三次或三次以上髋关节镜翻修手术在女性患者中更为常见，髋臼软骨高度病变导致手术失败的风险增加

Q3 Medicine

Arthroscopy Sports Medicine and Rehabilitation Pub Date : 2025-08-01 DOI:10.1016/j.asmr.2025.101166

Joseph J. Ruzbarsky M.D. , Spencer M. Comfort M.D. , Vera M. Stetzelberger M.D. , Justin J. Ernat M.D. , Nicholas A. Felan B.A. , Grant J. Dornan M.S. , Marc J. Philippon M.D.

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引用次数: 0

摘要

目的分析多次髋关节镜翻修患者的危险因素，并报告髋关节镜术后至少2年的生存率。方法纳入2011年1月至2018年9月期间接受髋关节镜翻修术的18-65岁患者，随访≥2年。排除标准为手术时年龄18岁或65岁，中心边缘角20°，既往同侧髋臼周围截骨，或拒绝参加。程序被分类为第一次（R1），第二次（R2）或第三次或更多次（R3+）修订。人口统计学、术前x线测量、基线患者报告结果（PROs）、术中发现和生存率在组间以及需要进一步手术或全髋关节置换术（THA）和不需要手术的患者之间进行比较。生存期定义为重新翻修和无关节置换术生存期。PROs包括改良Harris髋关节评分、髋关节结果评分-日常生活活动、HOS-Sport、西安大略和麦克马斯特大学骨关节炎指数，以及简短的身心成分评分（12项简短的身体成分评分/精神成分评分）。结果284髋（246例）符合纳入标准，平均随访4.3±2.1年。女性（52% vs 63% vs 78%, P = 0.03）、在外部机构进行首次髋关节镜检查（62% vs 78% vs 96%, P < 0.001）、较小的α角（64°vs 56°vs 50°，P < 0.001）以及较差的基线PROs（修改后的Harris髋关节评分、髋关节结局评分-日常生活活动、HOS-Sport、西安大略和麦克马斯特大学骨关节炎指数；P = 0.05, P = 0.01, P < 001, P = 0.01）与更多的先前修订相关。失败发生率组间无差异（P = 0.29），但R3+组进一步手术或THA的风险比高于R1组（风险比2.4,95%可信区间1.04-5.38,P = 0.04）。结论：在至少2年的随访中，女性性别、较低的基线PROs、囊膜缺陷和更大的失败风险与更多的先前翻修相关。非发育不良的外侧中缘角较低、严重髋臼软骨损伤或翻修≥3次的患者再次翻修或THA的风险增加。证据水平：IV级，治疗性病例系列。

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Three or More Revision Hip Arthroscopy Surgeries Is More Common in Female Patients and High-Grade Acetabular Chondral Lesions Lead to Increased Risk of Failure

Purpose

To characterize risk factors for patients who underwent multiple-revision hip arthroscopies and report survivorship at a minimum 2 years after hip arthroscopy.

Methods

Patients aged 18-65 years who underwent revision hip arthroscopy between January 2011 and September 2018 with ≥2-year follow-up were included. Exclusion criteria were age <18 or >65 years at time of surgery, center-edge angle <20°, previous ipsilateral periacetabular osteotomy, or refusal to participate. Procedures were categorized as first (R1), second (R2), or third or more (R3+) revisions. Demographics, preoperative radiographic measurements, baseline patient-reported outcomes (PROs), intraoperative findings, and survivorship were compared across groups and between those requiring further surgery or total hip arthroplasty (THA) and those who did not. Survivorship was defined as re-revision and arthroplasty-free survival. PROs included modified Harris Hip Score, Hip Outcome Score – Activities Daily Living, HOS-Sport, Western Ontario and McMaster Universities Osteoarthritis Index, and Short Form Physical and Mental Component Scores (12-Item Short Form Physical Component Score/Mental Component Score).

Results

A total of 284 hips (246 patients) met inclusion criteria, with mean follow-up of 4.3 ± 2.1 years. Female sex (52% vs 63% vs 78%, P = .03), primary hip arthroscopy at an outside institution (62% vs 78% vs 96%, P < .001), smaller alpha angle (64° vs 56° vs 50°, P < .001), and worse baseline PROs (modified Harris Hip Score, Hip Outcome Score – Activities Daily Living, HOS-Sport, Western Ontario and McMaster Universities Osteoarthritis Index; P = .05, P = .01, P < .001, P = .01) were associated with more previous revisions. Failure incidence did not differ between groups (P = .29), but the hazard ratio for further surgery or THA was greater for R3+ versus R1 (hazard ratio 2.4, 95% confidence interval 1.04-5.38, P = .04).

Conclusions

At a minimum 2-year follow-up, more prior revisions were associated with female sex, lower baseline PROs, capsular deficiency, and greater failure risk. Patients with lower nondysplastic lateral center-edge angles, severe acetabular cartilage damage, or ≥3 revisions had elevated risk for re-revision or THA.