Hip Arthroscopic Surgery for Femoroacetabular Impingement With Capsular Management: Factors Associated With Achieving Clinically Significant Outcomes

Cvetanovich, Gregory L.; Weber, Alexander E.; Kuhns, Benjamin D.; Alter, Jennifer; Harris, Joshua D.; Mather, Richard C.; Nho, Shane J.

doi:10.1177/0363546517739824

Cited by 102 publications

(110 citation statements)

References 49 publications

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“…The current study adds to the literature in that it derived MCID and PASS for the patient study population as opposed to what has been previously published; it has twice the study population as current 2-year outcome studies; it defines clinical high functional status; and it provides ROC curve and factor analysis for creating predictor models. 35 Psychological distress and mental health disease are increasingly recognized as significant influences on pain and function associated with orthopedic conditions. 21,[36][37][38][39][40] In a previous study, preoperative predictors of increased baseline (preoperative) pain and decreased baseline function included mental health, activity level, sex, and smoking.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Predictors of Achieving Clinically Significant Athletic Functional Status After Hip Arthroscopy for Femoroacetabular Impingement at Minimum 2-Year Follow-Up

Stone

Beck

Malloy

et al. 2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Section: Discussionmentioning

confidence: 99%

Preoperative Predictors of Achieving Clinically Significant Athletic Functional Status After Hip Arthroscopy for Femoroacetabular Impingement at Minimum 2-Year Follow-Up

Stone

Beck

Malloy

et al. 2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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“…The previously reported MCID using the mean change method for the mHHS was 8, 18 and a net change of 11.31 was reported as slightly improved by Nwachukwu et al 29 When we considered the mean change in PROM scores in the current study to represent the MCID, we found a change of 15.2 for the mHHS and 20.7 for the SF-36. Given that our cohort consisted of all competitive athletes, a higher value for the MCID might have been expected; however, as the preoperative baseline PROM scores were generally much higher than in similar nonathletic cohorts, 3,9,28,30,39 the scope for the increase in PROM scores was also lower.…”

Section: Discussionmentioning

confidence: 91%

Defining the Minimal Clinically Important Difference in Athletes Undergoing Arthroscopic Correction of Sports-Related Femoroacetabular Impingement: The Percentage of Possible Improvement

Carton

Filan

2020

Orthopaedic Journal of Sports Medicine

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Background: Measures of clinically meaningful improvement in patient-reported outcomes within orthopaedics are becoming a minimum requirement to establish the success of an intervention. Purpose: To (1) define the minimal clinically important difference (MCID) at 2 years postoperatively in competitive athletes undergoing hip arthroscopic surgery for symptomatic, sports-related femoroacetabular impingement utilizing existing anchor- and distribution-based methods and (2) derive a measure of the MCID using the percentage of possible improvement (POPI) method and compare against existing techniques. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: There were 2 objective outcome measures—the modified Harris Hip Score (mHHS) and 36-Item Short Form Health Survey (SF-36)—administered at baseline and 2 years postoperatively. External anchor questions were used to determine the MCID through mean change, mean difference, and receiver operating characteristic (ROC) techniques. Distribution-based calculations consisted of 0.5 SD, effect size, and standard error of measurement techniques. The POPI was calculated alongside each technique as an achieved percentage change of maximum available improvement for each athlete relative to the individual baseline score. The impact of the preoperative baseline score on the MCID was assessed by assigning athletes to groups determined by baseline percentiles. Statistical analysis was performed, with P < .05 considered significant. Results: There were 576 athletes (96% male; mean age, 25.9 ± 5.7 years). The MCID score change (and POPI) for the mHHS and SF-36 ranged from 2.4 to 16.7 (21.6%-63.6%) and from 3.3 to 24.9 (22.1%-57.4%), respectively. The preoperative threshold value for achieving the ROC-determined MCID was 80.5 and 86.5 for the mHHS and 70.1 and 72.4 for the SF-36 for the patient-reported outcome measure (PROM) score– and POPI-calculated MCID, respectively. Through the commonly used mean change method, 40.0% (mHHS) and 42.4% (SF-36) of athletes were unable to achieve the MCID because of high baseline scores and PROM ceiling effects compared with 0% when the POPI technique was used. A highly significant difference for the overall MCID was observed between preoperative baseline percentile groups for the mHHS ( P = .014) and SF-36 ( P = .004) (improvement in points), while there was no significant difference between groups for either the mHHS ( P = .487) or SF-36 ( P = .417) using the POPI technique. Conclusion: The MCID defined by an absolute value of improvement was unable to account for postoperative progress in a large proportion of higher functioning athletes. The POPI technique negated associated ceiling effects, was unrestricted by the baseline score, and may be more appropriate in quantifying clinically important improvement.

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“…2 In a prospectively collected series of patients treated with hip arthroscopy for FAI, Cvetanovich et al demonstrated that at 2-year follow-up, there was a 1.2% rate of revision hip arthroscopy and 1.7% rate of conversion to THA. 57 Factors associated with success of hip arthroscopy included younger age, Tönnis grade 0, and larger medial joint space.…”

Section: Femoroacetabular Impingementmentioning

confidence: 98%

Treatment of Early-Onset Hip Osteoarthritis in Young Patients

et al. 2018

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Pain and debilitating symptoms due to hip osteoarthritis (OA) can significantly compromise quality of life in young, active patients. The management of the young adult with hip OA presents a unique set of challenges, with symptoms that originate from a variety of underlying hip pathologies, and patient age spanning from youth through middle age. Early options for hip OA include nonoperative treatment with anti-inflammatory medications, physical therapy, and injections. For patients with structural hip abnormalities (femoroacetabular impingement or dysplasia), arthroscopy or reconstructive osteotomy are acceptable treatment options. In advanced disease, joint-preserving techniques are often ineffective, and patients may require joint resurfacing or replacement. The treatment strategies for early hip OA continues to evolve with the development of new and refined surgical techniques, especially in the setting of underlying hip pathology, and a growing popularity of utilizing biologic agents. The purpose of this manuscript is to review current conservative and surgical management and to describe an algorithm for treatment of early-onset hip OA.

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Hip Arthroscopic Surgery for Femoroacetabular Impingement With Capsular Management: Factors Associated With Achieving Clinically Significant Outcomes

Cited by 102 publications

References 49 publications

Preoperative Predictors of Achieving Clinically Significant Athletic Functional Status After Hip Arthroscopy for Femoroacetabular Impingement at Minimum 2-Year Follow-Up

Preoperative Predictors of Achieving Clinically Significant Athletic Functional Status After Hip Arthroscopy for Femoroacetabular Impingement at Minimum 2-Year Follow-Up

Defining the Minimal Clinically Important Difference in Athletes Undergoing Arthroscopic Correction of Sports-Related Femoroacetabular Impingement: The Percentage of Possible Improvement

Treatment of Early-Onset Hip Osteoarthritis in Young Patients

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