Matthew J Kraeutler, Preston M Terle, Mahant Malempati, Jaydeep Dhillon, Kristian Samuelsson, Omer Mei-Dan
{"title":"边缘发育不良患者髋关节镜手术失败的风险因素包括：Tönnis 角≥ 15 度、年龄≥ 40-42 岁、性别为女性、前壁指数< 0.35、髋关节瓣膜剥除术和已有的髋关节骨性关节炎：系统回顾","authors":"Matthew J Kraeutler, Preston M Terle, Mahant Malempati, Jaydeep Dhillon, Kristian Samuelsson, Omer Mei-Dan","doi":"10.1016/j.arthro.2024.10.021","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>To systematically review the literature to determine potential risk factors for failure of hip arthroscopy (HA) in patients with borderline hip dysplasia (BHD).</p><p><strong>Methods: </strong>A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines by searching PubMed, the Cochrane Library, and Embase to identify English language clinical studies reporting on patients with BHD undergoing HA from 2003 to 2023. The search terms used were: (borderline OR mild) AND hip AND (arthroscopy OR dysplasia) AND failure. The primary outcomes assessed were risk factors reported by each study for failure of a HA-only approach in BHD patients.</p><p><strong>Results: </strong>Fourteen studies (8 level III, 6 level IV) met inclusion criteria, totaling 749 hips. Patient age ranged from 29.8 to 39.2 years with a mean follow-up ranging from 24.0 to 144.0 months. The overall percentage of females ranged from 11.8 to 100.0%. Overall, the clinical failure rate ranged from 0 to 53.3% and the reoperation rate ranged from 0 to 44.0%. The predominant predictors of poor outcomes following HA alone included Tönnis angle ≥ 15°, age ≥ 40-42 years at surgery, and female sex. Other risk factors for failure were preoperative clinical arthritis, grade 3 or 4 articular cartilage changes to the femoral head or acetabulum, an anterior wall index (AWI) < 0.35, and labral debridement. Revision procedures performed included revision HA (n=88, 0-28.0%), total hip arthroplasty (n=55, 0-23.7%), and endoscopic shelf acetabuloplasty (n=5, 0-11.0%). One study included an additional 9 patients converting to either PAO or total hip arthroplasty (THA) without distinguishing between the two.</p><p><strong>Conclusion: </strong>For patients with BHD, Tönnis angle ≥ 15°, age ≥ 40-42 years at surgery, female sex, AWI < 0.35, labral debridement, and preexisting hip osteoarthritis are common risk factors for treatment failure following isolated HA.</p><p><strong>Level of evidence: </strong>IV, systematic review of level III-IV studies.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":null,"pages":null},"PeriodicalIF":4.4000,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Risk Factors for Failure of Hip Arthroscopy in Patients with Borderline Dysplasia include a Tönnis angle ≥ 15 degrees, Age ≥ 40-42 years, Female Sex, Anterior Wall Index < 0.35, Labral Debridement, and Preexisting Hip Osteoarthritis: A Systematic Review.\",\"authors\":\"Matthew J Kraeutler, Preston M Terle, Mahant Malempati, Jaydeep Dhillon, Kristian Samuelsson, Omer Mei-Dan\",\"doi\":\"10.1016/j.arthro.2024.10.021\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>To systematically review the literature to determine potential risk factors for failure of hip arthroscopy (HA) in patients with borderline hip dysplasia (BHD).</p><p><strong>Methods: </strong>A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines by searching PubMed, the Cochrane Library, and Embase to identify English language clinical studies reporting on patients with BHD undergoing HA from 2003 to 2023. The search terms used were: (borderline OR mild) AND hip AND (arthroscopy OR dysplasia) AND failure. The primary outcomes assessed were risk factors reported by each study for failure of a HA-only approach in BHD patients.</p><p><strong>Results: </strong>Fourteen studies (8 level III, 6 level IV) met inclusion criteria, totaling 749 hips. Patient age ranged from 29.8 to 39.2 years with a mean follow-up ranging from 24.0 to 144.0 months. The overall percentage of females ranged from 11.8 to 100.0%. Overall, the clinical failure rate ranged from 0 to 53.3% and the reoperation rate ranged from 0 to 44.0%. The predominant predictors of poor outcomes following HA alone included Tönnis angle ≥ 15°, age ≥ 40-42 years at surgery, and female sex. Other risk factors for failure were preoperative clinical arthritis, grade 3 or 4 articular cartilage changes to the femoral head or acetabulum, an anterior wall index (AWI) < 0.35, and labral debridement. Revision procedures performed included revision HA (n=88, 0-28.0%), total hip arthroplasty (n=55, 0-23.7%), and endoscopic shelf acetabuloplasty (n=5, 0-11.0%). One study included an additional 9 patients converting to either PAO or total hip arthroplasty (THA) without distinguishing between the two.</p><p><strong>Conclusion: </strong>For patients with BHD, Tönnis angle ≥ 15°, age ≥ 40-42 years at surgery, female sex, AWI < 0.35, labral debridement, and preexisting hip osteoarthritis are common risk factors for treatment failure following isolated HA.</p><p><strong>Level of evidence: </strong>IV, systematic review of level III-IV studies.</p>\",\"PeriodicalId\":55459,\"journal\":{\"name\":\"Arthroscopy-The Journal of Arthroscopic and Related Surgery\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":4.4000,\"publicationDate\":\"2024-10-25\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Arthroscopy-The Journal of Arthroscopic and Related Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.arthro.2024.10.021\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.arthro.2024.10.021","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
摘要
目的：系统回顾文献，确定边缘性髋关节发育不良（BHD）患者髋关节镜（HA）手术失败的潜在风险因素：根据《系统综述和元分析首选报告项目》（Preferred Reporting Items for Systematic Reviews and Meta-Analyses）指南，通过检索PubMed、Cochrane图书馆和Embase，对2003年至2023年接受HA手术的BHD患者的英文临床研究进行了系统综述。使用的检索词为(边缘或轻度）、髋关节、（关节镜或发育不良）、失败。评估的主要结果是每项研究报告的 BHD 患者单纯 HA 方法失败的风险因素：14项研究（8项III级，6项IV级）符合纳入标准，共计749个髋关节。患者年龄从29.8岁到39.2岁不等，平均随访时间从24.0个月到144.0个月不等。女性的总体比例从 11.8% 到 100.0% 不等。总体而言，临床失败率为 0 至 53.3%，再次手术率为 0 至 44.0%。单用HA治疗效果不佳的主要预测因素包括托尼斯角≥15°、手术时年龄≥40-42岁和女性。其他失败风险因素包括术前临床关节炎、股骨头或髋臼关节软骨3级或4级病变、前壁指数（AWI）< 0.35以及唇缘剥离。进行的翻修手术包括翻修HA（88例，0-28.0%）、全髋关节置换术（55例，0-23.7%）和内窥镜髋臼置换术（5例，0-11.0%）。一项研究纳入了另外9名转为PAO或全髋关节置换术（THA）的患者，但未对两者进行区分：结论：对于BHD患者，Tönnis角≥15°、手术时年龄≥40-42岁、女性、AWI＜0.35、唇清创和既往存在髋关节骨关节炎是孤立HA治疗失败的常见风险因素：证据级别：IV，对III-IV级研究的系统回顾。
Risk Factors for Failure of Hip Arthroscopy in Patients with Borderline Dysplasia include a Tönnis angle ≥ 15 degrees, Age ≥ 40-42 years, Female Sex, Anterior Wall Index < 0.35, Labral Debridement, and Preexisting Hip Osteoarthritis: A Systematic Review.
Purpose: To systematically review the literature to determine potential risk factors for failure of hip arthroscopy (HA) in patients with borderline hip dysplasia (BHD).
Methods: A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines by searching PubMed, the Cochrane Library, and Embase to identify English language clinical studies reporting on patients with BHD undergoing HA from 2003 to 2023. The search terms used were: (borderline OR mild) AND hip AND (arthroscopy OR dysplasia) AND failure. The primary outcomes assessed were risk factors reported by each study for failure of a HA-only approach in BHD patients.
Results: Fourteen studies (8 level III, 6 level IV) met inclusion criteria, totaling 749 hips. Patient age ranged from 29.8 to 39.2 years with a mean follow-up ranging from 24.0 to 144.0 months. The overall percentage of females ranged from 11.8 to 100.0%. Overall, the clinical failure rate ranged from 0 to 53.3% and the reoperation rate ranged from 0 to 44.0%. The predominant predictors of poor outcomes following HA alone included Tönnis angle ≥ 15°, age ≥ 40-42 years at surgery, and female sex. Other risk factors for failure were preoperative clinical arthritis, grade 3 or 4 articular cartilage changes to the femoral head or acetabulum, an anterior wall index (AWI) < 0.35, and labral debridement. Revision procedures performed included revision HA (n=88, 0-28.0%), total hip arthroplasty (n=55, 0-23.7%), and endoscopic shelf acetabuloplasty (n=5, 0-11.0%). One study included an additional 9 patients converting to either PAO or total hip arthroplasty (THA) without distinguishing between the two.
Conclusion: For patients with BHD, Tönnis angle ≥ 15°, age ≥ 40-42 years at surgery, female sex, AWI < 0.35, labral debridement, and preexisting hip osteoarthritis are common risk factors for treatment failure following isolated HA.
Level of evidence: IV, systematic review of level III-IV studies.
期刊介绍：
Nowhere is minimally invasive surgery explained better than in Arthroscopy, the leading peer-reviewed journal in the field. Every issue enables you to put into perspective the usefulness of the various emerging arthroscopic techniques. The advantages and disadvantages of these methods -- along with their applications in various situations -- are discussed in relation to their efficiency, efficacy and cost benefit. As a special incentive, paid subscribers also receive access to the journal expanded website.
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