Effective Treatment of Femoraacetabular Impingement of the Hip

髋关节股骨髋臼撞击症的有效治疗

• 批准号: 8919241
• 负责人: STEPHEN L LYMAN
• 金额: $ 37.58万
• 依托单位: HOSPITAL FOR SPECIAL SURGERY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-01 至 2019-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8919241
• 关键词: Accounting; Address; Affect; Aftercare; Age; Algorithms; Anterior; Arthroscopic Surgical Procedures; Arthroscopy; Biological Preservation; Cartilage; Characteristics; Clinical; Cohort Studies; Counseling; Deformity; Degenerative polyarthritis; Deterioration; Development; Effectiveness; Equipoise; Femur; Goals; Head and neck structure; Health; Hip Injuries; Hip Osteoarthritis; Hip Pain; Hip region structure; Inferior; Injury; Knee; Knowledge; Lead; Left; Lesion; Location; Long-Term Effects; Magnetic Resonance Imaging; Maps; Measures; Mechanics; Methods; Morphology; Motion; Observational Study; Operative Surgical Procedures; Outcome; Pain; Pathology; Patient Outcomes Assessments; Patient Selection; Patients; Procedures; Prognostic Factor; Randomized; Randomized Controlled Trials; Recommendation; Registries; Research Personnel; Risk; Safety; Sampling; Shoulder; Staging; Structure; Surgeon; Techniques; Testing; Therapeutic; Torsion; Vertebral column; acetabulum; base; cartilage degradation; cohort; effective therapy; evidence based guidelines; experience; follow-up; improved; improved functioning; indexing; instrument; minimally invasive; patient population; patient registry; prospective; rho; sex; success; symptomatic improvement

DESCRIPTION (provided by applicant): Femoroacetabular impingement (FAI) is a common mechanism leading to hip injury, leading to hip pain and early osteoarthritis (OA). While a benefit to FAI surgery has been suggested, no studies have identified prognostic factors associated with successful FAI arthroscopy, leaving surgeons without adequate indications. Despite this lack of evidence, rapid increase in the use of hip arthroscopy is reminiscent of that seen for knee and shoulder arthroscopy. The enthusiasm for hip arthroscopy has clearly grown at a faster rate than our ability to accumulate information. The patient population currently treated operatively for FAI is highly heterogeneous, making a randomized controlled trial (RCT) extremely difficult to mount. This observational study will establish clinical equipoise for a futue RCT. Aims/Methods: (Aim 1): Determine the clinical and morphologic factors associated with successful FAI management. "Success" will be defined by an improvement in pain and function measured using a hip-specific patient-reported outcome instrument 2 years post-presentation. Operative and non-operative patients will be propensity score matched to limit the study to those eligible for either therapeutic approach. Patient characteristics and bony morphology will be assessed with regard to the development of hip pain and early chondro-labral pathology and their effect on patient outcome at 2 years. (Aim 2). Measure the effect of FAI arthroscopy on subsequent cartilage degeneration. A random sample of patients who had initial quantitative MRI assessment (T2 mapping and T1 rho) will be followed up with MRI 5 years after surgery to assess cartilage deterioration. Accomplishing these aims will allow us to test 3 hypotheses: Hypothesis 1A. Patients undergoing FAI arthroscopy for certain indications (e.g., cam lesion) will have improved function at 2 years compared to patients who choose non-operative management. Hypothesis 1B. Arthroscopic correction of abnormal bony morphology associated with intra-articular derangement will result in improved patient outcomes compared to surgical interventions that do not address bony morphology. Hypothesis 2. Progression of cartilage degeneration will be less pronounced among patients undergoing FAI arthroscopy for bony morphology correction than those treated non-operatively for similar morphology. Benefits: The first aim will clarify prognostic factors associated with improved outcomes and will provide surgeons with evidence for appropriate indications for FAI treatment while the second aim will provide the first evidence that appropriately identified patients have a decreased risk of early OA. Achieving these aims, we will identify appropriate indications, prognostic factors, and treatment algorithms for FAI. We will also have identified a more homogeneous subset of patients for which an RCT will determine the best course of treatment. The use of propensity score matching in the setting of arthroscopic surgery will also aid other researchers struggling with the issues of generalizability and timely completion of RCTs.

描述（由申请人提供）：股髋臼撞击（FAI）是导致髋部损伤的常见机制，导致髋部疼痛和早期骨关节炎（OA）。虽然有人认为 FAI 手术有好处，但没有研究确定与成功的 FAI 关节镜检查相关的预后因素，导致外科医生没有足够的适应症。尽管缺乏证据，但髋关节镜检查使用的快速增加让人想起膝关节镜和肩关节镜检查的情况。对髋关节镜检查的热情的增长速度显然快于我们积累信息的能力。目前接受 FAI 手术治疗的患者群体具有高度异质性，因此开展随机对照试验 (RCT) 极其困难。这项观察性研究将为未来的随机对照试验建立临床平衡。目标/方法：（目标 1）：确定与成功 FAI 管理相关的临床和形态因素。 “成功”的定义是在就诊后 2 年使用髋部特异性患者报告结果仪器测量疼痛和功能的改善。手术患者和非手术患者将进行倾向评分匹配，以将研究限制于符合任一治疗方法条件的患者。将评估患者特征和骨形态，了解髋部疼痛的发生情况和早期软骨盂唇病理及其对患者 2 年预后的影响。 （目标 2）。测量 FAI 关节镜检查对随后软骨退化的影响。接受初始定量 MRI 评估（T2 映射和 T1 rho）的患者的随机样本将在手术后 5 年进行 MRI 随访，以评估软骨恶化情况。实现这些目标将使我们能够检验 3 个假设：假设 1A。与选择非手术治疗的患者相比，因某些适应症（例如凸轮损伤）而接受 FAI 关节镜检查的患者在 2 年后的功能将得到改善。假设1B。与不解决骨形态的手术干预相比，关节镜矫正与关节内紊乱相关的异常骨形态将改善患者的治疗效果。假设 2：与接受类似形态非手术治疗的患者相比，接受 FAI 关节镜检查以矫正骨形态的患者中，软骨退变的进展不太明显。好处：第一个目标将阐明与改善结果相关的预后因素，并将为外科医生提供 FAI 治疗适当适应症的证据，而第二个目标将提供第一个证据，证明适当识别的患者可以降低早期 OA 的风险。为了实现这些目标，我们将确定 FAI 的适当适应症、预后因素和治疗算法。我们还将确定一个更同质的患者子集，随机对照试验将为其确定最佳治疗方案。在关节镜手术中使用倾向评分匹配也将帮助其他研究人员解决随机对照试验的普遍性和及时完成问题。