Effect of cam resection depth on clinical outcomes after primary hip arthroscopy.

IF 1.3 4区医学 Q3 ORTHOPEDICS HIP International Pub Date : 2024-03-01 Epub Date: 2023-09-03 DOI:10.1177/11207000231197358

Emre Acar, Onur Hapa, Onur Gürsan, Ali Balcı, Selahaddin Aydemir, Alaa Mukat, Selahattin Ağca, Mustafa Çeltik, Gökay Gedik

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Abstract

Background: The amount of resection or the starting point of the resection on the femoral head for cam lesions in femoroacetabular impingement (FAI) is controversial.

Aim: The purpose of this study was to study the effect of postoperative resection depth, and resection arc ratio of cam lesion on the frequency of achieving substantial clinical benefit (SCB), patient acceptable state (PASS) in modified Harris Hip Score (mHHS) and Hip Outcome Score Activity of Daily Living (HOS_ADL), 2 years postoperatively.

Patients and methods: All patients who underwent first-time hip arthroscopy for FAI with a 2-year follow-up were included in this study. Patient-reported outcomes included the mHHS, HOS_ADL, and visual analogue scale for pain (Pain VAS). Radiological parameters such as alpha angle_traditional (α_T), alpha angle_cartilage (α_C), resection arc ratio (% alpha angle_cartilage-alpha angle_traditional/360°), resection depth (''D''mm) and resection depth ratio 'D%' (D/femoral head diameter %) were measured using the 45° Dunn view.

Results: We identified 26 patients (27 hips) with 2-year follow-up. There were 10 female and 16 male patients. The mean age of the patients was 33 ± 12 years.Higher frequency of achieving SCB threshold for mHHS was related to labrum repair (73% vs. debridement '27%' p = 0.03), lower preoperative α_T (64° vs. 76°, p = 0.04), lower preoperative mHHS (54 vs. 81, p < 0.001) and higher preoperative VAS scores (8 vs. 7, p = 0.02). Higher frequency of reaching PASS threshold for mHHS was associated with lower α_C (82°vs. 92° p:0.02), lower RA (8% vs. 11%, p = 0.03), lower D (2.8 mm vs. 4.5 mm p:0.03), lower D% (4.7% vs. 8.4% p = 0.04) and higher postoperative mHHS (97 vs. 82 p < 0.001).

Conclusions: A higher frequency of achieving SCB for HOS_ADL was related to lower D% (5% vs. 10.5%, p = 0.04).Cam resection depth affects the frequency of achieving clinically meaningful scores and resection depth less than 6% of the femoral head diameter seems to be appropriate for optimal results. The starting point of resection on head cartilage needs to be <90° when alpha angle is used for reference.

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凸轮切除深度对初次髋关节镜检查后临床结果的影响。

背景：股骨髋臼撞击（FAI）中凸轮病变的股骨头切除量或切除起点存在争议。目的：本研究的目的是研究凸轮病变的术后切除深度和切除弧比对改良Harris髋关节评分（mHHS）和日常生活髋关节结果评分（HOSADL）中获得实质性临床疗效（SCB）的频率、患者可接受状态（PASS）的影响术后数年。患者和方法：本研究包括所有首次接受髋关节镜检查并进行2年随访的FAI患者。患者报告的结果包括mHHS、HOSADL和疼痛视觉模拟量表（疼痛VAS）。使用45°Dunn视图测量放射参数，如α-斜角软骨（αT）、α-角软骨（αC）、切除弧比（%α-角状软骨/360°）、切除深度（“D”mm）和切除深度比“D%”（D/股骨头直径%）。结果：我们确定了26名患者（27髋），并进行了2年的随访。其中女性10例，男性16例。患者的平均年龄为33岁 ± 12 年。mHHS达到SCB阈值的频率较高与阴唇修复有关（73%vs.清创术“27%”p = 0.03），术前αT较低（64°vs.76°，p = 0.04），术前mHHS较低（54对81，p p = mHHS达到PASS阈值的频率越高，αC越低（82°vs.92°p:0.02），RA越低（8%vs.11%，p=0.03），D越低（2.8 mm vs.4.5 mm p:0.03），D%越低（4.7%vs.8.4%，p=0.04），术后mHHS越高（97 vs.82 p<0.001） = 0.04）。凸轮切除深度影响获得临床有意义评分的频率，切除深度小于股骨头直径的6%似乎适合获得最佳结果。头部软骨切除的起点需要

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来源期刊

HIP International 医学-整形外科

CiteScore

4.20

自引率

0.00%

发文量

审稿时长

2 months

期刊介绍： HIP International is the official journal of the European Hip Society. It is the only international, peer-reviewed, bi-monthly journal dedicated to diseases of the hip. HIP International considers contributions relating to hip surgery, traumatology of the hip, prosthetic surgery, biomechanics, and basic sciences relating to the hip. HIP International invites reviews from leading specialists with the aim of informing its readers of current evidence-based best practice. The journal also publishes supplements containing proceedings of symposia, special meetings or articles of special educational merit. HIP International is divided into six independent sections led by editors of the highest scientific merit. These sections are: • Biomaterials • Biomechanics • Conservative Hip Surgery • Paediatrics • Primary and Revision Hip Arthroplasty • Traumatology