Effective Treatment of Femoraacetabular Impingement of the Hip

描述（由申请人提供）：股骨髋臼撞击（FAI）是导致髋关节损伤的常见机制，导致髋关节疼痛和早期骨关节炎（OA）。虽然FAI手术的益处已经被提出，但没有研究确定与成功的FAI关节镜相关的预后因素，使外科医生没有足够的适应症。尽管缺乏证据，但髋关节镜使用的快速增加让人想起膝关节和肩关节镜的使用。对髋关节镜的热情显然比我们积累信息的能力增长得更快。目前接受FAI手术治疗的患者人群具有高度异质性，因此很难进行随机对照试验（RCT）。这项观察性研究将为未来的RCT建立临床平衡。目的/方法：（目的1）：确定与FAI成功管理相关的临床和形态学因素。“成功”定义为就诊后2年使用髋关节特异性患者报告结局工具测量的疼痛和功能改善。手术和非手术患者的倾向评分将匹配，以将研究限制在符合任一治疗方法的患者中。将评估患者特征和骨形态，包括髋关节疼痛和早期软骨-盂唇病理学的发展及其对2年时患者结局的影响。(Aim 2）。测量FAI关节镜检查对随后软骨退变的影响。随机抽取接受了初始定量MRI评估（T2标测和T1 rho）的患者样本，在术后5年进行MRI随访，以评估软骨退化情况。实现这些目标将允许我们测试3个假设：假设1A。因某些适应症（例如，CAM病变）与选择非手术治疗的患者相比，在2年时功能将得到改善。假设1B。关节镜下矫正与关节内紊乱相关的异常骨形态，与不解决骨形态的手术干预相比，将改善患者结局。假设2.与非手术治疗相似形态的患者相比，接受FAI关节镜手术进行骨形态矫正的患者的软骨退化进展不太明显。优点：第一个目标将阐明与改善结局相关的预后因素，并为外科医生提供FAI治疗的适当适应症的证据，而第二个目标将提供第一个证据，证明适当识别的患者早期OA风险降低。实现这些目标，我们将确定适当的适应症，预后因素和治疗算法FAI。我们还将确定一个更同质的患者子集，RCT将确定最佳治疗方案。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的问题。

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.