Utility of Ultrasound-Guided Anesthetic Intra-articular Injection to Estimate the Outcome of Hip Arthroscopy in Patients with Femoroacetabular Impingement Syndrome

摘要

Objective To investigate the effectiveness of ultrasound (US) guided intra-hip joint injection to estimate the outcome of hip arthroscopy in patients with femoroacetabular impingement (FAI) syndrome. Methods Patients with FAI syndrome (n?=?60) were prospectively enrolled in our study. Before hip arthroscopy, a mix of 4?mL 2% lidocaine and 4?mL 1% ropivacaine were injected into the hip joint under the guidance of US. The clinical efficacy of the intra-articular injection was evaluated by comparing the visual analog scale (VAS) and international hip outcome tool 12 (iHOT-12) results before and after the injection. The outcome of hip arthroscopy was evaluated by iHOT-12, the modified Harris hip score (MHHS), and the patient's satisfaction 12?months after the operation. The outcome of intra-articular injection and hip arthroscopy were compared. Factors related to the outcomes of hip arthroscopy were evaluated. The correlation between the efficacy of intra-hip joint injection and arthroscopy was evaluated. Results The VAS of patients decreased from 11.3?±?7.7 to 3.3?±?4.5, and the iHOT-12 increased from 52.1?±?23.2 to 84.1?±?18.1 after intra-articular injection (all P ?0.001). The iHOT-12 score increased from 52.1?±?23.2 to 78.9?±?19.2, and the MHHS increased from 66.5?±?6.8 to 81.6?±?8.1 after hip arthroscopy (all P ?0.001). The satisfaction rate of arthroscopy, including very satisfied and effective patients, was 93.3%. Multi-variable logistic regression showed that only iHOT-12 improved value after injection was included in the regression formula of satisfaction, with the β of ?0.154, standard error of 0.071, Wald value of 4.720, and OR of 0.857 (95%CI 0.746–0.985) ( P =?0.03). Significant correlation was detected between iHOT-12 scores after intra-articular anesthesia and at 12?months after arthroscopy (r?=?0.784, P ?0.001). So was the iHOT-12 improved value ( r =?0.781, P ?0.001) and the iHOT-12 improved ratio ( r =?0.848, P ?0.001). If we had performed arthroscopy only on patients with post-injection iHOT-12 score improvement ≥10, the satisfaction rate of arthroscopy would have increased to 96.6%. Conclusions US-guided intra-hip joint injection may provide a feasible way to estimate the outcome of hip arthroscopy in patients with FAI syndrome, and could be used as a method for indication selection of hip arthroscopy.