Patient-Reported Outcome Surveys for Femoroacetabular Impingement Syndrome Demonstrate Strong Correlations, High Minimum Clinically Important Difference Agreement and Large Ceiling Effects


      To determine the correlation between different patient-reported outcome (PRO) measurements used to assess outcomes after arthroscopic treatment of femoroacetabular impingement syndrome (FAIS) in a single cohort of patients.


      Patients undergoing primary hip arthroscopy for FAIS (without dysplasia, arthritis, or joint hypermobility) were retrospectively analyzed from a prospectively collected cohort. PROs collected before surgery and at 2-year follow-up included the Visual Analog Scale (VAS) for pain, modified Harris Hip Score (mHHS), Hip Disability and Osteoarthritis Outcome Scores (HOOS) with subscales for symptoms, pain, activities of daily living (ADL), sport, and quality of life (QoL), and the physical and mental components of the Short Form-12 (SF-12 PCS and SF-12 MCS).


      Three hundred patients with 2 years’ follow-up (mean age 35.1 ± 11.3, BMI 24.7 ± 3.8, 52.7% female, median Tönnis grade 1) were identified. All patients underwent femoroplasty and labral repair. There was a strong correlation among nearly all the PRO surveys at 2-year follow-up, with the highest correlations identified between mHHS and HOOS-Pain (r = .86, P < .001) and mHHS and HOOS-ADL (r = .85, P < .001). Preoperative scores and the change from preoperative to postoperative scores demonstrated an overall moderate correlation between surveys. There was a consistently weak correlation between the SF-12 MCS and all other PROs. There were strong agreements (67%-77%) in the patients achieving minimal clinically important differences (MCID) for each PRO survey. All surveys except the SF-12 demonstrated a ceiling effect after surgery, with 13% to 43% of patients achieving the maximum score.


      PRO surveys used for FAIS demonstrate strong correlations, especially in the evaluation of patients during the postoperative period. MCID for VAS, mHHS, and HOOS demonstrate strong agreement, whereas large ceiling effects were seen with the mHHS and HOOS. The results support a more efficient use of PRO scores while being able to accurately capture patient outcomes.

      Level of Evidence

      IV, retrospective case series.
      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


        • Stulberg J.
        The physician quality reporting initiative—A gateway to pay for performance: What every health care professional should know.
        Qual Manag Health Care. 2008; 17: 2-8
        • Suk M.
        • Norvell D.
        • Hanson B.
        • Dettori J.
        • Helfet D.
        Evidence-based orthopaedic surgery: What is evidence without the outcomes?.
        J Am Acad Orthop Surg. 2008; 16: 123-129
        • The American Board of Orthopaedic Surgery
        Certification examinations part II: Patient reported outcomes.
        • Stone A.
        • Jacobs C.
        • Luo T.
        • et al.
        High Degree of variability in reporting of clinical and patient-reported outcomes after hip arthroscopy.
        Am J Sports Med. 2018; 46: 3040-3046
        • Barbera J.
        • Selverian S.
        • Courington R.
        • Mikhail C.
        • Colvin A.
        The top 50 most influential articles in hip arthroscopy.
        Arthroscopy. 2020; 36: 716-722
        • Erickson B.
        • Cvetanovich G.
        • Frank R.
        • et al.
        International trends in arthroscopic hip preservation surgery-are we treating the same patient?.
        J Hip Preserv Surg. 2015; 2: 28-41
        • Annin S.
        • Lall A.
        • Yelton M.
        • et al.
        Patient-reported outcomes in athletes following hip arthroscopy for femoroacetabular impingement with subanalysis on return to sport and performance level: A systematic review.
        Arthroscopy. 2021; 37: 2657-2676
        • Levy D.
        • Kuhns B.
        • Chahal J.
        • Philippon M.
        • Kelly B.
        • Nho S.
        Hip arthroscopy outcomes with respect to patient acceptable symptomatic state and minimal clinically important difference.
        Arthroscopy. 2016; 32: 1877-1886
        • O'Reilly-Shah V.
        Factors influencing healthcare provider respondent fatigue answering a globally administered in-app survey.
        PeerJ. 2017; 5: e3785
        • Ben-Nun P.
        Respondent fatigue.
        in: Lavrakas P.J. Encyclopedia of survey research methods. Sage Publications, Thousand Oaks, CA2008: 742-743 (2)
        • Oji N.
        • Jansson H.
        • Bradley K.
        • Feeley B.
        • Zhang A.
        Comparing patient-reported outcome measurements for femoroacetabular impingement syndrome.
        Am J Sports Med. 2021; 49: 1578-1588
        • Brand J.
        • Hardy R.
        • Tori A.
        • Fuchs H.
        • Sungur E.
        • Monroe E.
        Relationship between iHOT12 and HOS scores in hip pain patients.
        J Hip Preserv Surg. 2021; 7: 57-61
        • Chambers C.
        • Monroe E.
        • Flores S.
        • Borak K.
        • Zhang A.
        Periportal capsulotomy: Technique and outcomes for a limited capsulotomy during hip arthroscopy.
        Arthroscopy. 2019; 35: 1120-1127
        • Flores S.
        • Sheridan J.
        • Borak K.
        • Zhang A.
        When do patients improve after hip arthroscopy for femoroacetabular impingement? A prospective cohort analysis.
        Am J Sports Med. 2018; 46: 3111-3118
        • Norman G.
        • JA S.
        • Wyrwich K.
        Interpretation of changes in health-related quality of life: The remarkable universality of half a standard deviation.
        Med Care. 2003; 41: 582-592
        • Nwachukwu B.
        • Beck E.
        • Kunze K.
        • Chahla J.
        • Rasio J.
        • Nho S.
        Defining the clinically meaningful outcomes for arthroscopic treatment of femoroacetabular impingement syndrome at minimum 5-year follow-up.
        Am J Sports Med. 2020; 48: 901-907
        • Beck E.
        • Nwachukwu B.
        • Kunze K.
        • Chahla J.
        • Nho S.
        How can we define clinically important improvement in pain scores after hip arthroscopy for femoroacetabular impingement syndrome? Minimum 2-year follow-up study.
        Am J Sports Med. 2019; 47: 3133-3140
        • Mukaka M.
        Statistics corner: A guide to appropriate use of correlation coefficient in medical research.
        Malawi Med J. 2012; 24: 69-71
        • Terwee C.
        • Bot S.
        • de Boer M.
        • et al.
        Quality criteria were proposed for measurement properties of health status questionnaires.
        J Clin Epidemiol. 2007; 60: 34-42
        • Ramisetty N.
        • Kwon Y.
        • Mohtadi N.
        Patient-reported outcome measures for hip preservation surgery—A systematic review of the literature.
        J Hip Preserv Surg. 2015; 2: 15-27
        • Carton P.
        • Filan D.
        Defining the minimal clinically important difference in athletes undergoing arthroscopic correction of sports-related femoroacetabular impingement: The percentage of possible improvement.
        Orthop J Sports Med. 2020; 8 (2325967119894747)
        • Nwachukwu B.
        • Chang B.
        • Kahlenberg C.
        • et al.
        Arthroscopic treatment of femoroacetabular impingement in adolescents provides clinically significant outcome improvement.
        Arthroscopy. 2017; 33: 1812-1818
        • Dick A.
        • Smith C.
        • Bankes M.
        • George M.
        The impact of mental health disorders on outcomes following hip arthroscopy for femoroacetabular impingement syndrome: A systematic review.
        J Hip Preserv Surg. 2020; 7: 195-204
        • Bido J.
        • Sullivan S.
        • Dooley M.
        • et al.
        PROMIS Global-10 poorly correlates with legacy outcomes for patients undergoing hip arthroscopy.
        J Hip Preserv Surg. 2021; 8: 67-74