寛骨臼関節唇損傷のサイズに基づく長期転帰および人工股関節全置換術への移行：最低8年間の追跡調査
Srish S Chenna1, Jeffrey S Mun1, Brandon J Allen1
1Department of Orthopaedic Surgery, Massachusetts General Hospital, Mass General Brigham Integrated Health Care System, Boston, Massachusetts, USA.
Background:
There is a paucity of literature on the effects of labral tear size on long-term patient-reported outcomes (PROs) and conversion to total hip arthroplasty (THA) after hip arthroscopy.
Purpose:
To understand the differences in hip arthroscopy survivorship and outcomes between patients with large labral tears (LLTs) and small labral tears (SLTs).
Study Design:
Cohort study; Level of evidence, 3.
Methods:
This retrospective cohort study included patients who underwent primary hip arthroscopy for symptomatic labral tears secondary to femoroacetabular impingement by a single surgeon from 2001 to 2013; they completed surveys for such PRO measures (PROMs) as the modified Harris Hip Score (mHHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sports Specific, 33-item International Hip Outcome Tool (iHOT-33), and pain relief. Patients ≤18 years of age, hip dysplasia LCEA <20°, and Tönnis grade ≥2 were excluded. Included patients were stratified into 2 cohorts: SLT (≤60°) and LLT (>60°).
Results:
In this study of 154 patients (48.7% female; mean ± SD age, 38 ± 10.8), there was a mean ± SD follow-up of 11.0 ± 2.4 years and body mass index of 26.1 ± 4.3 kg/m2. Women experienced a higher frequency of SLT than men (59.8% vs 40.2%; P = .003). Student t tests demonstrated that the SLT cohort experienced significantly better outcomes than the LLT cohort for mHHS, HOS-ADL, and iHOT-33. Multivariate linear regression analyses adjusting for demographic, radiographic, and intraoperative findings indicated that LLT size can predict worse long-term outcomes after hip arthroscopy for mHHS and HOS-ADL (P < .05). Kaplan-Meier estimates and weighted Cox regression demonstrated that the conversion rate to THA for LLT was significantly greater than that for SLT (hazard ratio, 7.92; 95% CI, 2.96-21.2; P < .0001).
Conclusion:
Those in the LLT cohort experienced a significantly greater conversion rate to THA than did the SLT cohort. Also, SLT size can independently predict better long-term outcomes on certain PROMs after primary hip arthroscopy.
