Patients With Borderline Hip Dysplasia Achieve Clinically Significant Outcome After Arthroscopic Femoroacetabular Impingement Surgery: A Case-Control Study With Minimum 2-Year Follow-up
Patients With Borderline Hip Dysplasia Achieve Clinically Significant Outcome After Arthroscopic Femoroacetabular Impingement Surgery: A Case-Control Study With Minimum 2-Year Follow-up
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DOI：
10.1177/0363546519865919
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发表时间：
2019-08-16
影响因子：
4.8
通讯作者：
Nho, Shane J.
中科院分区：
文献类型：
--
作者：
Beck, Edward C.;Nwachukwu, Benedict U.;Nho, Shane J.
背景资料：髋关节镜医生治疗股骨髋臼撞击综合征（FAIS）的边缘性髋关节发育不良（BHD）患者的趋势越来越明显，而不解决髋臼覆盖问题。然而，这些患者的结局和失败率的文献是相互矛盾的。目的：（1）确定与非BHD患者相比，BHD患者是否实现了2年相似的患者报告结局、最小临床重要差异（MCID）和患者可接受的症状状态（PASS），以及（2）确定在接受髋关节镜检查治疗FAIS的BHD患者中实现MCID和PASS的预测因素。研究设计：队列研究;证据等级3。研究方法：收集并回顾性分析了2012年1月至2017年1月期间接受初次髋关节镜检查和常规关节囊闭合治疗FAIS的连续患者的数据。BHD患者（外侧中心-边缘角[LCEA]，20度-25度）按年龄、性别和体重指数（BMI）2：1匹配，对照组患者髋臼覆盖正常（LCEA，>25度-40度）。比较两组患者报告的结局、MCID和PASS。多变量逻辑回归分析确定了BHD组实现MCID和PASS的重要预测因素。结果如下：BHD组的MCID定义为髋关节结局评分-日常生活活动、髋关节结局评分-运动特异性、改良Harris髋关节评分和iHOT-12分别为9.2、13.7、8.5和15.2。两组达到PASS的阈值评分分别为87.9、76.4、78.1和60.0。共有112名患者被确定为BHD（LCEA，20度-25度），并与224名对照组相匹配。两组的平均得分在2年内都有统计学显著性增加;然而，它们之间的差异没有统计学显著性（所有P > 0.05）。BHD和非BHD队列达到至少1个阈值评分的MCID（86.6% vs 85.6%，P = 0.837）和PASS（78.6% vs 79.8%，P = 0.79）的频率无统计学差异。然而，在改良Harris髋关节评分阈值上，BHD患者和非BHD患者达到PASS的比率存在统计学显著差异（62.5% vs 74.5%，P = 0.028）。最终的逻辑模型表明，较低的BMI（比值比[OR]，0.872; P = .029），术前α角较低（OR，0.965; P = .014），女性（OR，3.647; P = .03）是实现MCID的独立术前预测因素，而术前α角较低（OR，0.943; P = 0.018）和自我报告的跛行（OR，18.53; P = 0.007）是实现PASS的独立术前预测因素。结论：接受关节镜下关节囊闭合治疗FAIS的BHD患者的结局改善与髋臼覆盖正常的患者无显著差异。较低的BMI、较低的α角、无跛行和女性是BHD患者获得有意义的临床显著结局改善的术前预测因素。
Background: There is a growing trend for hip arthroscopists to treat patients with borderline hip dysplasia (BHD) for femoroacetabular impingement syndrome (FAIS) without addressing the acetabular coverage. However, the literature of outcomes and failure rates for these patients is conflicting. Purpose: (1) To identify whether patients with BHD achieved 2-year similar patient-reported outcome, minimal clinically important difference (MCID), and patient acceptable symptomatic state (PASS) when compared with patients without BHD and (2) to identify predictors for achieving the MCID and PASS among patients with BHD who are undergoing hip arthroscopy for FAIS. Study Design: Cohort study; Level of evidence, 3. Methods: Data from consecutive patients who underwent primary hip arthroscopy with routine capsular closure for the treatment of FAIS between January 2012 and January 2017 were collected and retrospectively analyzed. Patients with BHD (lateral center-edge angle [LCEA], 20 degrees-25 degrees) were matched 2:1 by age, sex, and body mass index (BMI) to control patients with normal acetabular coverage (LCEA, >25 degrees-40 degrees). Patient-reported outcome, MCID, and PASS were compared between the groups. Multivariate logistic regression analysis identified significant predictors of achieving the MCID and PASS in the BHD group. Results: The MCID in the BHD group was defined as 9.2, 13.7, 8.5, and 15.2 for the Hip Outcome Score-Activities of Daily Living, Hip Outcome Score-Sport Specific, modified Harris Hip Score, and iHOT-12, respectively. Threshold scores for achieving the PASS in both groups were 87.9, 76.4, 78.1, and 60.0. A total of 112 patients were identified as having BHD (LCEA, 20 degrees-25 degrees) and were matched to 224 controls. Both groups saw statistically significant increases in score averages over the 2-year period; however, the differences between them were not statistically significant (P > .05 for all). There was no statistical difference in the frequency of the BHD and non-BHD cohorts achieving the MCID on at least 1 threshold score (86.6% vs 85.6%, P = .837) and the PASS (78.6% vs 79.8%, P = .79). There was, however, a statistically significant difference between the rates of patients with and without BHD achieving the PASS on the modified Harris Hip Score threshold (62.5% vs 74.5%, P = .028). The final logistic models demonstrated that lower BMI (odds ratio [OR], 0.872; P = .029), lower preoperative alpha angle (OR, 0.965; P = .014), and female sex (OR, 3.647; P = .03) are independent preoperative predictors of achieving the MCID, while lower preoperative alpha angle (OR, 0.943; P = .018) and self-reported limp (OR, 18.53; P = .007) are independent preoperative predictors of achieving the PASS. Conclusion: Outcome improvements in patients with BHD who are undergoing arthroscopic treatment with capsular closure for FAIS are not significantly different from patients with normal acetabular coverage. Lower BMI, lower alpha angle, absence of limp, and female sex are preoperative predictors of achieving meaningful clinically significant outcome improvements in patients with BHD.