Abstract：
UNASSIGNED: The indications for hip arthroscopy in patients aged ≥40 years remain controversial, as observational studies have suggested that advanced age portends poor functional outcomes, poor durability of improvement, and high rates of conversion to total hip arthroplasty.
UNASSIGNED: To compare hip arthroscopy versus nonoperative management for symptomatic labral tears in patients aged ≥40 years with limited radiographic osteoarthritis.
UNASSIGNED: Randomized controlled trial; Level of evidence, 1.
UNASSIGNED: This single-surgeon, parallel randomized controlled trial included patients aged ≥40 years with limited osteoarthritis (Tönnis grades 0-2) who were randomized 1:1 to arthroscopic surgery with postoperative physical therapy (SPT) or physical therapy alone (PTA). Patients who received PTA and achieved unsatisfactory improvement were permitted to cross over to SPT after completing ≥14 weeks of physical therapy (CO). The primary outcomes were the International Hip Outcome Tool-33 score and modified Harris Hip Score at 24 months after surgery, and secondary outcomes included other patient-reported outcome measures and the visual analog scale for pain. The primary analysis was performed on an intention-to-treat basis using linear mixed-effects models. Sensitivity analyses included modified as-treated and treatment-failure analyses.
UNASSIGNED: A total of 97 patients were included, with 52 (53.6%) patients in the SPT group and 45 (46.4%) patients in the PTA group. Of the patients who underwent PTA, 32 (71.1%) patients crossed over to arthroscopy at a mean of 5.10 months (SD, 3.3 months) after physical therapy initiation. In both intention-to-treat and modified as-treated analyses, the SPT group displayed superior mean patient-reported outcome measure and pain scores across the study period for nearly all metrics relative to the PTA group. In the treatment-failure analysis, the SPT and CO groups showed greater improvement across all metrics compared with PTA; however, post hoc analyses revealed no significant differences in improvement between the SPT and CO groups. No significant differences were observed between groups in rates of total hip arthroplasty conversion.
UNASSIGNED: In patients ≥40 years of age with limited osteoarthritis, hip arthroscopy with postoperative physical therapy led to better outcomes than PTA at a 24-month follow-up. However, additional preoperative physical therapy did not compromise surgical outcomes and allowed some patients to avoid surgery. When surgery is indicated, age ≥40 years should not be considered an independent contraindication to arthroscopic acetabular labral repair.
UNASSIGNED: NCT03909178 (ClinicalTrials.gov identifier).
UNASSIGNED: To compare hip arthroscopy versus nonoperative management for symptomatic labral tears in patients aged ≥40 years with limited radiographic osteoarthritis.
UNASSIGNED: Randomized controlled trial; Level of evidence, 1.
UNASSIGNED: This single-surgeon, parallel randomized controlled trial included patients aged ≥40 years with limited osteoarthritis (Tönnis grades 0-2) who were randomized 1:1 to arthroscopic surgery with postoperative physical therapy (SPT) or physical therapy alone (PTA). Patients who received PTA and achieved unsatisfactory improvement were permitted to cross over to SPT after completing ≥14 weeks of physical therapy (CO). The primary outcomes were the International Hip Outcome Tool-33 score and modified Harris Hip Score at 24 months after surgery, and secondary outcomes included other patient-reported outcome measures and the visual analog scale for pain. The primary analysis was performed on an intention-to-treat basis using linear mixed-effects models. Sensitivity analyses included modified as-treated and treatment-failure analyses.
UNASSIGNED: A total of 97 patients were included, with 52 (53.6%) patients in the SPT group and 45 (46.4%) patients in the PTA group. Of the patients who underwent PTA, 32 (71.1%) patients crossed over to arthroscopy at a mean of 5.10 months (SD, 3.3 months) after physical therapy initiation. In both intention-to-treat and modified as-treated analyses, the SPT group displayed superior mean patient-reported outcome measure and pain scores across the study period for nearly all metrics relative to the PTA group. In the treatment-failure analysis, the SPT and CO groups showed greater improvement across all metrics compared with PTA; however, post hoc analyses revealed no significant differences in improvement between the SPT and CO groups. No significant differences were observed between groups in rates of total hip arthroplasty conversion.
UNASSIGNED: In patients ≥40 years of age with limited osteoarthritis, hip arthroscopy with postoperative physical therapy led to better outcomes than PTA at a 24-month follow-up. However, additional preoperative physical therapy did not compromise surgical outcomes and allowed some patients to avoid surgery. When surgery is indicated, age ≥40 years should not be considered an independent contraindication to arthroscopic acetabular labral repair.
UNASSIGNED: NCT03909178 (ClinicalTrials.gov identifier).
摘要：
■对于年龄≥40岁的患者，髋关节镜检查的适应症仍存在争议，正如观察性研究表明，高龄预示着不良的功能结局，改进的耐久性差，和高的全髋关节置换术的转换率。
■比较髋关节镜检查与非手术治疗对年龄≥40岁的X线片有限的骨关节炎患者的症状性唇撕裂。
■随机对照试验；证据水平，1.
■这位单外科医生,平行随机对照试验纳入年龄≥40岁的局限性骨性关节炎(Tönnnis0~2级)患者,这些患者以1:1的比例随机分为关节镜手术联合术后物理治疗(SPT)或单纯物理治疗(PTA).接受PTA并取得不令人满意的改善的患者在完成≥14周的物理治疗（CO）后被允许跨入SPT。主要结果是手术后24个月的国际髋关节结果工具-33评分和改良的Harris髋关节评分。次要结局包括患者报告的其他结局指标和疼痛视觉模拟量表.主要分析是使用线性混合效应模型在意向治疗的基础上进行的。敏感性分析包括改良的治疗和治疗失败分析。
■共包括97名患者，SPT组52例（53.6%），PTA组45例（46.4%）。在接受PTA的患者中，32例(71.1%)患者在平均5.10个月时接受关节镜检查(SD，物理治疗开始后3.3个月）。在意向治疗和修改后的治疗分析中，与PTA组相比,SPT组在整个研究期间,在几乎所有指标中,患者报告的平均结局指标和疼痛评分均较高.在处理失败分析中，与PTA相比，SPT和CO组在所有指标上都显示出更大的改善；然而，事后分析显示，SPT组和CO组之间的改善没有显着差异。两组之间的全髋关节置换术转换率没有显着差异。
■对于年龄≥40岁的局限性骨关节炎患者，在24个月的随访中,髋关节镜检查加术后物理治疗的结果优于PTA.然而,额外的术前物理治疗不会影响手术结局,部分患者可以避免手术.当需要手术时，年龄≥40岁不应被视为关节镜下髋臼唇修复术的独立禁忌症.
■NCT03909178（ClinicalTrials.gov标识符）。
■比较髋关节镜检查与非手术治疗对年龄≥40岁的X线片有限的骨关节炎患者的症状性唇撕裂。
■随机对照试验；证据水平，1.
■这位单外科医生,平行随机对照试验纳入年龄≥40岁的局限性骨性关节炎(Tönnnis0~2级)患者,这些患者以1:1的比例随机分为关节镜手术联合术后物理治疗(SPT)或单纯物理治疗(PTA).接受PTA并取得不令人满意的改善的患者在完成≥14周的物理治疗（CO）后被允许跨入SPT。主要结果是手术后24个月的国际髋关节结果工具-33评分和改良的Harris髋关节评分。次要结局包括患者报告的其他结局指标和疼痛视觉模拟量表.主要分析是使用线性混合效应模型在意向治疗的基础上进行的。敏感性分析包括改良的治疗和治疗失败分析。
■共包括97名患者，SPT组52例（53.6%），PTA组45例（46.4%）。在接受PTA的患者中，32例(71.1%)患者在平均5.10个月时接受关节镜检查(SD，物理治疗开始后3.3个月）。在意向治疗和修改后的治疗分析中，与PTA组相比,SPT组在整个研究期间,在几乎所有指标中,患者报告的平均结局指标和疼痛评分均较高.在处理失败分析中，与PTA相比，SPT和CO组在所有指标上都显示出更大的改善；然而，事后分析显示，SPT组和CO组之间的改善没有显着差异。两组之间的全髋关节置换术转换率没有显着差异。
■对于年龄≥40岁的局限性骨关节炎患者，在24个月的随访中,髋关节镜检查加术后物理治疗的结果优于PTA.然而,额外的术前物理治疗不会影响手术结局,部分患者可以避免手术.当需要手术时，年龄≥40岁不应被视为关节镜下髋臼唇修复术的独立禁忌症.
■NCT03909178（ClinicalTrials.gov标识符）。
