Outcomes of Hip Arthroscopy in Patients Aged 50 Years or Older Compared With a Matched-Pair Control of Patients Aged 30 Years or Younger
Outcomes of Hip Arthroscopy in Patients Aged 50 Years or Older Compared With a Matched-Pair Control of Patients Aged 30 Years or Younger
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DOI：
10.1016/j.arthro.2014.08.030
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发表时间：
2015-02-01
影响因子：
4.7
通讯作者：
Gupta, Asheesh
中科院分区：
文献类型：
--
作者：
Domb, Benjamin G.;Linder, Dror;Gupta, Asheesh
目的：年龄被认为是髋关节镜手术的一个不良预后因素。本研究的目的是在至少2年的术后随访中比较50岁或以上患者与30岁或以下患者的匹配对照组的患者特征和髋关节镜术后结局。研究方法：在2008年9月至2010年3月期间，前瞻性收集了所有50岁或以上接受初次髋关节镜手术的患者的数据。52例患者符合我们的入选和匹配标准，其中所有52例（100%）可接受至少2年的随访。将该队列与年龄在30岁或30岁以下接受类似手术的患者配对对照组进行比较。结果：研究组的平均年龄为54.8岁（范围：50 - 69岁），对照组的平均年龄为20.3岁（范围：13 - 30岁）。两组按1：1比例匹配，每组包括18名男性患者（34.6%）和34名女性患者（65.4%），平均随访期为32个月（范围，24至54个月）。在年轻对照组中，从术前到2年随访，改良Harris髋关节评分的评分改善为62.9至84.2，非关节炎髋关节评分为60.5至84.2，髋关节结局评分-日常生活活动为63.1至86.5，髋关节结局评分-运动特定子量表为42.2至72.7。在老年研究组中，从术前到2年随访，改良Harris髋关节评分的评分改善为61.2至82.2，非关节炎髋关节评分为59.9至80.4，髋关节结局评分-日常生活活动评分为63.9至83，髋关节结局评分-运动特定子量表为41.2至64.6。术后2年随访时，两组的所有改善均具有统计学显著性（P < .001）。两组最终随访时所有患者报告结局（PRO）评分无显著差异。当我们比较PRO评分（Delta）从术前到术后2年的变化时，两组之间没有显著差异。年轻对照组的总体生存率为98.1%，老年研究组为82.7%。结论：50岁或以上的生存者在PRO和患者满意度评分方面与30岁或以下的患者表现出相似的改善。年轻对照组的2年生存率为98.1%，老年研究组为82.7%。因此，我们认为，髋关节镜应被视为一个有效的治疗选择时，髋关节疼痛的患者年龄在50岁或以上的Tonnis关节炎等级为0或1。应告知老年患者以后转为全髋关节置换术的可能性。未来的工作可能包括开发一种决策工具来评估预后，以更好地描述老年人群中髋关节镜手术的适应症。
Purpose: Age has been suggested as a negative prognostic factor for hip arthroscopy. The purpose of this study was to compare patient characteristics and outcomes after hip arthroscopy in patients aged 50 years or older with a matched control group of patients aged 30 years or younger at a minimum postoperative follow-up of 2 years. Methods: Between September 2008 and March 2010, data were prospectively collected on all patients aged 50 years or older undergoing primary hip arthroscopy. Fifty-two patients met our inclusion and matching criteria, of whom all 52 (100%) were available for follow-up at a minimum of 2 years. This cohort was compared with a matched-pair control group of patients aged 30 years or younger who underwent similar procedures. Results: The mean age of the study group was 54.8 years (range, 50 to 69 years), and that of the control group was 20.3 years (range, 13 to 30 years). The groups were matched at a 1: 1 ratio, including 18 male patients (34.6%) and 34 female patients (65.4%) in each group, with a mean follow-up period of 32 months (range, 24 to 54 months). In the younger control group, the score improvement from preoperatively to 2 years' follow-up was 62.9 to 84.2 for the modified Harris Hip Score, 60.5 to 84.2 for the Non-Arthritic Hip Score, 63.1 to 86.5 for the Hip Outcome Score-Activities of Daily Living, and 42.2 to 72.7 for the Hip Outcome Score-Sport-Specific Subscale. In the older study group, the score improvement from preoperatively to 2 years' follow-up was 61.2 to 82.2 for the modified Harris Hip Score, 59.9 to 80.4 for the Non-Arthritic Hip Score, 63.9 to 83 for the Hip Outcome ScoreeActivities of Daily Living, and 41.2 to 64.6 for the Hip Outcome Score-Sport-Specific Subscale. All improvements in both groups were statistically significant at the 2-year postoperative follow-up (P < .001). There was no significant difference for all patient-reported outcome (PRO) scores at final follow-up between both groups. When we compared the change in PRO scores (Delta) from preoperatively to 2 years postoperatively, there was no significant difference between both groups. The overall survivorship rate was 98.1% for the younger control group and 82.7% for the older study group. Conclusions: Survivors aged 50 years or older show similar improvement to patients aged 30 years or younger in PRO and patient satisfaction scores. The 2-year survivorship rate was 98.1% for the younger control group and 82.7% for the older study group. Therefore we believe that hip arthroscopy should be considered a valid treatment option when treating hip pain in patients aged 50 years or older with a Tonnis arthritic grade of 0 or 1. Older patients should be counseled on the possibility of later conversion to total hip arthroplasty. Future work may include development of a decision-making tool to assess for prognosis to better delineate the indications for hip arthroscopy in the older population.