Effective Treatment of Femoraacetabular Impingement of the Hip

描述(申请人提供)：髋臼撞击(FAI)是导致髋关节损伤的一种常见机制，导致髋关节疼痛和早期骨关节炎(OA)。虽然FAI手术的好处已经被提出，但没有研究确定与FAI关节镜检查成功相关的预后因素，这使得外科医生没有足够的适应症。尽管缺乏证据，但髋关节镜的使用迅速增加，这让人想起膝关节和肩关节镜的情况。髋关节镜检术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手术治疗的患者群体是高度异质性的，这使得随机对照试验(RCT)的建立变得极其困难。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)：确定与成功处理FAI相关的临床和形态因素。“成功”将被定义为疼痛和功能的改善，使用髋关节特有的患者报告的结果仪器在陈述2年后进行测量。手术患者和非手术患者的倾向评分将匹配，以将研究限制在那些有资格接受任何一种治疗方法的患者。两年后，将根据髋关节疼痛和早期软骨-唇部病理的发展及其对患者预后的影响来评估患者的特征和骨骼形态。(目标2)。测量FAI关节镜对关节软骨退变的影响。随机抽取接受初步定量MRI评估(T2标测和T1Rho)的患者样本，在术后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，接受FAI关节镜检查以确定某些适应症(例如凸轮损伤)的患者在2年后的功能将得到改善。假设1B。关节镜下矫正与关节内紊乱相关的异常骨形态，与不涉及骨形态的外科治疗相比，将会改善患者的预后。假说2：在接受FAI关节镜矫正骨质形态的患者中，软骨退行性变的进展比那些非手术治疗的相似形态的患者要少。好处：第一个目标将澄清与改善结果相关的预后因素，并将为外科医生提供证据，证明FAI治疗的适当适应症，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同质的患者子集，RCT将决定最佳疗程。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在推广和及时完成随机对照试验的问题上苦苦挣扎。

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.