Two-Year Outcomes of Primary Arthroscopic Surgery in Patients with Femoroacetabular Impingement: A Comparative Study of Labral Repair and Labral Reconstruction.

IF 4.4 1区 医学 Q1 ORTHOPEDICS
Grant J Dornan, Joseph J Ruzbarsky, Spencer M Comfort, Justin J Ernat, Maitland D Martin, Karen K Briggs, Marc J Philippon
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引用次数: 0

Abstract

Background: Labral repair has become the preferred method for the arthroscopic treatment of acetabular labral tears that are associated with femoroacetabular impingement (FAI) resulting in pain and dysfunction. Labral reconstruction is performed mainly in revision hip arthroscopy but can be utilized in the primary setting for absent or calcified labra. The purpose of this study was to compare the minimum 2-year patient-reported outcomes (PROs) and risk of revision or conversion to arthroplasty between primary labral reconstruction and primary labral repair.

Methods: Patients with FAI who underwent primary hip arthroscopy with labral repair or reconstruction performed by the senior author between 2006 and 2018 were identified from a prospectively enrolled patient outcome registry. Exclusion criteria included confounding injuries, dysplasia, prior ipsilateral hip surgery, or a joint space of <2 mm. Patients who were 18 to 80 years old were eligible for inclusion. Multiple regression with inverse propensity score weighting was conducted to estimate the average treatment effect in the treated (ATT) for labral reconstruction versus labral repair with respect to postoperative PROs and the likelihood of subsequent surgery (revision hip arthroscopy or conversion to arthroplasty). PRO end points included the Hip Outcome Score Activities of Daily Living subscale (HOS-ADL), modified Harris hip score, Western Ontario and McMaster Universities Osteoarthritis Index total score (WOMAC), 12-Item Short Form Health Survey Physical Component Summary score (SF-12 PCS), and patient satisfaction.

Results: A total of 150 hips undergoing primary labral reconstruction and 998 hips undergoing primary labral repair were included. The median follow-up time was 5.3 years in the reconstruction group and 5.8 years in the repair group. Compared with labral repair, labral reconstruction was associated with a higher risk of conversion to total hip arthroplasty (THA) (20% versus 7%; adjusted odds ratio, 3.2; 95% confidence interval [CI], 1.2 to 8.8; p = 0.024). Inverse propensity score-weighted multiple regression estimated a significant negative effect of labral reconstruction, relative to labral repair, on the postoperative values for the HOS-ADL (ATT, -3.3; 95% CI, -5.8 to -0.7; p = 0.012) and WOMAC (ATT, 2.6; 95% CI, 0.1 to 5.2; p = 0.044).

Conclusions: Compared with primary labral reconstruction, primary labral repair resulted in better postoperative HOS-ADL and WOMAC values and decreased conversion to THA. These findings were demonstrated in both the unadjusted group comparisons and multivariable modeling. These data support the use of labral repair in the primary setting of labral tears and the reservation of labral reconstruction for more advanced labral pathology or for revision cases.

Level of evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

股骨髋臼撞击症患者初次关节镜手术的两年疗效:髋臼唇修复术与髋臼唇重建术的比较研究。
背景:髋臼唇修复术已成为关节镜治疗髋臼唇撕裂的首选方法,髋臼唇撕裂与股骨髋臼撞击(FAI)有关,导致疼痛和功能障碍。髋臼唇重建术主要在翻修髋关节镜手术中进行,但也可用于缺失或钙化髋臼唇的初次治疗。本研究的目的是比较初级唇瓣重建术和初级唇瓣修复术的至少2年患者报告结果(PROs)以及翻修或转为关节成形术的风险:从一项前瞻性登记的患者结果登记中筛选出2006年至2018年期间接受初级髋关节镜手术并由资深作者进行唇瓣修复或重建的FAI患者。排除标准包括混杂性损伤、发育不良、同侧髋关节手术或关节间隙结果:共纳入了150个接受初级髋关节唇重建术的髋关节和998个接受初级髋关节唇修复术的髋关节。重建组的中位随访时间为5.3年,修复组为5.8年。与唇修补术相比,唇重建术与较高的转为全髋关节置换术(THA)风险相关(20% 对 7%;调整后的几率比为 3.2;95% 置信区间 [CI],1.2 至 8.8;P = 0.024)。根据反倾向得分加权多元回归估计,相对于唇瓣修复术,唇瓣重建术对HOS-ADL(ATT,-3.3;95% CI,-5.8至-0.7;p = 0.012)和WOMAC(ATT,2.6;95% CI,0.1至5.2;p = 0.044)的术后值有显著的负面影响:结论:与原发性唇瓣重建相比,原发性唇瓣修复术的术后HOS-ADL和WOMAC值更好,转为THA的情况也更少。这些结果在未经调整的组间比较和多变量模型中都得到了证实。这些数据支持在阴唇撕裂的初治情况下使用阴唇修复术,并为更晚期的阴唇病理或翻修病例保留阴唇重建术:证据等级:治疗三级。有关证据等级的完整描述,请参阅 "作者须知"。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
8.90
自引率
7.50%
发文量
660
审稿时长
1 months
期刊介绍: The Journal of Bone & Joint Surgery (JBJS) has been the most valued source of information for orthopaedic surgeons and researchers for over 125 years and is the gold standard in peer-reviewed scientific information in the field. A core journal and essential reading for general as well as specialist orthopaedic surgeons worldwide, The Journal publishes evidence-based research to enhance the quality of care for orthopaedic patients. Standards of excellence and high quality are maintained in everything we do, from the science of the content published to the customer service we provide. JBJS is an independent, non-profit journal.
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