40岁以上人群经关节镜治疗股髋臼撞击综合征后转全髋关节置换术的中期临床结果和危险因素

IF 3.3 Q1 ORTHOPEDICS

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine Pub Date : 2025-07-18 DOI:10.1016/j.jisako.2025.100929

Hirotaka Nakashima MD, PhD , Yoichi Murata MD, PhD , Shinichiro Takada MD, PhD , Keisuke Nakayama MD, PhD , Haruki Nishimura MD, PhD , Hokuto Fukuda MD , Akinori Sakai MD, PhD , Soshi Uchida MD, PhD

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引用次数: 0

摘要

导语：髋关节镜治疗老年人群股髋臼撞击综合征（FAIS）临床效果良好，全髋关节置换术（THA）转换率较高。然而，40岁以上患者转为THA的危险因素尚不清楚。本研究的目的是回顾40岁以上的FAIS患者在髋关节镜治疗后的中期临床结果，并揭示转化为THA的危险因素。方法：回顾性分析2009年3月至2015年12月接受髋关节镜治疗的FAIS患者。评估患者报告的结果评分（PROs）和THA的转化情况。为了确定转化为THA的预测因素，通过单变量和多变量分析对非THA组和THA组进行比较。结果：172例患者中，98例符合纳入标准，70例患者（男34例，女36例）随访5年以上。手术时平均年龄53.6±9.8岁，平均体重指数23.3±2.9 kg/m2。16例（22.9%）患者在术后平均47.3±38.1个月转为THA。非THA组侧心缘角明显大于THA组（p = 0.040）。THA组微骨折比例显著高于非THA组（p < 0.001）。Cox风险模型显示，微骨折是THA转化的预测因子(风险比5.405,95% CI 1.876-15.384；p = 0.002)。非tha组的PROs术后明显改善。结论：微骨折所需的软骨损伤是THA转行的危险因素。在至少5年的随访中，40岁以上的FAIS患者在初次髋关节镜治疗后转为THA的比率为22.9%。证据级别：Ⅳ。

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Midterm clinical outcomes and risk factor for conversion to total hip arthroplasty after arthroscopic treatment for femoroacetabular impingement syndrome in individuals over 40 years of age

Introduction

The clinical outcomes of hip arthroscopic treatment for femoroacetabular impingement syndrome (FAIS) in the older population are good, with a relatively high conversion rate of total hip arthroplasty (THA). However, the risk factors for conversion to THA in patients over 40 years of age are unclear. The purpose of this study was to review the midterm clinical outcomes after hip arthroscopic treatment for FAIS in patients over 40 years of age and to reveal the risk factors for conversion to THA.

Methods

Patients with FAIS who underwent primary hip arthroscopic treatment from March 2009 to December 2015 were retrospectively reviewed. Patient-reported outcome scores (PROs) and conversion to THA were assessed. To identify the predictors of conversion to THA, the non-THA and THA groups were compared via univariate and multivariate analyses.

Results

Among 172 patients, 98 met the inclusion criteria, and 70 patients (34 males and 36 females) were followed for more than 5 years. The mean age at surgery was 53.6 ± 9.8 years, and the mean body mass index was 23.3 ± 2.9 kg/m². Sixteen patients (22.9%) were converted to THA at a mean of 47.3 ± 38.1 months after surgery. The lateral center-edge angle in the non-THA group was significantly greater than that in the THA group (p = 0.040). The proportion of microfracture in the THA group was significantly greater than that in the non-THA group (p < 0.001). The Cox hazard model revealed that microfracture was a predictor of conversion to THA (hazard ratio 5.405, 95% CI: 1.876–15.384; p = 0.002). The PROs in the non-THA group significantly improved after surgery.

Conclusion

The risk factor for conversion to THA was cartilage damage needed for microfracture. The rate of conversion to THA after primary hip arthroscopic treatment for FAIS in individuals over 40 years of age was 22.9% at a minimum 5-year follow-up.