Clinically Relevant Thresholds for Hip Arthroscopy Vary: A Systematic Review

Purpose: To identify the patient acceptable symptom state (PASS) and substantial clinical benefit (SCB) thresholds for hip arthroscopy and provide guidance on how to choose among the thresholds.

Methods: A systematic review of literature was conducted in PubMed and MEDLINE databases in August 2024 using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Studies with Level I to IV evidence that defined SCB or PASS thresholds for patient-reported outcomes for hip arthroscopy in the setting of intra-articular pathology were included. Case reports, review, technique, and non-English articles were excluded. Title, authors, publication date, study design, patient demographics, timepoint of interest, threshold values, anchor information, and calculation method were recorded.

Results: In total, 35 studies met the inclusion criteria, with 102 PASS thresholds and 82 SCB thresholds being defined across 13 patient-reported outcomes. Hip Outcome Score-Sport-Specific Subscale was the most commonly defined PASS threshold with 22 designations at the 12-, 24-, 60-, and 120-month periods ranging from 63.9-75, 64.3-82.3, 75.2-86.8, and 60.2-61.1, respectively. The International Hip Outcome Tool was the most commonly defined threshold for SCB, with 18 thresholds designations at the 12-, 24-, and 60-month periods ranged from 72.6-86.0, 66.7-86.0, and 86.1-87.5.

Conclusions: Clinically relevant thresholds exhibit significant variability depending on the characteristics of the specific cohort. This study identified several key factors contributing to the heterogeneity in PASS and SCB values, including (1) the anchor questions used, particularly for SCB, (2) the criteria defining responders versus non-responders, (3) the follow-up time at the time point of interest, (4) sample size, and (5) the demographics of the patient population. When determining which threshold to use, surgeons should prioritize those that align closely with the follow-up timepoint of interest for the specific procedure for more accurate comparisons.

Level of evidence: Level IV, systematic review of Level II-IV studies.