Six-Month Outcome Scores Predicts Short-Term Outcomes After Hip Arthroscopy


      To determine whether early patient-reported outcome improvements in the 6 months after surgery are predictive of achieving a patient acceptable symptomatic state (PASS) at 2 years.


      A prospectively collected database was retrospectively reviewed. Inclusion criteria included patients ≥18 years of age, Tönnis grade 0 or 1 changes, radiographic imaging consistent with femoroacetabular impingement or labral pathology, a primary diagnosis of symptomatic femoroacetabular impingement for which they underwent primary hip arthroscopy, and baseline, 6-month, and 2-year modified Harris Hip Score (mHHS) scores. Revision cases were excluded. Receiver operating characteristic curve analysis was conducted to determine whether 6-month change in mHHS was a predictor for achieving PASS at 2 years.


      There were 173 patients (mean age: 39.8, 61.8% female) included within the study. Patients who do not achieve the minimal clinically important difference (MCID), defined as a change of 8 points in mHHS, by 6 months (n = 21) tended to have significantly lower mHHS scores at 1 year and 2 years compared with those who did (n = 152). Only 52% of patients who did not achieve MCID by 6 months achieved MCID by 2 years (vs 98% for those that did) and only 24% achieved PASS by 2 years (vs 88% that did). Using the MCID as a cutoff for improvement in mHHS at 6 months results in a 96% sensitivity but 47% specificity for predicting PASS achievement at 2 years. Using 24 points of improvement in mHHS as a cutoff at 6 months improves sensitivity and specificity to 81% and 80%, respectively.


      Early improvement in mHHS scores is associated with 2-year outcomes. Patients who do not achieve MCID within 6 months of surgery have a high rate of not achieving PASS at 2 years.

      Level of Evidence

      IV, case series study
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Montgomery S.R.
        • Ngo S.S.
        • Hobson T.
        • et al.
        Trends and demographics in hip arthroscopy in the United States.
        Arthroscopy. 2013; 29: 661-665
        • Bozic K.J.
        • Chan V.
        • Valone F.H.
        • Feeley B.T.
        • Vail T.P.
        Trends in hip arthroscopy utilization in the United States.
        J Arthroplasty. 2013; 28: 140-143
        • Schairer W.W.
        • Nwachukwu B.U.
        • Suryavanshi J.R.
        • Yen Y.-M.
        • Kelly B.T.
        • Fabricant P.D.
        A shift in hip arthroscopy use by patient age and surgeon volume: A New York State-based population analysis 2004 to 2016.
        Arthroscopy. 2019; 35: 2847-2854.e1
        • McCarthy J.C.
        • Lee J.
        Hip arthroscopy: Indications and technical pearls.
        Clin Orthop Relat Res. 2005; 441: 180-187
        • Riff A.J.
        • Kunze K.N.
        • Movassaghi K.
        • et al.
        Systematic review of hip arthroscopy for femoroacetabular impingement: The importance of labral repair and capsular closure.
        Arthroscopy. 2019; 35: 646-656.e3
        • Stephan P.
        • Röling M.A.
        • Mathijssen N.M.C.
        • Hannink G.
        • Bloem R.M.
        Developing a risk prediction model for the functional outcome after hip arthroscopy.
        BMC Musculoskelet Disord. 2018; 19: 122
        • Stone A.V.
        • Beck E.C.
        • Malloy P.
        • et al.
        Preoperative predictors of achieving clinically significant athletic functional status after hip arthroscopy for femoroacetabular impingement at minimum 2-year follow-up.
        Arthroscopy. 2019; 35: 3049-3056.e1
        • Nicholson J.A.
        • Clement N.D.
        • Clelland A.D.
        • MacDonald D.
        • Simpson A.H.R.W.
        • Robinson C.M.
        Displaced midshaft clavicle fracture union can be accurately predicted with a delayed assessment at 6 weeks following injury: A prospective cohort study.
        J Bone Joint Surg Am. 2020; 102: 557-566
        • Sim Y.
        • Horner N.S.
        • de Sa D.
        • Simunovic N.
        • Karlsson J.
        • Ayeni O.R.
        Reporting of non-hip score outcomes following femoroacetabular impingement surgery: A systematic review.
        J hip Preserv Surg. 2015; 2: 224-241
        • Harris W.H.
        Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation.
        J Bone Joint Surg Am. 1969; 51: 737-755
        • Potter B.K.
        • Freedman B.A.
        • Andersen R.C.
        • Bojescul J.A.
        • Kuklo T.R.
        • Murphy K.P.
        Correlation of Short Form-36 and disability status with outcomes of arthroscopic acetabular labral debridement.
        Am J Sports Med. 2005; 33: 864-870
        • Aprato A.
        • Jayasekera N.
        • Villar R.N.
        Does the modified Harris hip score reflect patient satisfaction after hip arthroscopy?.
        Am J Sports Med. 2012; 40: 2557-2560
        • Harris J.D.
        • Brand J.C.
        • Cote M.P.
        • Faucett S.C.
        • Dhawan A.
        Research Pearls: The significance of statistics and perils of pooling. Part 1: Clinical versus statistical significance.
        Arthrosc J Arthrosc Relat Surg. 2017; 33: 1102-1112
        • Kemp J.L.
        • Collins N.J.
        • Roos E.M.
        • Crossley K.M.
        Psychometric properties of patient-reported outcome measures for hip arthroscopic surgery.
        Am J Sports Med. 2013; 41: 2065-2073
        • Chahal J.
        • Van Thiel G.S.
        • Mather R.C.
        • et al.
        The patient acceptable symptomatic state for the modified Harris Hip Score and Hip Outcome Score among patients undergoing surgical treatment for femoroacetabular impingement.
        Am J Sports Med. 2015; 43: 1844-1849
        • Lopez-Raton M.
        • Rodriguez-Alvarez M.X.
        • Cadarso-Suarez C.
        • Gude-Sampedro F.
        OptimalCutpoints: An R package for selecting optimal cutpoints in diagnostic tests.
        J Stat Softw. 2014; 61
        • Mandrekar J.N.
        Receiver operating characteristic curve in diagnostic test assessment.
        J Thorac Oncol. 2010; 5: 1315-1316
        • Kvien T.K.
        • Heiberg T.
        • Hagen K.B.
        Minimal clinically important improvement/difference (MCII/MCID) and patient acceptable symptom state (PASS): What do these concepts mean?.
        Ann Rheum Dis. 2007; 66 (iii40-1 (suppl 3))
        • Wolfson T.S.
        • Ryan M.K.
        • Begly J.P.
        • Youm T.
        Outcome trends after hip arthroscopy for femoroacetabular impingement: When do patients improve?.
        Arthroscopy. 2019; 35: 3261-3270
        • Levy D.M.
        • Kuhns B.D.
        • Chahal J.
        • Philippon M.J.
        • Kelly B.T.
        • Nho S.J.
        Hip Arthroscopy outcomes with respect to patient acceptable symptomatic state and minimal clinically important difference.
        Arthroscopy. 2016; 32: 1877-1886
        • Perets I.
        • Craig M.J.
        • Mu B.H.
        • Maldonado D.R.
        • Litrenta J.M.
        • Domb B.G.
        Midterm outcomes and return to sports among athletes undergoing hip arthroscopy.
        Am J Sports Med. 2018; 46: 1661-1667
        • Gicquel T.
        • Gédouin J.-E.
        • Krantz N.
        • et al.
        Function and osteoarthritis progression after arthroscopic treatment of femoro-acetabular impingement: A prospective study after a mean follow-up of 4.6 (4.2–5.5) years.
        Orthop Traumatol Surg Res. 2014; 100: 651-656
        • Board T.N.
        Predictive factors of success in hip impingement surgery.
        Hip Int. 2015; 25: 393
        • Saadat E.
        • Martin S.D.
        • Thornhill T.S.
        • Brownlee S.A.
        • Losina E.
        • Katz J.N.
        Factors associated with the failure of surgical treatment for femoroacetabular impingement: Review of the literature.
        Am J Sports Med. 2014; 42: 1487-1495
        • Nabavi A.
        • Olwill C.M.
        • Harris I.A.
        Preoperative predictors of outcome in the arthroscopic treatment of femoroacetabular impingement.
        Hip Int. 2015; 25: 402-405
        • Stone A.V.
        • Malloy P.
        • Beck E.C.
        • et al.
        Predictors of persistent postoperative pain at minimum 2 years after arthroscopic treatment of femoroacetabular impingement.
        Am J Sports Med. 2019; 47: 552-559
        • Hingsammer A.M.
        • Stelzeneder D.
        • Kalish L.A.
        • Millis M.B.
        • Kim Y.-J.
        Prognostic factors for mid-term symptom relief after open surgical correction for femoroacetabular impingement.
        Hip Int. 2015; 25: 406-412
        • Gupta A.
        • Redmond J.M.
        • Hammarstedt J.E.
        • Lindner D.
        • Stake C.E.
        • Domb B.G.
        Does obesity affect outcomes after hip arthroscopy? A cohort analysis.
        J Bone Joint Surg Am. 2015; 97: 16-23
        • Philippon M.J.
        • Schroder E.
        • Souza B.G.
        • Briggs K.K.
        Hip arthroscopy for femoroacetabular impingement in patients aged 50 years or older.
        Arthroscopy. 2012; 28: 59-65