Rate of continued conservative management versus progression to surgery at minimum 1-year follow-up in patients with pre-arthritic hip pain.
Rate of continued conservative management versus progression to surgery at minimum 1-year follow-up in patients with pre-arthritic hip pain.
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DOI：
10.1002/pmrj.12746
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发表时间：
2022-05
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影响因子：
--
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中科院分区：
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大量文献描述了关节炎前期髋部疼痛的手术结果，但进展到手术的患者比例仍然未知。旨在确定因关节炎前髋部疼痛而到三级转诊中心就诊并在至少一年随访后进行手术的患者比例。回顾性队列研究。单一三级护理学术医疗中心。 13 至 40 岁的患者向保守或外科骨科专家进行初步评估，并被诊断为关节炎前期髋部疼痛（n = 713 名患者，830 个髋部）。不适用。主要结局是整个队列至少一年随访后进展至手术的比率。使用多元逻辑回归确定整个队列和放射学定义的亚组的手术进展预测因子。候选预测因素包括基线人口统计学、放射学、临床诊断和患者报告的结果测量。在平均年龄 25.4 (SD 8.1) 岁、72.7% 为女性、平均随访 2.6（范围 1.0–4.8）年的队列中，429/830 髋关节（51.7% [95% CI 48.2%−55.1%]）进展到手术。整个队列中手术进展的预测因素包括年龄较小（OR 0.95/年[95% CI 0.93–0.98]）、疼痛持续时间超过六个月（OR 1.87–2.03，p≤0.027）、身体功能较差（OR 0.96/患者报告结果测量信息系统（PROMIS）点[0.92–0.99]）以及临床诊断股骨髋臼撞击 (FAI)（OR 3.47 [2.05–5.89]）、髋臼发育不良（OR 2.75 [1.73–4.35]）和/或盂唇撕裂（OR 10.71 [6.98–16.47]）。放射学不典型增生（外侧中心边缘角<20°）增加了所有亚组手术的可能性（OR 2.05–8.47，p≤.008）。增加最大 α 角增加了严重 cam FAI (α>63°) 患者手术的可能性 (OR 1.03/度 [1.00–1.06])。几乎一半患有关节炎前髋部疼痛的患者在至少一年的随访中没有进展到手术。对于大多数患者来说，尝试保守治疗可能是值得的。
Extensive literature has described surgical outcomes for pre-arthritic hip pain, but the proportion of patients who progress to surgery remains unknown. To determine the proportion of patients who present to a tertiary referral center for pre-arthritic hip pain and progress to surgery at minimum one year follow-up. Retrospective cohort study. Single tertiary care academic medical center. Thirteen to 40-year-olds who presented for initial evaluation to a conservative or surgical orthopedic specialist and were diagnosed with pre-arthritic hip pain (n=713 patients, 830 hips). Not applicable. The primary outcome was the rate of progression to surgery at minimum one year follow-up for the entire cohort. Predictors of progression to surgery were determined for the entire cohort and for radiographically defined subgroups using multiple logistic regression. Candidate predictors included baseline demographic, radiographic, clinical diagnosis, and patient-reported outcome measures. In a cohort with mean age 25.4 (SD 8.1) years, 72.7% female, and mean follow-up 2.6 (range 1.0–4.8) years, 429/830 hips (51.7% [95% CI 48.2%−55.1%]) progressed to surgery. Predictors of surgical progression in the entire cohort included younger age (OR 0.95/year [95% CI 0.93–0.98]), pain duration longer than six months (OR 1.87–2.03, p≤.027), worse physical function (OR 0.96/Patient-Reported Outcomes Measurement Information System (PROMIS) point [0.92–0.99]), and a clinical diagnosis of femoroacetabular impingement (FAI) (OR 3.47 [2.05–5.89]), acetabular dysplasia (OR 2.75 [1.73–4.35]), and/or labral tear (OR 10.71 [6.98–16.47]). Radiographic dysplasia (lateral center edge angle<20°) increased the likelihood of surgery in all subgroups (OR 2.05–8.47, p≤.008). Increasing maximum α angle increased the likelihood of surgery in patients with severe cam FAI (α>63°) (OR 1.03/degree [1.00–1.06]). Almost half of patients with pre-arthritic hip pain did not progress to surgery at minimum one year follow-up. A trial of conservative management is likely worthwhile in most patients.
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影响因子：
4.3
作者：
Hays, Ron D.;Spritzer, Karen L.;Amtmann, Dagmar;Lai, Jin-Shei;DeWitt, Esi Morgan;Rothrock, Nan;DeWalt, Darren A.;Riley, William T.;Fries, James F.;Krishnan, Eswar
通讯作者：
Krishnan, Eswar
影响因子：
5.3
作者：
Clohisy, John C.;Carlisle, John C.;Millis, Michael B.
通讯作者：
Millis, Michael B.
影响因子：
4.8
作者：
Beck, Edward C.;Drager, Justin;Nho, Shane J.
通讯作者：
Nho, Shane J.
影响因子：
1.5
作者：
Degen RM;Bernard JA;Pan TJ;Ranawat AS;Nawabi DH;Kelly BT;Lyman S
通讯作者：
Lyman S
DOI：
10.13063/2327-9214.1015
发表时间：
2013
期刊：
EGEMS (Washington, DC)
影响因子：
--
作者：
Broderick JE;DeWitt EM;Rothrock N;Crane PK;Forrest CB
通讯作者：
Forrest CB