2025年06月 保髋进展 JCR Q1

PURPOSE: To report the minimal clinically important difference (MCID) and substantial clinical benefit (SCB) values using the Patient-Reported Outcome Measurement Information System (PROMIS) and International Hip Outcome Tool 12 (iHOT-12) in patients undergoing hip arthroscopy (HA) with concomitant periacetabular osteotomy (PAO), HA + PAO for acetabular dysplasia, and intra-articular pathology with a minimum 2-year follow-up. METHODS: Data from patients who underwent HA + PAO were prospectively collected and retrospectively analyzed. Inclusion criteria consisted of patients who had a diagnosis of hip dysplasia or hip instability and had a minimum 2-year patient-reported outcome measure follow-up. Data were collected electronically preoperatively and postoperatively at 6 months, 1 year, and 2 years. Outcome measures analyzed were the iHOT-12 and PROMIS computer adaptive tests: Physical Function (PF), Pain Interference (PI), and Global Physical Health (GPH). MCID and SCB were calculated for these measures. RESULTS: In total, 106 patients were included in the study with an average age of 23.5 ± 6.6 years, an average body mass index of 24.3, and the majority being female (94%). The values for MCID were calculated to be 40.9, 40.7, 60.2, and 43.5, and the percentage achieving MCID at 2 years was 82.6%, 82.9%, 79.6%, and 80.1% for the iHOT-12, PROMIS-PF, PROMIS-PI, and PROMIS-GPH respectively. The 1-year and 2-year SCB scores for ≥80% satisfaction and percent achieving were as follows, respectively: iHOT-12, 71.8 (60.3%), 61.9 (65.1%); PROMIS-PF, 47.1 (64.2%), 47.2 (71.7%); PROMIS-PI, 50.6 (48.1%), 52.3 (49.1%); and PROMIS-GPH, 49.3 (54.7%), 49.3 (55.7%). The 1-year and 2-year SCB scores for 100% satisfaction and percent achieving were as follows, respectively: iHOT-12, 80.2 (44.3%), 81.3 (47.2%); PROMIS-PF, 50.7 (46.2%), 50.3 (56.6%); PROMIS-PI, 52.4 (34.9%), 52.4 (49.1%); and PROMIS-GPH, 52.5 (36.8%), 49.3 (55.7%). CONCLUSIONS: This study reports values for MCID and SCB

Research to investigate causes for continued symptoms in patients who undergo hip arthroscopic treatment is an opportunity to improve outcomes. A disconcertingly large number of patients (47%-66%) show a joint effusion/synovitis on magnetic resonance imaging at 6 to 12 months after hip arthroscopy for femoroacetabular impingement syndrome, and a recent study shows that this is associated with inferior 2-year clinical outcomes compared to patients without effusions. Perhaps the effusions are associated with comorbid structural abnormalities such as cartilage degeneration, capsule defect, labral reinjury, adhesions, or microinstability/hyperlaxity. In theory, interventions to treat the effusion, such as intra-articular injections or anti-inflammatory medications (which also prophylax against heterotopic ossification), will produce sustained clinical improvement.

Patient-reported outcome (PRO) measures are critical toward understanding the influence and benefits of orthopedic surgery. While clinically important outcome values (CIOVs) have been developed to allow clinical interpretation of PRO values, gaps in outcome metrics still remain. The CIOVs can be used to describe specific populations of interest, such as in patients with hip dysplasia undergoing combined hip arthroscopy and periacetabular osteotomy. With differing populations, however, the presence and/or absence of modifying factors limits cross-comparison of CIOVs. Using a different perspective, such as the use of simple questions that are important for both the patient and the surgeon, can provide important information that helps fill in the gaps left from traditional PROs.

PURPOSE: To compare minimum 2-year patient-reported outcomes (PROs) of revision arthroscopic labral reconstruction after failed primary labral repair with those of matched primary labral reconstruction cases. METHODS: Data from patients who underwent labral reconstruction between June 2008 and November 2024 were retrospectively reviewed. Inclusion criteria required revision hip arthroscopy with labral reconstruction and a minimum 2-year follow-up for PROs, including the modified Harris Hip Score, Nonarthritic Hip Score, Hip Outcome Score-Sport-Specific Subscale, International Hip Outcome Tool 12 score, patient satisfaction rating, and visual analog scale pain score. Exclusion criteria included Tönnis grade greater than 1, pre-existing hip conditions, lateral center-edge angle less 20°, intraoperative gluteus medius repair, ongoing Workers' Compensation claims, and patients with microinstability who underwent remplissage or capsular reconstruction. Revision patients (n = 75) were matched 1:1 with a benchmark control group of primary reconstruction patients (n = 75). RESULTS: At a minimum 2-year follow-up, both groups showed significant improvement in all PROs (P < .001), with comparable rates of improvement (P > .05). However, the revision group showed inferior postoperative outcomes across all PROs (P < .01) and lower rates of achieving the patient acceptable symptom state compared with the control group. CONCLUSIONS: Both primary and revision labral reconstructions lead to significant clinical improvement. However, primary reconstruction achieves superior outcomes, with a higher percentage of patients reaching clinically meaningful thresholds. These findings suggest that when labral tissue quality is questionable, performing a reconstruction at the index procedure may be preferable to attempting a repair that risks eventual failure and the need for revision. LEVEL OF EVIDENCE: Level III, retrospective comparative matched case series.