Purpose
To define minimal clinically important difference (MCID) and substantial clinical
benefit (SCB) for adolescents undergoing arthroscopic femoroacetabular impingement
(FAI) surgery.
Methods
A prospective institutional hip preservation registry was reviewed to identify hip
arthroscopies performed for FAI. Patients with pre-existing hip conditions such as
slipped capital femoral epiphysis and Legg-Calve-Perthese were excluded. Included
patients were 18 years and younger. The modified Harris Hip Score (mHHS), the Hip
Outcome Score (HOS), and the international Hip Outcome Tool (iHOT-33) were administered
as part of the registry. MCID was calculated using a distribution-based method, and
SCB was calculated using a physical function anchor question. Receiver operating characteristic
analysis with area under the curve (AUC) was used for psychometric analyses.
Results
Forty-seven adolescents were identified. The majority of patients were female (n =
32, 68.1%) with a mean age of 16.5 (±1.1) years. The MCID (% achieving) for the mHHS,
HOS activities of daily living (ADL), HOS Sport, and iHOT-33 was 9.5 (85%), 9.8 (79%),
12.1 (85%), and 10.7 (94%), respectively. Ninety-two percent of adolescents reported
some form of improved hip physical ability on the anchor question. The following 1-year
absolute outcome scores were significantly representative of an SCB state on the mHHS,
HOS ADL, HOS Sport, and mHHS, respectively (AUC): 93.5 (0.79), 98.5 (0.84), 96.9 (0.81),
and 85.9 (0.76).
Conclusions
Adolescents undergoing arthroscopic FAI surgery achieve clinically significant outcome
improvement. We found that the vast majority of adolescents achieve MCID on hip-specific
patient-reported outcome tools. However, although adolescents readily achieve MCID,
a considerable improvement in postoperative outcome score is often needed to perceive
a substantial benefit (SCB). The available hip outcome tools may be subject to ceiling
effects for measuring clinically significant outcome improvement in adolescents.
Level of Evidence
Level IV, case series.
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Article info
Publication history
Published online: June 13, 2017
Accepted:
April 3,
2017
Received:
November 21,
2016
Footnotes
See commentary on page 1819
The authors report that they have no conflicts of interest in the authorship and publication of this article.
This investigation was performed at the Hospital for Special Surgery, New York.
Identification
Copyright
© 2017 by the Arthroscopy Association of North America
