Background: Central acetabular stenosis (CAS), defined as an osteophyte within the acetabular fossa, is associated with higher rates of femoral head chondral damage and, when left untreated, inferior short-term outcomes after hip arthroscopic surgery. Central acetabular decompression (CAD) is an arthroscopic technique to resect the osteophyte and resurface the acetabular fossa to improve contact mechanics of the femoral head. Purpose: The primary aim was to provide the 5-year hip preservation rate and patient-reported outcomes in patients undergoing hip arthroscopic surgery for femoroacetabular impingement (FAI) concomitantly with CAD for CAS. A secondary aim was to compare outcomes in patients treated with CAD for CAS to a propensity score–matched control group of patients without CAS. Study Design: Cohort study; Level of evidence, 3. Methods: A surgical registry with prospectively collected data was reviewed for patients who underwent CAD for CAS identified during primary hip arthroscopic surgery for FAI. The primary outcome for the study was conversion to arthroplasty within 5 years postoperatively. Secondary outcomes included revision arthroscopic surgery and patient-reported outcome scores. Multivariate regression analysis was performed to evaluate the risk factors for progression to arthroplasty. A propensity score–matched control group based on preoperative age, sex, body mass index, and Tönnis grade was formed of patients undergoing hip arthroscopic surgery for FAI without CAS to evaluate the differences in outcomes between the 2 groups. Results: There were 155 of 189 eligible patients (82.0%) who had a minimum 5-year follow-up. Within this cohort, the mean age was 45.9 ± 10.8 years, with 90 female patients (58.1%). At the 5-year time point, the arthroplasty-free survivorship rate was 80.6% (125/155). For patients not requiring arthroplasty, significant postoperative improvements were durable ( P < .001), with high satisfaction. On multivariate analysis, severe acetabular chondral defects were most predictive of conversion to arthroplasty. The control group of patients with FAI without CAS demonstrated lower rates of chondral damage and higher rates of arthroplasty-free survivorship ( P < .01). For patients not requiring arthroplasty, postoperative outcome scores, rates of achieving clinically relevant outcome thresholds, and satisfaction with surgery were comparable between the CAD and control groups. Conclusion: Patients with CAS undergoing CAD during primary hip arthroscopic surgery for FAI had durable postoperative improvements and high satisfaction with surgery at a minimum 5-year follow-up. As expected, intraoperative chondral damage rates were significantly greater, and arthroplasty-free survivorship rates were lower, in the CAD group compared with the control group. Nonetheless, 81% of patients undergoing CAD who did not require arthroplasty had significant improvements that were comparable with the control group. We conclude that, with appropriate expectations, patients with FAI and CAS may be treated successfully with advanced arthroscopic techniques.

中文翻译：

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髋臼中央狭窄患者髋臼中央减压术后中期结局：与匹配对照组的比较

背景：髋臼中央狭窄 （CAS），定义为髋臼窝内的骨赘，与较高的股骨头软骨损伤率有关，如果不及时治疗，髋关节镜手术后的短期结果较差。中央髋臼减压术 （CAD） 是一种关节镜技术，用于切除骨赘并重塑髋臼窝，以改善股骨头的接触力学。目的： 主要目的是提供接受髋关节镜手术治疗股髋臼撞击 （FAI） 和 CAD 伴随 CAS 的患者的 5 年髋关节保留率和患者报告的结果。次要目的是比较接受 CAD 治疗 CAS 的患者与倾向评分匹配的无 CAS 患者的对照组的结果。研究设计：队列研究;证据水平，3.方法： 对于在 FAI 初次髋关节镜手术中发现的接受 CAD 的 CAS 患者，回顾了具有前瞻性收集数据的手术登记。该研究的主要结果是术后 5 年内转为关节置换术。次要结局包括翻修、关节镜手术和患者报告的结局评分。进行多因素回归分析以评估进展为关节置换术的危险因素。根据术前年龄、性别、体重指数和 Tönnis 分级，对接受髋关节镜手术治疗 FAI 且无 CAS 的患者形成倾向评分匹配的对照组，以评估 2 组之间结局的差异。结果： 189 名符合条件的患者中有 155 名 （82.0%） 接受了至少 5 年的随访。 在该队列中，平均年龄为 45.9 ± 10.8 岁，其中 90 名女性患者 （58.1%）。在 5 年时间点，无关节置换术存活率为 80.6% （125/155）。对于不需要关节置换术的患者，术后显著改善持久 （ P < .001），满意度高。在多变量分析中，严重的髋臼软骨缺损最能预测转为关节置换术。对照组无 CAS 的 FAI 患者表现出较低的软骨损伤率和较高的无关节置换术存活率 （P < .01）。对于不需要关节置换术的患者，CAD 组和对照组之间的术后结局评分、达到临床相关结局阈值的比率和手术满意度相当。结论： 在 FAI 初次髋关节镜手术中接受 CAD 的 CAS 患者在至少 5 年的随访中具有持久的术后改善和对手术的高度满意度。正如预期的那样，与对照组相比，CAD 组的术中软骨损伤率显着更高，无关节置换术存活率更低。尽管如此，81% 不需要关节置换术的接受 CAD 的患者有显著改善，与对照组相当。我们得出的结论是，在适当的期望下，FAI 和 CAS 患者可能会使用先进的关节镜技术成功治疗。