Residual Deformity Is the Most Common Reason for Revision Hip Arthroscopy: A Three-dimensional CT Study
Residual Deformity Is the Most Common Reason for Revision Hip Arthroscopy: A Three-dimensional CT Study
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DOI：
10.1007/s11999-014-4069-9
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发表时间：
2015-04-01
影响因子：
4.2
通讯作者：
Bedi, Asheesh
中科院分区：
文献类型：
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作者：
Ross, James R.;Larson, Christopher M.;Bedi, Asheesh
先前的研究报告，残余畸形是髋关节镜翻修的最常见原因。本研究的目的是：（1）确定股骨髋臼撞击（FAI）翻修手术前有残留症状的髋关节的三维（3-D）形态;（2）使用动态、计算机辅助、3-D分析确定这些患者的活动范围（ROM）限制;在2008年至2013年期间，一名资深外科医生（BTK）对既往关节镜手术失败后有残余FAI畸形和症状的患者进行了关节镜下FAI翻修手术;所有47例患者（50个髋关节）均进行了术前CT扫描。患者平均年龄为29 ± 9岁（范围：16-52岁）。创建髋关节的三维模型，以允许使用经验证的基于计算机的动态成像软件测量股骨和髋臼形态以及骨撞击的ROM。在同一时间段内，由同一外科医生成功进行FAI初次关节镜治疗的65例患者接受了症状性对侧髋关节的术前CT扫描;因此，该组65例患者偶然提供了最初手术髋关节的术后评价，并作为对照组。对初次成功FAI治疗队列中的虚拟矫正与实际矫正进行了比较。相应地，将推荐的虚拟矫正与翻修队列中初次手术失败后就诊时明显的矫正进行了比较。分析由两个独立的观察者（JRR，OA）进行，配对t检验用于连续变量的比较，而卡方检验用于分类变量，p < 0.05定义为显著性。（45/50）因症状性FAI接受翻修手术的患者存在残余畸形;翻修髋关节的平均最大α角为68 A ° AA +/-A16 A °，最常位于1：15，将髋臼视为钟面，1 - 5点为独立于侧的前部。26%（13/50）的髋关节有过度覆盖的迹象，外侧中心边缘角大于或等于40 A度。动态分析显示，平均直接髋关节屈曲114 A度A A +/- A 11 A度的骨撞击。髋关节内旋90 A °屈曲、内收、内旋与骨接触分别为28 A ° AA +/-A12 A °和20 A ° AA +/-A10 A °，这比接受高容量髋关节镜手术的髋关节少（所有p < 0.001）。我们发现，与大多数患者存在残余畸形的成功结果相比，有残余症状的患者存在明显的畸形不完全矫正的放射学证据（45/50 [90%]）接受残余FAI手术。我们建议对撞击结构的全三维切除给予谨慎的关注。III级，回顾性研究，病例系列。
Previous studies have reported residual deformity to be the most common reason for revision hip arthroscopy. An awareness of the most frequent locations of the residual deformities may be critical to minimize these failures.The purposes of this study were to (1) define the three-dimensional (3-D) morphology of hips with residual symptoms before revision femoroacetabular impingement (FAI) surgery; (2) determine the limitation in range of motion (ROM) in these patients using dynamic, computer-assisted, 3-D analysis; and (3) compare these measures with a cohort of patients who underwent successful arthroscopic surgery for FAI by a high-volume hip arthroscopist.Between 2008 and 2013, one senior surgeon (BTK) performed revision arthroscopic FAI procedures on patients with residual FAI deformity and symptoms after prior unsuccessful arthroscopic surgery; all of these 47 patients (50 hips) had preoperative CT scans. Mean patient age was 29 +/- A 9 years (range, 16-52 years). Three-dimensional models of the hips were created to allow measurements of femoral and acetabular morphology and ROM to bony impingement using a validated, computer-based dynamic imaging software. During the same time period, 65 patients with successful primary arthroscopic treatment of FAI by the same surgeon underwent preoperative CT scans for the symptomatic contralateral hip; this group of 65 patients thus fortuitously provided postoperative evaluation of the originally operated hip and served as a control group. A comparison of the virtual correction with the actual correction in the primary successful FAI treatment cohort was performed. Correspondingly, a comparison of the recommended virtual correction with the correction evident at the time of presentation after failed primary surgery in the revision cohort was performed. Analysis was performed by two independent observers (JRR, OA) and a paired t-test was used for comparison of continuous variables, whereas chi-square testing was used for categorical variables with p < 0.05 defined as significant.Ninety percent (45 of 50) of patients undergoing revision surgery for symptomatic FAI had residual deformities; the mean maximal alpha angle in revision hips was 68A degrees A A +/- A 16A degrees and was most often located at 1:15, considering the acetabulum as a clockface and 1 to 5 o'clock as anterior independent of side. Twenty-six percent (13 of 50) of hips had signs of overcoverage with a lateral center-edge angle greater than or equal to 40A degrees. Dynamic analysis revealed mean direct hip flexion of 114A degrees A A +/- A 11A degrees to osseous impingement. Internal rotation in 90A degrees of hip flexion and flexion, adduction, internal rotation to osseous contact were 28A degrees A A +/- A 12A degrees and 20A degrees A A +/- A 10A degrees, respectively, which were less than those in hips that had underwent hip arthroscopy by a high-volume hip arthroscopist (all p < 0.001).We found marked radiographic evidence of incomplete correction of deformity in patients with residual symptoms compared with patients with successful results with residual deformity present in the large majority of patients (45 of 50 [90%]) undergoing residual FAI surgery. We recommend careful attention to full 3-D resection of impinging structures.Level III, retrospective study, case series.