The Natural Course of Recovery After Hip Arthroscopy for Femoroacetabular Impingement According to the International Hip Outcome Tool–12 and Hip Outcome Score Sports Subscale

Abstract

Background: A paucity of literature exists regarding trajectories of functional and sports-specific recovery after hip arthroscopy for femoroacetabular impingement syndrome (FAIS). Purpose: To determine if subgroups of patients exist based on the recovery trajectory of patient-reported outcomes (PROs) after hip arthroscopy for FAIS in the short-term period and to determine clinical predictors for these subgroups of patients. Study Design: Case-control study; Level of evidence, 3. Methods: A prospectively maintained repository was queried for patients who had undergone primary hip arthroscopy for the treatment of FAIS between January 2012 and May 2018. Patients who completed the preoperative, 1-year, and 2-year International Hip Outcome Tool–12 (iHOT-12) or the Hip Outcome Score Sports Subscale (HOS-SS) were included. The latent class growth analysis (LCGA) and growth mixture models (GMMs) were used to identify subgroups of patients based on trajectories of recovery for the iHOT-12 and the HOS-SS utilizing preoperative, 1-year, and 2-year follow-ups. LCGA and GMM models using 1 to 6 classes for each PRO were performed, and the best-fit model for each PRO was selected. After final model selection, a multivariable multinomial logistic regression was performed, with the largest class being the reference group to determine clinical predictors of subgroup membership. Results: A total of 443 and 556 patients were included in the iHOT-12 and HOS-SS analyses, respectively. For the iHOT-12, we identified the following 3 subgroups: early progressors (70%), late regressors (22.3%), and late progressors (7.7%). Predictors of late regression were workers’ compensation status, psychiatric history, preoperative chronic pain, and lower preoperative iHOT-12 scores; and late progressors were less likely to participate in sports. For the HOS-SS, we identified the following 4 subgroups: early progressors (47.7%), late regressors (17.4%), late progressors (6.8%), and steady progressors (28.1%). Predictors of less favorable recovery trajectories (late regressors and late progessors) were older age, male sex, back pain, psychiatric history, preoperative chronic pain, greater alpha angle, and lower preoperative HOS-SS scores. Conclusion: Using the growth mixture modeling, 3 natural courses of health-related quality of life (early progression, late regression, and late progression) and 4 natural courses of recovery of athletic function (steady progression, late regression, late progression, and early progression) were identified. Preoperative psychiatric conditions, chronic pain, workers’ compensation status, and lower iHOT-12 scores were predictive of less than favorable trajectories of recovery according to the iHOT-12, and male sex, older age, back pain, preoperative narcotic use, and lower preoperative HOS-SS were predictors of less favorable recovery trajectories according to the HOS-SS.

A Smartphone App Shows Patients Return to Preoperative Gait Metrics 6 Weeks After Hip Arthroscopy, and Gait Metrics Have Low to Moderate Correlations With a Hip-Specific Patient-Reported Outcome Measure

“…Thus far, PROs have been widely used to characterize recovery and have served as a primary assessment of improvement after hip arthroscopy. 42 In the current study, there were universal improvements in the PROs at 6 months, and the proportion of patients meeting the PROs at 6 months was greater than at 3 months. The overall proportion achieving thresholds for MCID and especially PASS was relatively low but at 6 months, which is not unexpected given that we used 1-year postoperative benchmarks.…”

“…Furthermore, while each patient was prescribed a rehabilitation process standard to this institution, the therapist, rehabilitation facility, and timing of when patients may have progressed through each phase of rehabilitation were heterogeneous between patients. Lastly, this study only analyzed gait, and other mechanical tasks such as squatting 44 , 45 or additional demographic or disease-related factors 42 , 46 may be more representative of functional improvement after hip arthroscopy.…”

Sex-Based Differences in Prevalence, Outcomes, and Complications of Hip Arthroscopy for Femoroacetabular Impingement: A Systematic Review and Meta-analysis

“…The 74 included studies consisted of 17 case series, § 6 case-control studies, 3 , 7 , 19 , 37 , 51 32 cohort studies, ‖ and 19 cross-sectional studies. ¶ A summary of the characteristics of each study is given in Appendix Table A2 .…”

Hip and Pelvis Movement Patterns in Patients With Femoroacetabular Impingement Syndrome Differ From Controls and Change After Hip Arthroscopy During a Step-Down Pivot-Turn Task

“…As inherent to the treatment of FAI syndrome, patients underwent a trial of nonoperative measures before undergoing surgery if indicated, which was the same time when enrollment and kinematic testing were performed. Patients diagnosed with FAI syndrome were excluded for any of the following reasons: radiographic evidence of osteoarthritis (To ¨nnis grade .1); history of chronic low back pain or reports of low back pain within the 6 months before study enrollment 5,30 ; history of surgery to the indexed or contralateral hip; history of any systemic disorders (musculoskeletal, neurologic, cardiorespiratory, integumentary, or endocrine system) that would prevent participation in the study tasks; and history of a developmental hip disorder, such as Legg-Calve ´-Perthes disease, slipped capital femoral epiphysis, or developmental hip dysplasia. All patients with FAI syndrome who met the study inclusion criteria for the current study were prospectively recruited for participation from December 2018 to December 2019.…”