Hip Arthroscopy Outcomes With Respect to Patient Acceptable Symptomatic State and Minimal Clinically Important Difference

David M Levy; Benjamin D Kuhns; Jaskarndip Chahal; Marc J Philippon; Bryan T Kelly; Shane J Nho

doi:10.1016/j.arthro.2016.05.014

Hip Arthroscopy Outcomes With Respect to Patient Acceptable Symptomatic State and Minimal Clinically Important Difference

Arthroscopy. 2016 Sep;32(9):1877-86. doi: 10.1016/j.arthro.2016.05.014. Epub 2016 Jun 18.

Authors

David M Levy¹, Benjamin D Kuhns², Jaskarndip Chahal², Marc J Philippon³, Bryan T Kelly⁴, Shane J Nho²

Affiliations

¹ Hip Preservation Center, Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A.. Electronic address: [email protected].
² Hip Preservation Center, Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A.
³ Steadman Philippon Research Institute, The Steadman Clinic, Vail, Colorado, U.S.A.
⁴ Center for Hip Preservation, Hospital for Special Surgery, New York, New York, U.S.A.

PMID: 27324968
DOI: 10.1016/j.arthro.2016.05.014

Abstract

Purpose: To determine whether the hip arthroscopy literature to date has shown outcomes consistent with published patient acceptable symptomatic state (PASS) and minimal clinically important difference (MCID) estimates.

Methods: All clinical investigations of hip arthroscopy using modified Harris Hip Score (mHHS) and/or Hip Outcome Score (HOS) outcomes with at least 1 year of follow-up were reviewed. Ninety-one studies (9,746 hips) were included for review. Eighty-one studies (9,317 hips) contained only primary hip arthroscopies and were the primary focus of this review. The remaining studies (429 hips) did not exclude patients with prior surgical history and were thus considered separately. Mean mHHS, HOS-ADL (Activities of Daily Living) and HOS-SS (Sports-Specific) scores were compared with previously published PASS and MCID values.

Results: After 31 ± 20 months, 5.8% of study populations required revision arthroscopy and 5.5% total hip arthroplasty. A total of 88%, 25%, and 30% of study populations met PASS for mHHS, HOS-ADL, and HOS-SS, respectively, and 97%, 90%, and 93% met MCID. On bivariate analysis, increasing age was associated with significantly worse postoperative mHHS (P < .01, R(2) = 0.14), HOS-SS (P = .05, R(2) = 0.12), and rates of reoperation (P = .02, R(2) = 0.08). Increasing body mass index was associated with significantly worse HOS-ADL (P = .02, R(2) = 0.35) and HOS-SS (P = .03, R(2) = 0.30).

Conclusions: In this meta-analysis of 81 studies of primary hip arthroscopy, we have found that more than 90% of study populations meet MCID standards for the most commonly used patient-reported outcomes measures in hip arthroscopy literature, mHHS and HOS. Eighty-eight percent meet PASS standards for the mHHS, but PASS standards are far more difficult to achieve for HOS-ADL (25%) and HOS-SS (30%) subscales. Differences in psychometric properties of the mHHS and HOS likely account for the discrepancies in PASS.

Level of evidence: Level IV, systematic review of Level I to IV studies.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Activities of Daily Living*
Arthroplasty, Replacement, Hip
Arthroscopy / methods*
Body Mass Index
Femoracetabular Impingement / surgery*
Follow-Up Studies
Hip Joint / physiopathology
Hip Joint / surgery*
Humans
Minimal Clinically Important Difference*
Osteoarthritis, Hip / surgery*
Patient Satisfaction
Postoperative Period
Reoperation
Risk Factors
Sports
Treatment Outcome