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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Pre-operative Predictors of Return to High Functional Status after Hip Arthroscopy for Femoroacetabular Impingement at 2-year Minimum Follow-up
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Pre-operative Predictors of Return to High Functional Status after Hip Arthroscopy for Femoroacetabular Impingement at 2-year Minimum Follow-up

机译：髋关节镜检查对髋臼股骨髋臼撞击后恢复至高功能状态的术前预测因素，为期最少2年

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Objectives: Pre-operative predictors of high functional level at two years following hip arthroscopy are unclear. We hypothesized that smoking status, comorbid disease (hypertension, diabetes, mental health diagnoses, prior surgeries, and spine pathology) would negatively affect outcomes at two-year follow-up while younger age, decreased body mass index (BMI), increased physical activity and shorter preoperative symptom duration would be able to predict outcomes after hip arthroscopy for femoroacetabular impingement (FAI). Methods: A prospectively collected registry was analyzed for all patients treated for FAI from 2012 to 2015. All patients had a minimum of 2-year follow-up with patient reported outcomes [PROs, including modified Harris Hip Score (mHHS), Hip Outcome Score (HOS)-Activities of Daily Living (ADL), HOS-Sport Specific (HOS-SS), Visual Analog Score (VAS)-Pain and satisfaction. Inclusion criteria were skeletally mature patients at the time of arthroscopy, signs and symptoms consistent with a diagnosis of FAI. Individuals with prior hip surgery, inflammatory arthropathy, and/or advanced osteoarthritis were excluded. Univariate and correlation analyses were performed to identify significant association and multivariate logistic regression analysis was used to identify significant predictors. Significance was set at α ≤ 0.05. Results: Of 1042 qualifying patients, 830 completed 2-year minimum follow-up (80%); mean age and body mass index (BMI) were 33.6±12.8 years and 25.4±11.3 respectively. The majority of patients were female (549, 66.1%), non-smokers (741, 89.3%), who participated in regular recreational sports (623, 75%). One-third (278, 33.5%) experienced preoperative symptoms longer than two-years while 157 (18.9%) experienced symptoms for one-to-two years, with 265 (31.9%) for 4-to-12 months, and 108 (13%) less than 4 months. Mean alpha angle and lateral center edge angle were 61.2±10.1 and 33.1±7.02, respectively. All patients demonstrated significant improvements in PROs following surgery: HOS-ADL (65.20±0.72 to 86.54±0.61; p<0.0001), HOS-SS (42.84±0.89 to 73.98±1.0; p<0.0001), and mHHS (57.4±0.58 to79.92±0.68; p<0.0001). In addition, VAS Pain was significantly decreased from 53.35±1.3 to 19.44±0.86 (p=0.032) with high two-year satisfaction at 81.11±28.28. Regression analysis identified the strongest predictors for high functioning outcomes in the HOS-SS were patients without a history of a mental health diagnoses (anxiety or depression; importance 0.29, p<0.0001) followed by younger age (importance 0.18; p<0.0001). Predictors for improved two-year HOS-ADL outcomes included shorter duration of symptoms (importance 0.22; p<0.0001) and decreased BMI (importance 0.164; p=0.001). Predictors for an improved mHHS included no pre-operative narcotic use (importance 0.19; p=0.001) and no history of a mental health diagnoses (importance 0.18; p=0.001). Predictors of HOS-ADL and mHHS were also significant predictors of a greater HOS-SS score (p=0.001 for all). Conclusion: Our results support the hypothesis that patients with mental health diagnoses, increased age and BMI, as well as prolonged preoperative symptom duration are predictors for inferior post-operative functional status at mid-term follow-up. Our results suggest that there are both modifiable and non-modifiable pre-operative factors that have the potential to predict a return to high functional status after hip arthroscopy for FAI.
机译：目的：髋关节镜检查后两年的高功能水平的术前预测因素尚不清楚。我们假设吸烟状况，合并症（高血压，糖尿病，精神健康诊断，先前手术和脊柱病理）将对两年随访产生不利影响，而年龄较小，体重指数（BMI）降低，体力活动增加术前症状持续时间的缩短和髋关节镜检查对股骨髋臼撞击（FAI）的效果将能够预测。方法：对2012年至2015年所有接受FAI治疗的患者进行前瞻性收集的登记册分析。所有患者至少接受了2年的随访，并报告了患者报告的结局[PRO，包括改良的Harris Hip评分（mHHS），Hip结果评分（HOS）-日常生活活动（ADL），HOS-运动特定（HOS-SS），视觉模拟评分（VAS）-疼痛和满意度。入选标准为关节镜检查时骨骼成熟的患者，体征和症状与FAI的诊断相符。排除有髋关节手术，炎症性关节炎和/或晚期骨关节炎的患者。进行单变量和相关性分析以识别显着的关联，并使用多元逻辑回归分析来识别显着的预测因子。显着性设定为α≤0.05。结果：在1042名合格患者中，有830名完成了至少2年的随访（80％）;平均年龄和体重指数（BMI）分别为33.6±12.8岁和25.4±11.3岁。大多数患者为女性（549人，占66.1％），非吸烟者（741人，占89.3％），他们参加了定期的休闲运动（623人，占75％）。三分之一（278，33.5％）的患者术前症状超过两年，而157（18.9％）的患者症状持续一到两年，其中265（31.9％）的患者在4至12个月内经历了症状，而108（ 13％）少于4个月。平均α角和横向中心边缘角分别为61.2±10.1和33.1±7.02。所有患者术后均表现出PRO的显着改善：HOS-ADL（65.20±0.72至86.54±0.61; p <0.0001），HOS-SS（42.84±0.89至73.98±1.0; p <0.0001）和mHHS（57.4±0.58）至79.92±0.68; p <0.0001）。此外，VAS疼痛显着降低，从53.35±1.3降至19.44±0.86（p = 0.032），两年满意度高，为81.11±28.28。回归分析确定了HOS-SS高功能结局的最强预测因素是无精神健康诊断史（焦虑或抑郁;重要性0.29，p <0.0001），其次是年龄较小（重要性0.18; p <0.0001）。改善两年HOS-ADL结果的预测指标包括症状持续时间缩短（重要性0.22; p <0.0001）和BMI降低（重要性0.164; p = 0.001）。预测mHHS改善的因素包括术前未使用麻醉药（重要性0.19; p = 0.001）和无精神健康诊断史（重要性0.18; p = 0.001）。 HOS-ADL和mHHS的预测指标也是HOS-SS得分更高的重要预测指标（所有指标p = 0.001）。结论：我们的结果支持以下假设：患有精神健康诊断，年龄和BMI升高以及术前症状持续时间延长的患者是中期随访中术后功能状态较差的预测因素。我们的研究结果表明，在髋关节镜下进行FAI后，术前因素有可修改和不可修改的潜力，可以预测其恢复高功能状态。

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