Failure to Achieve Threshold Scores on Patient-Reported Outcome Measures Within 1 Year Has a Predictive Risk of Subsequent Hip Surgery Within 5 Years of Primary Hip Arthroscopy: A Case-Control Study

Abstract

Background: Research has identified factors that influence achievement rates of threshold scores on patient-reported outcome measures (PROMs) after hip arthroscopy. However, little data exist on whether failure to achieve a threshold score (minimal clinically important difference [MCID] or substantial clinical benefit [SCB]) in the short term after hip arthroscopy predicts the risk of future hip surgery. Purpose/Hypothesis: The purpose of this study was to determine if failure to achieve the MCID or SCB on PROMs within 1 year of hip arthroscopy can be considered a risk factor for repeat surgery within 5 years of primary hip arthroscopy. It was hypothesized that failure to achieve threshold scores would increase the risk of subsequent hip surgery. Study Design: Case-control study; Level of evidence, 3. Methods: A retrospective review of prospectively collected data was completed. Four PROMs were collected preoperatively and within 1 year of hip arthroscopy: modified Harris Hip Score, Hip Outcome Score–Activities of Daily Living, Hip Outcome Score–Sports, and the 33-Item International Hip Outcome Tool. Results: Two cohorts were formed: (1) a study cohort (n = 88) composed of patients who underwent repeat hip surgery within 5 years of hip arthroscopy and (2) a control cohort (n = 288) composed of patients who did not require repeat hip surgery. The study cohort had significantly ( P < .001) lower scores on all postoperative PROMs, and a significantly ( P < .001) smaller percentage of the study cohort met the MCID and SCB. Multivariable regression analysis demonstrated that not achieving the MCID or SCB on each of the PROMs is an independent risk factor for repeat hip surgery. For every PROM in which a patient failed to achieve the MCID, the odds of subsequent surgery increased by 1.68 (95% CI, 1.42-1.98; P < .001). For every PROM in which a patient failed to achieve the SCB, the odds of subsequent surgery increased by 1.63 (95% CI, 1.35-1.97; P < .001). Conclusion: Failure to meet threshold scores on PROMs after hip arthroscopy was an independent risk factor for subsequent hip surgery. This study establishes a novel utility of PROMs and confirms the importance of these metrics in the orthopaedic literature.

Hip Arthroscopic Surgery With Chondrolabral Refixation, Osteochondroplasty, and Routine Capsular Closure for Femoroacetabular Impingement Syndrome: Clinical Outcomes at a Minimum 10-Year Follow-up

“…One study showed that patients not meeting the MCID or substantial clinical benefit by 1 year postoperatively are at risk of subsequent surgery within 5 years postoperatively. 20 Furthermore, the trend identified in VAS pain scores can likely be attributed to the timeline of patients undergoing revision and conversion to THA; from 2 to 5 years postoperatively, patients who would undergo secondary surgery were still included in PRO analyses, contributing to the higher VAS pain scores seen at the 5-year time point. When these patients undergoing secondary surgery (revision and conversion to THA) were excluded subsequently beyond the 2- to 5-year time frame, the VAS scores therefore improved at 10 years postoperatively.…”

“…35,39,49 Previously published long-term clinical outcomes assessing the efficacy of hip arthroscopic surgery for the treatment of FAIS have necessarily included patients without capsular repair and/or labral repair when such procedures would be indicated in modern practice. [17][18][19][20][21][22][23][24][25] As a result, these investigations do not reflect the long-term findings associated with contemporary techniques for the treatment of FAIS, including surgical correction of pathomorphology, chondrolabral refixation, and capsular management. The current literature supports that hip arthroscopic surgery for FAIS has reliable short-and midterm patient-reported outcomes (PROs) and clinical success, 2,15,30,38,43,52,57,70 including in athletes 11,12,59 and adolescents, 31,42 among other unique populations.…”