A Comparison of Clinical Outcomes After Unilateral or Bilateral Hip Arthroscopic Surgery Age- and Sex-Matched Cohort Study
A Comparison of Clinical Outcomes After Unilateral or Bilateral Hip Arthroscopic Surgery Age- and Sex-Matched Cohort Study
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DOI：
10.1177/0363546517719020
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发表时间：
2017-11-01
影响因子：
4.8
通讯作者：
Nho, Shane J.
中科院分区：
文献类型：
--
作者：
Kuhns, Benjamin D.;Hannon, Charles P.;Nho, Shane J.
背景资料：大量接受髋关节镜手术治疗股骨髋臼撞击症（FAI）的患者存在双侧畸形，可能需要双侧髋关节手术。目的：比较接受双侧髋关节镜手术的患者与接受单侧髋关节镜手术的匹配队列患者的结局。研究设计：队列研究;证据等级，3.方法：对2012年1月至2014年1月期间由一名接受过研究员培训的外科医生进行首次髋关节镜手术治疗FAI并至少随访2年的连续患者系列进行了评价。确定了接受分期双侧髋关节镜手术的患者，并根据年龄、性别和体重指数（BMI）将其与接受单侧髋关节镜手术的患者按1：2匹配。结果：双侧组43例患者与单侧组86例患者性别匹配（女性24例[56%] vs女性48例[56%]; P < 0. 05），双侧组86例患者性别匹配（女性24例[56%] vs女性48例[56%]; P < 0. 05），单侧组86例患者性别匹配（女性24例[56%] vs女性48例[56%]; P < 0. 05）。年龄（分别为28.6 6 10.8岁vs 28.9 6 10.8岁; P = .88）和BMI（分别为24.8 +/- 5.8 kg/m2 vs 24.8 +/- 4.0 kg/m2; P =.98）。两组之间的术前人口统计学或影像学无显著差异。两组的髋关节结局评分-日常生活活动（HOS-ADL）、髋关节结局评分-运动子量表（HOS-SS）和改良Harris髋关节评分（mHHS）均显示出术前至术后的显著改善（均P <0.0001）。与单侧组患者相比，接受双侧髋关节镜手术的患者在mHHS和疼痛评分方面的改善较少。单侧组65例（76%）患者达到mHHS的最小临床重要差异（MCID），双侧组21例（49%）（P = 0.03），而mHHS组64例（74%）患者达到患者可接受的症状状态（PASS），双侧组22例（51%）（P = 0.02）。手术间隔大于10个月的双侧组患者术后HOS-ADL评分较低（P = 0.04），疼痛和HOS-SS评分改善较低（分别为P <0.0001和P = 0.05）。结论：接受单侧和双侧髋关节镜手术治疗FAI的患者2年后功能结局改善。然而，与接受单侧髋关节镜手术的患者相比，接受双侧髋关节镜手术的患者的mHHS和疼痛评分改善较少，但HOS-ADL，HOS-SS或满意度评分无差异。两次手术间隔超过10个月的双侧组患者的结局评分低于初次手术后10个月内接受第二次手术的患者。
Background: A significant number of patients undergoing hip arthroscopic surgery for femoroacetabular impingement (FAI) have bilateral deformities and may require surgery for both hips.Purpose: To compare outcomes between patients who underwent bilateral hip arthroscopic surgery to a matched cohort of patients who underwent unilateral hip arthroscopic surgery.Study Design: Cohort study; Level of evidence, 3.Methods: A consecutive series of patients who underwent primary hip arthroscopic surgery for FAI by a single fellowship-trained surgeon from January 2012 to January 2014 and had a minimum follow-up of 2 years were evaluated. Patients who underwent staged bilateral hip arthroscopic surgery were identified and matched 1: 2 to patients who underwent unilateral hip arthroscopic surgery based on age, sex, and body mass index (BMI). Demographic, preoperative, and postoperative variables were compared between the groups.Results: Forty-three patients in the bilateral group were matched with 86 patients in the unilateral group based on sex (24 female [56%] vs 48 female [56%], respectively; P..99), age (28.6 6 10.8 years vs 28.9 6 10.8 years, respectively; P = .88), and BMI (24.8 +/- 5.8 kg/m(2) vs 24.8 +/- 4.0 kg/m(2), respectively; P =.98). There were no significant preoperative demographic or radiographic differences between the groups. Both groups demonstrated significant preoperative to postoperative improvements in the Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sports Subscale (HOS-SS), and modified Harris Hip Score (mHHS) (P < .0001 for all). When compared with patients in the unilateral group, patients who underwent bilateral hip arthroscopic surgery had less improvement in mHHS and pain scores. Sixty-five (76%) patients in the unilateral group achieved the minimum clinically important difference (MCID) for the mHHS compared with 21 (49%) in the bilateral group (P = .03), while 64 (74%) patients achieved the patient acceptable symptomatic state (PASS) for the mHHS compared with 22 (51%) in the bilateral group (P = .02). Patients in the bilateral group with greater than 10 months between surgical procedures had lower postoperative HOS-ADL scores (P = .04) and lower improvement in pain and HOS-SS scores (P < .0001 and P = .05, respectively).Conclusion: Patients who underwent unilateral and bilateral hip arthroscopic surgery for FAI had improved functional outcomes after 2 years. However, patients who underwent bilateral hip arthroscopic surgery had less improvement in their mHHS and pain scores compared with those who underwent unilateral hip arthroscopic surgery but no differences in HOS-ADL, HOS-SS, or satisfaction scores. Patients in the bilateral group with longer than 10 months between surgical procedures had lower outcome scores than patients who underwent their second surgical procedure within 10 months of their primary surgery.