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: 9325448
• 负责人: STEPHEN L LYMAN
• 金额: $ 38.11万
• 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/9325448
• 关键词: Address; Affect; Aftercare; Age; Algorithms; Anterior; Arthroscopic Surgical Procedures; Arthroscopy; Biological Preservation; Cartilage; Characteristics; Clinical; Counseling; Deformity; Degenerative polyarthritis; Deterioration; Development; Diagnostic radiologic examination; Effectiveness; Eligibility Determination; Equipoise; Femur; Goals; Head and neck structure; Hip Injuries; Hip Osteoarthritis; Hip Pain; Hip region structure; Inferior; Injury; Knee; Knowledge; Lead; Lesion; Location; Magnetic Resonance Imaging; Measures; Mechanics; Methods; Morphology; Motion; Observational Study; Operative Surgical Procedures; Outcome; Pain; Pathology; Patient Outcomes Assessments; Patient Selection; Patient-Focused Outcomes; Patients; Procedures; Prognostic Factor; Prospective cohort study; Randomized; Randomized Controlled Trials; Recommendation; Registries; Research Personnel; Risk; Safety; Sampling; Shoulder; Structure; Surgeon; Techniques; Testing; Therapeutic; Time; Torsion; Vertebral column; acetabulum; base; cartilage degradation; cohort; effective therapy; evidence based guidelines; experience; follow-up; improved; improved functioning; improved outcome; indexing; instrument; minimally invasive; patient population; patient registry; patient subsets; public health relevance; 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）：股骨替代撞击（FAI）是导致髋关节损伤的常见机制，导致髋部疼痛和早期骨关节炎（OA）。尽管已经提出了对FAI手术的好处，但尚无研究确定与成功的FAI关节镜检查相关的预后因素，而外科医生没有足够的适应症。尽管缺乏证据，但髋关节镜检查的使用迅速增加让人联想到膝盖和肩关节镜检查的髋关节镜检查。对髋关节镜检查的热情显然比我们积累信息的能力更快地增长了。目前对FAI手术进行治疗的患者人群是高度异质的，这使得一项随机对照试验（RCT）极难安装。这项观察性研究将为期货RCT建立临床平衡。目的/方法：（目标1）：确定与成功的FAI管理相关的临床和形态因素。 “成功”将通过使用髋关节特异性患者报告的结果仪器测得的疼痛和功能的改善来定义。手术和非手术患者的倾向评分将匹配，以将研究限制为有资格接受任何一种治疗方法的研究。将评估患者特征和骨形态，以评估髋关节疼痛和早期软骨结构病理学的发展及其对2年时患者预后的影响。 （目标2）。测量FAI关节镜检查对随后的软骨变性的影响。将在手术后5年进行最初定量MRI评估（T2映射和T1 RHO）的患者的随机样本，以评估软骨恶化。完成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，接受FAI关节镜检查的患者（例如，CAM病变）在2年时的功能将提高。假设1b。与无法解决骨形态的手术干预措施相比，与关节内危险相关的异常骨形态的关节镜校正将导致患者结局的改善。假设2。在FAI关节镜检查以进行骨形态校正的患者中，软骨变性的进展将不如非手术治疗相似的形态的患者。好处：第一个目的将阐明与改善结果相关的预后因素，并将为外科医生提供适当指示的FAI治疗的证据，而第二个目标将提供第一个证据，证明适当确定的患者患有早期OA的风险降低。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RCT将确定最佳治疗过程的患者的更均匀的子集。在关节镜手术的情况下，倾向得分匹配的使用还将有助于其他研究人员解决可普遍性和及时完成RCT的问题。