Does Obesity Affect Outcomes in Hip Arthroscopy? A Matched-Pair Controlled Study With Minimum 2-Year Follow-up
Does Obesity Affect Outcomes in Hip Arthroscopy? A Matched-Pair Controlled Study With Minimum 2-Year Follow-up
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DOI：
10.1177/0363546514565089
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发表时间：
2015-04-01
影响因子：
4.8
通讯作者：
Domb, Benjamin G.
中科院分区：
文献类型：
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作者：
Gupta, Asheesh;Redmond, John M.;Domb, Benjamin G.
背景：髋关节镜在过去十年中越来越受欢迎，随着新技术的发展，其适应症也越来越广泛。然而，一直缺乏文献评估髋关节镜手术的结果在肥胖patients.Purpose：比较2年的临床结果肥胖患者行初次髋关节镜手术与匹配的nonobese controls.Study设计：队列研究;证据等级，3.方法：从2008年2月至2012年2月，前瞻性收集所有肥胖患者行初次髋关节镜手术的数据。以1：2的比例选择配对的非肥胖对照组。所有患者均在术前和术后采用4项患者报告结局（PRO）指标进行评估：改良Harris髋关节评分、非关节炎髋关节评分、髋关节结局评分-日常生活活动和髋关节结局评分-运动特定子量表。结果：肥胖组62例（62髋），对照组124例（124髋）。在术前基线时，肥胖组的PRO评分显著低于对照组。两组的所有评分均显示出统计学显著的术后改善（P <0.05）。术前和术后，肥胖组的所有PRO指标的绝对评分均显著较低。然而，两组之间PRO评分从术前到术后的改善（Δ）无显著差异。转换为全髋关节置换术，翻修率和并发症发生率在两组之间没有显着差异;然而，转换为全髋关节置换术和翻修率往往是肥胖患者的两倍高，但该研究没有动力为这2 outcome.Conclusion：总体而言，肥胖患者术前和2年随访时的绝对PRO评分较低。肥胖和非肥胖患者的所有PRO评分均显示出显著改善，并且两组之间的评分变化相似。这些结果表明，虽然肥胖患者在髋关节镜检查后可能没有类似的绝对评分，但与基线相比，他们可能表现出类似的改善效果。只要相应地调整预期，髋关节镜似乎是肥胖患者的可行治疗选择。
Background: Hip arthroscopy has gained popularity over the past decade, and its indications have broadened as newer techniques have been developed. However, there has been a paucity of literature evaluating the outcomes of hip arthroscopy in obese patients.Purpose: To compare 2-year clinical outcomes of obese patients undergoing primary hip arthroscopy with matched nonobese controls.Study Design: Cohort study; Level of evidence, 3.Methods: From February 2008 to February 2012, data were collected prospectively on all obese patients undergoing primary hip arthroscopy. A matched-pair nonobese control group was selected at a 1:2 ratio. All patients were assessed pre- and postoperatively with 4 patient-reported outcome (PRO) measures: the modified Harris Hip Score, Non-Arthritic Hip Score, Hip Outcome Score-Activities of Daily Living, and Hip Outcome Score-Sport Specific Subscale. Pain was estimated on the visual analog scale, and satisfaction was measured on a scale from 0 to 10.Results: Sixty-two hips (62 patients) were included in the obese group and 124 hips (124 patients) in the control group. At preoperative baseline, the obese group had significantly lower PRO scores when compared with the control group. Both groups demonstrated statistically significant postoperative improvement in all scores (P < .05). Absolute scores were significantly lower in the obese group for all PRO measures, pre- and postoperatively. However, the improvement (delta) in PRO scores from pre- to postoperative time was not significantly different between groups. The rate of conversion to total hip arthroplasty, the rate of revision, and the complication rate were not significantly different between the 2 groups; however, rates of conversion to total hip arthroplasty and revision tended to be twice as high in the obese patients, but the study was not powered for these 2 outcomes.Conclusion: Overall, obese patients had lower absolute PRO scores preoperatively and at 2-year follow-up. Both obese and nonobese patients demonstrated significant improvement in all PRO scores, and the change in scores were similar between groups. These results indicate that while obese patients may not have similar absolute scores after hip arthroscopy, they may show similar gains in improvement when compared with baseline. Hip arthroscopy appears to be a viable treatment option in the obese patient as long as expectations are adjusted accordingly.