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Lamba A, Wang AS, Okoroha KR, Levy BA, Krych AJ, Hevesi M. Satisfactory Clinical Outcomes and Continuance of Sports After Hip Arthroscopic Labral Repair in Young Competitive Athletes at Minimum 8.5-Year Follow-Up. Arthroscopy 2024; 40:1126-1132. [PMID: 37716632 DOI: 10.1016/j.arthro.2023.08.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 08/22/2023] [Accepted: 08/28/2023] [Indexed: 09/18/2023]
Abstract
PURPOSE To evaluate long-term patient-reported outcomes and achievement rates of patient acceptable symptomatic state (PASS) in young athletes undergoing hip arthroscopy, and to report long-term sports continuance and reoperation. METHODS Inclusion criteria consisted of age <24 years at surgery, femoroacetabular impingement undergoing primary hip arthroscopy with labral repair, and participation in sport with intent to return to sport after surgery. The enrollment period was from April 2009 to June 2014. Modified Harris Hip Scores (mHHS), Hip Outcome Score (HOS), HOS Activities of Daily Living (HOS-ADL), and HOS Sport (HOS-Sport) were collected preoperatively, 2 years' postoperatively, and final follow-up. Patients were evaluated for PASS achievement, reoperation, and sports participation. RESULTS Forty-two hips in 37 patients (11 male, 26 female, age: 17.7 ± 2.1 years, range 13.6-23.0, body mass index 22.8 ± 2.9, range 17.6-33.7) met inclusion criteria and were followed for 10.0 ± 1.3 years (range 8.5-13.0) postoperatively. Mean mHHS, HOS-ADL and HOS-Sports outcome scores at minimum 8.5 years were 82.2 ± 12.9, 89.6 ± 10.9, and 81.8 ± 16.4, respectively, with significant (P < .001) postoperative improvements. Thirty survey respondents (83%) met PASS for mHHS, 27 (75%) for HOS-ADL, and 24 (67%) for HOS-Sports. At minimum 8.5-year follow-up, only 9 of 37 (24%) cited their hip as the reason for stopping sport. Of the remaining patients, 17 of 28 (61%), continued playing their initial sport. There was no difference in patient-reported outcomes between patients who endorsed sports continuance and patients who did not report sports continuance and did not cite their hip as a reason (P ≥ .229). At final follow-up, 4 hips (10%) had undergone subsequent surgical intervention at a mean of 4.8 ± 3.3 years (range 1.0-8.4) postoperatively. CONCLUSIONS Durable mid-term outcomes and satisfactory PASS achievement rates are observed in young amateur athletes undergoing primary hip arthroscopy. At minimum 8.5-year follow up, approximately 1 in 4 patients discontinue their sports due to hip related reasons. LEVEL OF EVIDENCE Level IV, case-series.
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Affiliation(s)
- Abhinav Lamba
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Allen S Wang
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Kelechi R Okoroha
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Bruce A Levy
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Mario Hevesi
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A..
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Wang AS, Lamba A, Okoroha KR, Levy BA, Krych AJ, Hevesi M. Long-Term Outcomes of Primary Hip Arthroscopy With Labral Repair for Femoroacetabular Impingement: Results at Minimum 9-Year Follow-up. Orthop J Sports Med 2023; 11:23259671231204337. [PMID: 37822420 PMCID: PMC10563472 DOI: 10.1177/23259671231204337] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 05/19/2023] [Indexed: 10/13/2023] Open
Abstract
Background Hip arthroscopy continues to advance and become increasingly commonly performed. With the evolution of techniques and instrumentation, labral repair rather than debridement has emerged as the treatment of choice for labral pathology. There remains a lack of data on long-term outcomes after labral repair. Purpose To (1) evaluate long-term patient-reported outcomes of primary hip arthroscopy with labral repair for femoroacetabular impingement, (2) report achievement rates of Patient Acceptable Symptom State (PASS) and minimal clinically important difference (MCID), and (3) investigate rates of reoperation and progression to total hip arthroplasty (THA). Study Design Case series; Level of evidence, 4. Methods Prospectively collected data were reviewed for patients who underwent primary hip arthroscopy with labral repair between 2010 and 2013. Patients' medical records were reviewed for demographic characteristics, intraoperative findings, reoperation, and progression to THA. Patients were assessed pre- and postoperatively using the following scales: visual analog scale (VAS) for pain; Tegner activity scale; modified Harris Hip Score (mHHS); 12-item International Hip Outcome Tool (iHOT-12); Hip Outcome Score-Activities of Daily Living (HOS-ADL); HOS-Sport-Specific Subscale (HOS-SSS); and Non-Arthritic Hip Score. Patients were also surveyed for satisfaction, subjective improvement, and level of function. Results A total of 32 patients (n = 24 women; n = 8 men) with a mean age of 27.7 years (range, 13.6-51 years) were evaluated for a mean of 9.4 years (range, 9-12.1 years). Patients achieved significant mean improvements in VAS pain at rest of 2 points, VAS pain with use of 1.9, mHHS of 19.9 points, iHOT-12 of 33.5 points, HOS-ADL of 17.4 points, and HOS-SSS of 29.5 points (P≤ .015 for all). Eleven patients (34.4%) underwent reoperation and 4 (12.5%) progressed to THA during the study period. At the final follow-up, the MCID achievement rate was ≥68%, the PASS achievement rates ranged from 39% to 65%, and the mean patient satisfaction was 8.1 on a 1 to 10 scale, with 10 denoting most satisfied. Conclusion Patients demonstrated significant postoperative improvements in pain, mHHS, iHOT-12, HOS-ADL, and HOS-SSS scores at 9 years postoperatively. The all-cause reoperation rate was 34.4%, and 12.5% of patients progressed to THA.
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Affiliation(s)
- Allen S. Wang
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Abhinav Lamba
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kelechi R. Okoroha
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Bruce A. Levy
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron J. Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mario Hevesi
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Martin RL, Harris JD, Ellis T, Kollmorgen R. Comparison of the PROMIS and iHOT-12 in Determining Satisfaction Levels After Hip Arthroscopy for FAIS. Orthop J Sports Med 2023; 11:23259671231168887. [PMID: 37197035 PMCID: PMC10184234 DOI: 10.1177/23259671231168887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 01/30/2023] [Indexed: 05/19/2023] Open
Abstract
Background The Patient-Reported Outcomes Measurement Information System (PROMIS) has not been fully evaluated for outcomes assessment after hip arthroscopy to correct femoroacetabular impingement syndrome (FAIS). Purpose/Hypothesis The purpose of this study was to compare the accuracy of the PROMIS Physical Function (PF) and Pain Interference (PI) subscales with the 12-Item International Hip Outcome Tool (iHOT-12) to define patients with 3 unique substantial clinical benefit (SCB) scores-patients who reported ≥80%, ≥90%, and 100% satisfaction at 1 year after hip arthroscopy for FAIS. We hypothesized that the iHOT-12 would be more accurate than the PROMIS-PF and PROMIS-PI subscales in identifying these 3 patient groups. Study Design Cohort study (diagnosis); Level of evidence, 2. Methods We reviewed the records of patients who underwent hip arthroscopy for symptomatic FAIS at 3 centers from January 2019 through June 2021 and had 1-year clinical and radiographic follow-up data. Patients completed the iHOT-12, PROMIS-PF, and PROMIS-PI on initial assessment and at 1 year (±30 days) postoperatively. Postoperative satisfaction was reported on an 11-category scale with anchors defined as "0% satisfied" and "100% satisfied." Receiver operator characteristic analysis was performed to determine the absolute SCB values for the iHOT-12 and PROMIS subscales that would most accurately identify those patients who reported ≥80%, ≥90%, and 100% satisfaction. Area under the curve (AUC) values and 95% CIs for the 3 instruments were compared. Results Included were 163 patients (111 [68%] women and 52 [32%] men), with a mean age of 26.1 years. Corresponding absolute SCB scores for patients who reported ≥80%, ≥90%, and 100% satisfaction were as follows: iHOT-12, 68.4, 72.1, 74.7; PROMIS-PF, 45, 47.7, 49.9; and PROMIS-PI, 55.9, 52.4, 51.9. The AUC ranged between 0.67 and 0.82, with overlapping 95% CIs indicating a minimal difference in accuracy between the 3 instruments. Sensitivity and specificity values ranged between 0.61 and 0.82. Conclusion The PROMIS-PF and PROMIS-PI subscales were as accurate as the iHOT-12 in defining absolute SCB scores for patients reporting ≥80%, ≥90%, and 100% satisfaction at 1-year follow-up after hip arthroscopy for FAIS.
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Affiliation(s)
- RobRoy L. Martin
- Department of Physical Therapy, Rangos School of Health Sciences, Duquesne University, Pittsburgh, Pennsylvania, USA
- RobRoy L. Martin, PhD, PT, Department of Physical Therapy, Rangos School of Health Sciences, Duquesne University, 600 Forbes Avenue, Pittsburgh, PA 15282, USA ()
| | - Joshua D. Harris
- Department of Orthopaedic Surgery, Houston Methodist, Houston, Texas, USA
| | | | - Robert Kollmorgen
- Department of Orthopedic Surgery, UCSF Fresno, Fresno, California, USA
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Day MA, Hancock KJ, Selley RS, Olsen RJ, Antao VC, Ranawat AS, Nawabi DH, Kelly BT. Patient-Reported Outcomes Measurement Information System Mobility Computerized Adaptive Testing Maintains High Correlation and Low Test Burden Compared With Legacy Hip-Specific Instruments in Patients Undergoing Hip Arthroscopy for Femoroacetabular Impingement. Arthroscopy 2022; 38:3023-3029. [PMID: 35469995 DOI: 10.1016/j.arthro.2022.03.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 02/06/2022] [Accepted: 03/18/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the reliability, construct validity, and responsiveness of the lower extremity-specific Patient-Reported Outcomes Measurement Information System (PROMIS) Mobility (MO) bank in patients who underwent hip arthroscopic surgery for femoroacetabular impingement. METHODS Patients who underwent primary hip arthroscopic surgery at a large academic musculoskeletal specialty center between November 2019 and November 2020 completed the following baseline and 6-month measures: PROMIS MO, PROMIS Pain Interference (PI), PROMIS Physical Function (PF), modified Harris Hip Score, International Hip Outcome Tool 33, visual analog scale, and Single Assessment Numeric Evaluation. Construct validity was evaluated using Spearman correlation coefficients. The number of questions until completion was recorded as a marker of test burden. The percentage of patients scoring at the extreme high (ceiling) or low (floor) for each measure was recorded to measure inclusivity. Responsiveness was tested by comparing differences between baseline and 6-month measures, controlling for age and sex, using generalized estimating equations. Magnitudes of responsiveness were assessed through the effect size (Cohen d). RESULTS In this study, 660 patients (50% female patients) aged 32 ± 14 years were evaluated. PROMIS MO showed a strong correlation with PROMIS PF (r = 0.84, P < .001), the International Hip Outcome Tool 33 (r = 0.73, P < .001), PROMIS PI (r = -0.76, P < .001), and the modified Harris Hip Score (r = 0.73, P < .001). Neither PROMIS MO, PROMIS PI, nor PROMIS PF met the conventional criteria for floor or ceiling effects (≥15%). The mean number of questions answered (± standard deviation) was 4.7 ± 2.1 for PROMIS MO, 4.1 ± 0.6 for PROMIS PI, and 4.1 ± 0.6 for PROMIS PF. From baseline to 6 months, the PROMIS and legacy measures exhibited significant responsiveness (P < .05), with similar effect sizes between the patient-reported outcome measures. CONCLUSIONS This longitudinal study reveals that in patients undergoing hip arthroscopy, PROMIS MO computerized adaptive testing maintains high correlation with legacy hip-specific instruments, significant responsiveness to change, and low test burden compared with legacy measures, with no ceiling or floor effects at 6-month postoperative follow-up. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Molly A Day
- Sports Medicine Institute, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A; Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, Wisconsin, U.S.A.
| | - Kyle J Hancock
- Sports Medicine Institute, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A; Department of Sports Medicine, Desert Orthopaedic Center, Las Vegas, Nevada, U.S.A
| | - Ryan S Selley
- Sports Medicine Institute, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Reena J Olsen
- Sports Medicine Institute, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Vinicius C Antao
- Sports Medicine Institute, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Anil S Ranawat
- Sports Medicine Institute, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Danyal H Nawabi
- Sports Medicine Institute, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Bryan T Kelly
- Sports Medicine Institute, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
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