Effective Treatment of Femoraacetabular Impingement of the Hip

描述（由申请人提供）：股髋臼撞击（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手术的益处已被提出，但没有研究确定FAI关节镜手术成功的预后因素，这使得外科医生没有足够的适应症。尽管缺乏证据，但髋关节镜使用的迅速增加使人想起膝关节和肩关节镜。对髋关节镜检查的热情显然比我们积累信息的能力增长得更快。目前接受手术治疗的FAI患者群体高度异质性，使得随机对照试验（RCT）极难进行。这项观察性研究将为未来的随机对照试验建立临床平衡。目的/方法：（目的1）：确定与FAI成功治疗相关的临床和形态学因素。“成功”的定义是患者在术后2年使用髋关节特异性预后指标测量疼痛和功能的改善。手术和非手术患者将进行倾向评分匹配，以限制研究适用于任何一种治疗方法的患者。将评估患者的特征和骨形态，以了解髋关节疼痛和早期软骨-唇部病理的发展及其对患者2年预后的影响。(目标2)。测量FAI关节镜对后续软骨退变的影响。随机抽取患者进行初始定量MRI评估（T2映射和T1 rho），术后5年随访MRI，评估软骨恶化情况。实现这些目标将允许我们测试3个假设：假设1A。与选择非手术治疗的患者相比，接受FAI关节镜治疗某些适应症（例如，凸轮病变）的患者在2年后功能得到改善。假设1 b。与不解决骨形态问题的手术干预相比，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预后。假设2。在接受FAI关节镜进行骨形态矫正的患者中，软骨退变的进展不像那些接受类似形态非手术治疗的患者那么明显。益处：第一个目的将澄清与预后改善相关的预后因素，并将为外科医生提供FAI治疗的适当适应症的证据；第二个目的将提供第一个证据，证明适当识别的患者早期OA的风险降低。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均匀的患者亚群，随机对照试验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有助于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。

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.