Purpose
To define minimal clinically important difference (MCID) and substantial clinical
benefit (SCB) in revision hip arthroscopy.
Methods
The modified Harris Hip Score (mHHS), the Hip Outcome Score (HOS), and the international
Hip Outcome Tool (iHOT-33) were administered to revision hip arthroscopy patients.
At 1 year postoperatively, patients graded their hip function based on anchor responses.
SCB was defined as both a net change and an absolute value. Receiver operating characteristic
analysis with area under the curve was used to confirm psychometric values. A distribution-based
method was used for MCID.
Results
Forty-nine patients were included with a mean age of 29.7 (±8.6) years. The most common
indication for revision hip arthroscopy was residual femoroacetabular impingement
(FAI; N = 34; 69.4%) followed by capsular management (N = 8; 16.3%). At 1-year follow-up,
34 patients reported feeling improved. Outcome score change corresponding to MCID
and SCB net change for the mHHS, HOS Activities of Daily Living (ADL), HOS Sports,
and iHOT-33 was 7.9/23.1, 7.9/16.2, 13.1/25.0, and 12.8/25.5, respectively. A higher
proportion of patients with residual FAI achieved MCID compared with patients with
other diagnoses. On the preoperative HOS ADL, HOS Sports, and iHOT-33, patients scoring
below 67.7 (0.78), 55.6 (0.81), and 35.7 (0.73) were significantly more likely to
achieve SCB postoperatively. Thirty-four patients (73.9%) were classified as receiving
physical function improvement, and on the HOS Sports, MCID was achieved by 65% whereas
43% met the SCB criteria.
Conclusions
MCID values ranged from 7.9 on the mHHS and the HOS ADL to 13.1 on the HOS Sports.
SCB net change ranged from 16.2 on the HOS ADL to 25.2 on the iHOT-33, whereas absolute
SCB ranged from 82.4 on the iHOT-33 to 84.7 on the mHHS. Residual FAI and capsular
management were the most common indications for revision surgery with patients who
underwent surgery for the former found to be most likely to achieve clinically significant
improvement.
Level of Evidence
Level IV, case series.
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References
- Hip morphology influences the pattern of damage to the acetabular cartilage: Femoroacetabular impingement as a cause of early osteoarthritis of the hip.J Bone Joint Surg Br. 2005; 87: 1012-1018
- Femoroacetabular impingement: A cause for osteoarthritis of the hip.Clin Orthop Relat Res. 2003; 417: 112-120
- Arthroscopic versus open treatment of femoroacetabular impingement: A systematic review of medium- to long-term outcomes.Am J Sports Med. 2016; 44: 1062-1068
- Predictors of hip arthroscopy outcomes for labral tears at minimum 2-year follow-up: the influence of age and arthritis.Arthroscopy. 2012; 28: 1359-1364
- Outcomes after the arthroscopic treatment of femoroacetabular impingement in a mixed group of high-level athletes.Am J Sports Med. 2011; 39: 14S-19S
- Preoperative outcome scores are predictive of achieving the minimal clinically important difference after arthroscopic treatment of femoroacetabular impingement.Am J Sports Med. 2017; 45: 612-619
- Defining the “substantial clinical benefit” after arthroscopic treatment of femoroacetabular impingement.Am J Sports Med. 2017; 45: 1297-1303
- How are we measuring clinically important outcome for operative treatments in sports medicine?.Phys Sportsmed. 2017; 45: 159-164
- Determining the clinical importance of treatment benefits for interventions for painful orthopedic conditions.J Orthop Surg Res. 2015; 10: 24
- Defining substantial clinical benefit following lumbar spine arthrodesis.J Bone Joint Surg Am. 2008; 90: 1839-1847
- Revision hip arthroscopic surgery: Outcome at three years.Knee Surg Sports Traumatol Arthrosc. 2014; 22: 932-937
- Revision hip arthroscopy: A systematic review of diagnoses, operative findings, and outcomes.Arthroscopy. 2015; 31: 1382-1390
- Revision hip preservation surgery with hip arthroscopy: Clinical outcomes.Arthroscopy. 2014; 30: 581-587
- Outcomes of revision hip arthroscopy: 2-year clinical follow-up.Arthroscopy. 2016; 32: 788-797
- Revision hip arthroscopy: A matched-cohort study comparing revision to primary arthroscopy patients.Am J Sports Med. 2016; 44: 2499-2504
- Revision hip arthroscopy indications and outcomes: A systematic review.Arthroscopy. 2015; 31: 2047-2055
- Causes and risk factors for revision hip preservation surgery.Am J Sports Med. 2014; 42: 2627-2633
- Femoroacetabular impingement in 45 professional athletes: Associated pathologies and return to sport following arthroscopic decompression.Knee Surg Sports Traumatol Arthrosc. 2007; 15: 908-914
- Evidence of capsular defect following hip arthroscopy.Knee Surg Sports Traumatol Arthrosc. 2014; 22: 902-905
- Intra-articular adhesions following hip arthroscopy: A risk factor analysis.Knee Surg Sports Traumatol Arthrosc. 2014; 22: 822-825
- Hip arthroscopic surgery: Patient evaluation, current indications, and outcomes.Am J Sports Med. 2013; 41: 1174-1189
- Femoroacetabular impingement: role of imaging.Musculoskelet Surg. 2013; 97: S117-S126
- Current concepts and trends for operative treatment of FAI: Hip arthroscopy.Curr Rev Musculoskelet Med. 2013; 6: 242-249
- Arthroscopic treatment of femoroacetabular impingement in adolescents provides clinically significant outcome improvement.Arthroscopy. 2017; 33: 1812-1818
- Willingness to go through surgery again validated the WOMAC clinically important difference from THR/TKR surgery.J Clin Epidemiol. 2008; 61: 907-918
- Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation.Med Care. 2003; 41: 582-592
- Responsiveness and clinically important differences for the WOMAC and SF-36 after hip joint replacement.Osteoarthritis Cartilage. 2005; 13: 1076-1083
- Estimating clinically significant differences in quality of life outcomes.Qual Life Res. 2005; 14: 285-295
- John Charnley Award: Preoperative patient-reported outcome measures predict clinically meaningful improvement in function after THA.Clin Orthop Relat Res. 2016; 474: 321-329
- Hip contact stress and femoral neck retroversion: a biomechanical study to evaluate implication of femoroacetabular impingement.J Hip Preserv Surg. 2015; 2: 287-294
Article Info
Publication History
Published online: April 10, 2018
Accepted:
January 31,
2018
Received:
September 5,
2017
Footnotes
See commentary on page 1869
The authors report that they have no conflicts of interest in the authorship and publication of this article. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2018 Published by Elsevier on behalf of the Arthroscopy Association of North America
