穿)，和执行的程序(实验室管理，FAI治疗,微骨折）。
■队列研究；证据水平，3.
这项回顾性队列研究纳入了2002年至2013年期间一名外科医生因FAI继发症状性唇膜撕裂而接受初次髋关节镜检查的患者。所有患者年龄≥18岁，至少有8年的随访和可用的术前X光片。主要结果是转换为全髋关节置换术（THA），次要结果包括关节镜翻修术，患者报告的结果指标，患者满意度。使用Beck分类评估CLJ分解。使用Kaplan-Meier估计和加权Cox回归来估计10年生存率（未转换为THA）并确定与THA转换相关的风险因素。
■在这项174髋的研究中（50.6％的女性；平均年龄，37.8±11.2年），平均随访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年转换为THA。未经调整的分析揭示了几个与THA转化显著相关的变量，包括年龄较大；较高的体重指数；较高的Tönnis等级；唇清创术；以及CLJ的晚期分解，Labrum,或关节软骨。表现为严重（43.6％；95％CI，31.9％-59.7％）与轻度（97.9％；95％CI，95.1％-100％）的CLJ分解的患者在10年时的生存率较差（P<.001）。多变量分析确定了恶化的CLJ击穿(每增加1个单位的加权危险比，6.41；95%CI，3.11-13.24)，年龄较大（1.09；95%CI，1.04-1.14），较高的Tönnis等级（4.59；95%CI，2.13-9.90）作为独立的阴性预后指标（全部P<.001）。
■尽管大多数患者取得了良好的最低8年结局，几个术前和术中因素与THA转换相关；其中，更糟糕的CLJ故障，更高的Tönnis等级,年龄和年龄是最强的预测因素。
■为了(1)报告FAI髋关节镜检查后的8年生存率和患者报告的结局指标，以及(2)表征结局与患者特征之间的关联（年龄，身体质量指数,sex),病理参数(Tönnis角度，α角,FAI类型,CLJ击穿)，和执行的程序(实验室管理，FAI治疗,微骨折）。
■队列研究；证据水平，3.
这项回顾性队列研究纳入了2002年至2013年期间一名外科医生因FAI继发症状性唇膜撕裂而接受初次髋关节镜检查的患者。所有患者年龄≥18岁，至少有8年的随访和可用的术前X光片。主要结果是转换为全髋关节置换术（THA），次要结果包括关节镜翻修术，患者报告的结果指标，患者满意度。使用Beck分类评估CLJ分解。使用Kaplan-Meier估计和加权Cox回归来估计10年生存率（未转换为THA）并确定与THA转换相关的风险因素。
■在这项174髋的研究中（50.6％的女性；平均年龄，37.8±11.2年），平均随访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年转换为THA。未经调整的分析揭示了几个与THA转化显著相关的变量，包括年龄较大；较高的体重指数；较高的Tönnis等级；唇清创术；以及CLJ的晚期分解，Labrum,或关节软骨。表现为严重（43.6％；95％CI，31.9％-59.7％）与轻度（97.9％；95％CI，95.1％-100％）的CLJ分解的患者在10年时的生存率较差（P<.001）。多变量分析确定了恶化的CLJ击穿(每增加1个单位的加权危险比，6.41；95%CI，3.11-13.24)，年龄较大（1.09；95%CI，1.04-1.14），较高的Tönnis等级（4.59；95%CI，2.13-9.90）作为独立的阴性预后指标（全部P<.001）。
■尽管大多数患者取得了良好的最低8年结局，几个术前和术中因素与THA转换相关；其中，更糟糕的CLJ故障，更高的Tönnis等级,年龄和年龄是最强的预测因素。
