Background:The indications for hip arthroscopy in patients aged ≥40 years remain controversial, as observational studies have suggested that advanced age portends poor functional outcomes, poor durability of improvement, and high rates of conversion to total hip arthroplasty.Purpose:To compare hip arthroscopy versus nonoperative management for symptomatic labral tears in patients aged ≥40 years with limited radiographic osteoarthritis.Study Design:Randomized controlled trial; Level of evidence, 1.Methods:This single-surgeon, parallel randomized controlled trial included patients aged ≥40 years with limited osteoarthritis (Tönnis grades 0-2) who were randomized 1:1 to arthroscopic surgery with postoperative physical therapy (SPT) or physical therapy alone (PTA). Patients who received PTA and achieved unsatisfactory improvement were permitted to cross over to SPT after completing ≥14 weeks of physical therapy (CO). The primary outcomes were the International Hip Outcome Tool-33 score and modified Harris Hip Score at 24 months after surgery, and secondary outcomes included other patient-reported outcome measures and the visual analog scale for pain. The primary analysis was performed on an intention-to-treat basis using linear mixed-effects models. Sensitivity analyses included modified as-treated and treatment-failure analyses.Results:A total of 97 patients were included, with 52 (53.6%) patients in the SPT group and 45 (46.4%) patients in the PTA group. Of the patients who underwent PTA, 32 (71.1%) patients crossed over to arthroscopy at a mean of 5.10 months (SD, 3.3 months) after physical therapy initiation. In both intention-to-treat and modified as-treated analyses, the SPT group displayed superior mean patient-reported outcome measure and pain scores across the study period for nearly all metrics relative to the PTA group. In the treatment-failure analysis, the SPT and CO groups showed greater improvement across all metrics compared with PTA; however, post hoc analyses revealed no significant differences in improvement between the SPT and CO groups. No significant differences were observed between groups in rates of total hip arthroplasty conversion.Conclusion:In patients ≥40 years of age with limited osteoarthritis, hip arthroscopy with postoperative physical therapy led to better outcomes than PTA at a 24-month follow-up. However, additional preoperative physical therapy did not compromise surgical outcomes and allowed some patients to avoid surgery. When surgery is indicated, age ≥40 years should not be considered an independent contraindication to arthroscopic acetabular labral repair.Registration:NCT03909178 (ClinicalTrials.gov identifier).

中文翻译：

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髋关节镜检查与物理治疗治疗 40 岁以上患者症状性髋臼盂唇撕裂的比较：随机对照试验的 24 个月结果


背景：年龄≥40岁的患者进行髋关节镜检查的适应证仍存在争议，因为观察性研究表明，高龄预示着功能结果不佳、改善的持久性较差以及转向全髋关节置换术的比率较高。目的：比较髋关节镜检查与非手术治疗治疗 40 岁以上患有局限性放射学骨关节炎患者的症状性盂唇撕裂的比较。 研究设计：随机对照试验；证据级别，1.方法：这项由单名外科医生进行的平行随机对照试验纳入了年龄≥40 岁的局限性骨关节炎（Tönnis 0-2 级）患者，他们按照 1:1 的比例随机分配至关节镜手术联合术后物理治疗 (SPT) 或单纯物理治疗（PTA）。接受 PTA 且改善效果不理想的患者在完成 ≥14 周的物理治疗 (CO) 后被允许转入 SPT。主要结局是术后 24 个月的国际髋关节结果工具 33 评分和改良的 Harris 髋关节评分，次要结局包括其他患者报告的结局指标和疼痛视觉模拟量表。主要分析是使用线性混合效应模型在意向治疗的基础上进行的。敏感性分析包括改良的治疗分析和治疗失败分析。结果：共纳入97例患者，其中SPT组52例（53.6%）患者，PTA组45例（46.4%）患者。在接受 PTA 的患者中，32 名 (71.1%) 患者在开始物理治疗后平均 5.10 个月（SD，3.3 个月）转而接受关节镜检查。 在意向治疗和修改后的治疗分析中，SPT 组在整个研究期间的几乎所有指标上都表现出优于 PTA 组的平均患者报告结果测量和疼痛评分。在治疗失败分析中，与 PTA 相比，SPT 和 CO 组在所有指标上均显示出更大的改善；然而，事后分析显示 SPT 组和 CO 组之间的改善没有显着差异。各组之间的全髋关节置换术转化率没有显着差异。结论：对于年龄≥40岁的局限性骨关节炎患者，在24个月的随访中，髋关节镜检查联合术后物理治疗比PTA具有更好的结果。然而，额外的术前物理治疗并不会影响手术结果，并允许一些患者避免手术。当需要手术时，年龄 ≥40 岁不应被视为关节镜下髋臼盂唇修复术的独立禁忌症。注册：NCT03909178（ClinicalTrials.gov 标识符）。