1
|
Terle PM, Peebles LA, Verma A, Kraeutler MJ. Minimal Clinically Important Difference (MCID), Substantial Clinical Benefit (SCB), and Patient Acceptable Symptom State (PASS) Values Following Hip Arthroscopy for Femoroacetabular Impingement Are Highly Dependent on Their Study Population and Calculation Methods: A Systematic Review. Arthroscopy 2024:S0749-8063(24)00562-0. [PMID: 39147078 DOI: 10.1016/j.arthro.2024.07.032] [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: 02/11/2024] [Revised: 07/16/2024] [Accepted: 07/17/2024] [Indexed: 08/17/2024]
Abstract
PURPOSE To provide a summary of available literature on the Minimal Clinically Important Difference (MCID), Substantial Clinical Benefit (SCB), and Patient Acceptable Symptom State (PASS) after hip arthroscopy for femoroacetabular impingement (FAI). METHODS A systematic review was conducted via the Cochrane Library, Pubmed, Ovid MEDLINE, and Embase to identify studies that calculated MCID, SCB, or PASS for Patient Reported Outcome Measures PROMs after hip arthroscopy for FAI. The electronic search strategy used was as follows: hip AND arthroscopy AND (MCID OR "minimal clinically important difference" OR SCB OR "substantial clinical benefit" OR PASS OR "patient acceptable symptom state"). Inclusion criteria were English language studies published from 1980 to 2023 reporting clinical outcome scores and calculated values of MCID, PASS, or SCB for patients undergoing hip arthroscopy for FAI. RESULTS Forty-two studies (5 level II, 19 level III, and 18 level IV) met inclusion and exclusion criteria. The most commonly used outcome measures across MCID, SCB, and PASS were the Hip Outcome Score sports-specific subscale (HOS-SSS) and the activities of daily living subscale (HOS-ADL), the modified Harris Hip Score (mHHS), and the twelve-item international Hip Outcome Tool (iHOT-12). The range of MCID values for HOS-SSS, HOS-ADL, mHHS, and iHOT-12 were 7.2-15.7, 7.3-15.4, 7.2-16.8, and 8.8-16.2 respectively. Similarly, for SCB the values ranged from 77.9-96.9, 90.4-98.5, 20.0-98.4, and 66.7-87.5, respectively. Lastly, the PASS values ranged from 63.9-80.9, 85.9-99.2, 74.0-97.0, and 59.5-86.0, respectively. CONCLUSION MCID, SCB, and PASS values for PROMs following hip arthroscopy for the management of FAI are highly dependent on their associated study including study population and calculation methods. LEVEL OF EVIDENCE IV, systematic review of Level II-IV studies.
Collapse
Affiliation(s)
- Preston M Terle
- Tulane University School of Medicine, New Orleans, Louisiana U.S.A.
| | - Liam A Peebles
- Tulane University School of Medicine, New Orleans, Louisiana U.S.A
| | - Arjun Verma
- Tulane University School of Medicine, New Orleans, Louisiana U.S.A
| | - Matthew J Kraeutler
- University of Colorado Anschutz Medical Campus, Department of Orthopedics, Aurora, Colorado U.S.A
| |
Collapse
|
2
|
Martin SD, Dean MC, Gillinov SM, Cherian NJ, Eberlin CT, Kucharik MP, Abraham PF, Nazal MR, Conaway WK, Quinlan NJ, Alpaugh K, Torabian KA. Hip Arthroscopy Versus Physical Therapy for the Treatment of Symptomatic Acetabular Labral Tears in Patients Older Than 40 Years: 24-Month Results From a Randomized Controlled Trial. Am J Sports Med 2024; 52:2574-2585. [PMID: 39101607 DOI: 10.1177/03635465241263595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/06/2024]
Abstract
BACKGROUND The indications for hip arthroscopy in patients aged ≥40 years remain controversial, as observational studies have suggested that advanced age portends poor functional outcomes, poor durability of improvement, and high rates of conversion to total hip arthroplasty. PURPOSE To compare hip arthroscopy versus nonoperative management for symptomatic labral tears in patients aged ≥40 years with limited radiographic osteoarthritis. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS This single-surgeon, parallel randomized controlled trial included patients aged ≥40 years with limited osteoarthritis (Tönnis grades 0-2) who were randomized 1:1 to arthroscopic surgery with postoperative physical therapy (SPT) or physical therapy alone (PTA). Patients who received PTA and achieved unsatisfactory improvement were permitted to cross over to SPT after completing ≥14 weeks of physical therapy (CO). The primary outcomes were the International Hip Outcome Tool-33 score and modified Harris Hip Score at 24 months after surgery, and secondary outcomes included other patient-reported outcome measures and the visual analog scale for pain. The primary analysis was performed on an intention-to-treat basis using linear mixed-effects models. Sensitivity analyses included modified as-treated and treatment-failure analyses. RESULTS A total of 97 patients were included, with 52 (53.6%) patients in the SPT group and 45 (46.4%) patients in the PTA group. Of the patients who underwent PTA, 32 (71.1%) patients crossed over to arthroscopy at a mean of 5.10 months (SD, 3.3 months) after physical therapy initiation. In both intention-to-treat and modified as-treated analyses, the SPT group displayed superior mean patient-reported outcome measure and pain scores across the study period for nearly all metrics relative to the PTA group. In the treatment-failure analysis, the SPT and CO groups showed greater improvement across all metrics compared with PTA; however, post hoc analyses revealed no significant differences in improvement between the SPT and CO groups. No significant differences were observed between groups in rates of total hip arthroplasty conversion. CONCLUSION In patients ≥40 years of age with limited osteoarthritis, hip arthroscopy with postoperative physical therapy led to better outcomes than PTA at a 24-month follow-up. However, additional preoperative physical therapy did not compromise surgical outcomes and allowed some patients to avoid surgery. When surgery is indicated, age ≥40 years should not be considered an independent contraindication to arthroscopic acetabular labral repair. REGISTRATION NCT03909178 (ClinicalTrials.gov identifier).
Collapse
Affiliation(s)
- Scott D Martin
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Michael C Dean
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Stephen M Gillinov
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nathan J Cherian
- Department of Orthopaedic Surgery, University of Nebraska, Omaha, Nebraska, USA
| | | | - Michael P Kucharik
- Department of Orthopaedic Surgery, University of South Florida, Tampa, Florida, USA
| | - Paul F Abraham
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, California, USA
| | - Mark R Nazal
- Department of Orthopaedic Surgery, University of Kentucky, Lexington, Kentucky, USA
| | - William K Conaway
- Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Noah J Quinlan
- Department of Orthopedics & Orthopedic Services, Bassett Healthcare Network, Cooperstown, New York, USA
| | - Kyle Alpaugh
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kaveh A Torabian
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| |
Collapse
|
3
|
Ferrer-Rivero J, Chahla J, Lizano-Diez X, Andriola V, López-Zabala I, Soler-Cano A, Tey-Pons M. Hip arthroscopy is an effective treatment for high-level female athletes. J ISAKOS 2024; 9:444-448. [PMID: 38403191 DOI: 10.1016/j.jisako.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 01/01/2024] [Accepted: 02/20/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVES This study aimed to assess the outcomes of hip arthroscopic surgery in high-level female athletes diagnosed with femoroacetabular impingement (FAI) compared to those with lower levels of sports activity. Additionally, we investigated the effectiveness of patient-reported outcomes (PROs) and the potential ceiling effect as a lack of sensitivity in detecting clinically statistically significant changes in high-level female athletes due to high baseline scores. METHODS We conducted a retrospective analysis of prospectively collected data from female patients who underwent hip arthroscopy for FAI between January 2016 and August 2022 with a minimum 1-year follow-up. Patients were categorised into two groups: high-level athletes (group A) and low sports activity level (group B). Various PROs, visual analogue scales for pain, and patient satisfaction were assessed preoperatively and postoperatively. Return to sports (RTS) rates were determined based on the patient's reported ability to return to their previous level of sports activity. The minimally clinically important differences (MCIDs) and the Patient-Acceptable Symptomatic State (PASS) analyses were used to evaluate the clinical impact of the Hip Outcome Score-Sport Subscale (HOS-SSS). RESULTS A total of 11 high-level female athletes were included in group A, and 22 were included in the low sports activity level group B. Both groups showed significant improvements in PROs, with no significant differences between them. RTS rates were lower in high-level athletes (63.6%) than in low sports activity patients (85.7%). Visual analogue scales for pain improved significantly in both groups. Patient satisfaction was high in both groups, with a median score of 9. The HOS-SSS showed no ceiling effect, and the MCID and PASS analyses indicated that a high proportion of patients in both groups achieved clinically relevant improvement in HOS-SSS. CONCLUSION Hip arthroscopic surgery is effective for FAI treatment in high-level female athletes, with outcomes similar to those in patients with lower sports activity levels. The absence of a ceiling effect in sports-related outcomes suggests that PROs can detect clinically significant changes in high-level female athletes. Although RTS rates were lower in high-level athletes, this difference was not significant. These findings underscore the value of using PROs to evaluate outcomes in female athletes with different sports-activity levels. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
| | - Jorge Chahla
- Midwest Orthopaedics at Rush University Medical Center, 60612 Chicago, IL, USA
| | - Xavier Lizano-Diez
- i-Move Traumatologia, 08017 Barcelona, Spain; Hospital Universitari del Mar, 08003 Barcelona, Spain
| | - Vito Andriola
- Hospital Universitari Parc Taulí, 08208 Sabadell, Spain
| | | | | | - Marc Tey-Pons
- i-Move Traumatologia, 08017 Barcelona, Spain; Hospital Universitari Parc Taulí, 08208 Sabadell, Spain.
| |
Collapse
|
4
|
Torabian KA, Cherian NJ, Eberlin CT, Dean MC, Dowley KS, LaPorte ZL, Kucharik MP, Gillinov SM, Martin SD. The Effect of Pelvic Incidence on Outcomes After Hip Arthroscopy for Femoroacetabular Impingement and Acetabular Labral Tears. Am J Sports Med 2024; 52:631-642. [PMID: 38369972 PMCID: PMC10905981 DOI: 10.1177/03635465231219261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 10/06/2023] [Indexed: 02/20/2024]
Abstract
BACKGROUND In the setting of femoroacetabular impingement (FAI), decompression osteoplasties reconcile deleterious loading patterns caused by cam and pincer lesions. However, native variations of spinopelvic sagittal alignment may continue to perpetuate detrimental effects on the labrum, chondrolabral junction, and articular cartilage after hip arthroscopy. PURPOSE To evaluate the effect of pelvic incidence (PI) on postoperative outcomes after hip arthroscopy for acetabular labral tears in the setting of FAI. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A retrospective query of prospectively collected data identified patients ≥18 years of age who underwent primary hip arthroscopy for FAI and acetabular labral tears between February 2014 and January 2022, with 3-, 6-, 12-, and 24-month follow-ups. Measurements for PI, pelvic tilt (PT), sacral slope (SS), and acetabular version were obtained via advanced diagnostic imaging. Patients were stratified into low-PI (<45°), moderate-PI (45°≤ PI ≤ 60°), and high-PI (>60°) cohorts. Patient-reported outcome measures (PROMs), clinically meaningful outcomes (ie, minimal clinically important difference, Patient Acceptable Symptom State, substantial clinical benefit, and maximal outcome improvement), visual analog scale (VAS) pain scores, and patient satisfaction were compared across cohorts. RESULTS A total of 74 patients met eligibility criteria and were stratified into low-PI (n = 28), moderate-PI (n = 31), and high-PI (n = 15) cohorts. Correspondingly, patients with high PI displayed significantly greater values for PT (P = .001), SS (P < .001), acetabular version (P < .001), and acetabular inclination (P = .049). By the 12- and 24-month follow-ups, the high-PI cohort was found to have significantly inferior PROMs, VAS pain scores, rates of clinically meaningful outcome achievement, and satisfaction relative to patients with moderate and/or low PI. No significant differences were found between cohorts regarding rates of revision arthroscopy, subsequent spine surgery, or conversion to total hip arthroplasty. CONCLUSION After hip arthroscopy, patients with a high PI (>60°) exhibited inferior PROMs, rates of achieving clinically meaningful thresholds, and satisfaction at 12 and 24 months relative to patients with low or moderate PI. Conversely, the outcomes of patients with low PI (<45°) were found to match the trajectory of those with a neutral spinopelvic alignment (45°≤ PI ≤ 60°). These findings highlight the importance of analyzing spinopelvic parameters preoperatively to prognosticate outcomes before hip arthroscopy for acetabular labral tears and FAI.
Collapse
Affiliation(s)
- Kaveh A. Torabian
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nathan J. Cherian
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Orthopaedic Surgery, University of Nebraska, Omaha, Nebraska, USA
| | - Christopher T. Eberlin
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Orthopedic Surgery, University of Iowa, Iowa City, Iowa, USA
| | - Michael C. Dean
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kieran S. Dowley
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Zachary L. LaPorte
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Michael P. Kucharik
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Orthopaedic Surgery, University of South Florida, Tampa, Florida, USA
| | - Stephen M. Gillinov
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Scott D. Martin
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| |
Collapse
|
5
|
Maldonado DR, George T, Padmanabhan S, Curley AJ, Domb BG. Defining Thresholds and Predictors for Achieving the Patient Acceptable Symptom State for Patient-Reported Outcome Measures After Revision Hip Arthroscopy. Am J Sports Med 2023; 51:3772-3780. [PMID: 37975493 DOI: 10.1177/03635465231209320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
BACKGROUND The Patient Acceptable Symptom State (PASS) after primary hip arthroscopy has been determined; nonetheless, the PASS still needs to be defined for revision hip arthroscopy. PURPOSE To define minimum 2-year follow-up PASS thresholds for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score-Sports Specific Subscale (HOS-SSS), visual analog scale (VAS) for pain, and International Hip Outcome Tool-12 (iHOT-12) after revision hip arthroscopy, and to identify predictors of achieving the PASS. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Data were prospectively collected and retrospectively reviewed for all patients who underwent revision hip arthroscopy between April 2017 and July 2020. Patients were included if they had baseline and minimum 2-year follow-up scores for the mHHS, NAHS, HOS-SSS, VAS for pain, and iHOT-12. PASS was calculated using the anchor-based method. Receiver operating characteristic curve analysis was used to determine the thresholds for the PASS. A multivariate logistic regression was used to identify predictors for achieving the PASS. RESULTS A total of 318 patients who underwent revision hip arthroscopy met the inclusion criteria. Of those patients, 292 (91.8%) had baseline and minimum 2-year follow-up. Of this group, 68 patients (72.1% female and 27.9% male; mean age, 32.9 years) answered the PASS anchor question. Achievement PASS rates were 58.8%, 41.2%, 52.9%, 60.3%, and 52.9% for the mHHS, NAHS, HOS-SSS, VAS, and iHOT-12, respectively. The area under the curve (AUC) values for the PASS for mHHS, NAHS, HOS-SSS, VAS, and iHOT-12 were 0.912, 0.888, 0.857, 0.903, and 0.871, respectively, indicating excellent discrimination. The PASS for the mHHS was 76 (sensitivity, 0.809; specificity, 0.905), for the NAHS was 86.3 (sensitivity, 0.660; specificity, 1), for the HOS-SSS was 64.3 (sensitivity, 0.745; specificity, 0.905), for the VAS was 3 (sensitivity, 0.830; specificity, 0.905), and for the iHOT-12 was 64.3 (sensitivity, 0.745; specificity, 0.905). Body mass index (BMI) was identified as a significant predictor of achieving PASS for the NAHS (OR, 0.967; 95% CI, 0.940-0.996; P = .027), as patients with a BMI ≤25.4 had 1.03 times higher odds ratio of achieving PASS for the NAHS. CONCLUSION After revision hip arthroscopy, the minimum 2-year follow-up PASS thresholds for the mHHS, NAHS, HOS-SSS, VAS for pain, and iHOT-12 were 76, 86.3, 64.3, 3, and 64.3, respectively. The odds ratio of achieving PASS for the NAHS was 1.03 times higher for patients with a BMI ≤25.4.
Collapse
Affiliation(s)
- David R Maldonado
- American Hip Institute Research Foundation, Chicago, Illinois, USA
- Department of Orthopaedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Tracy George
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | | | - Andrew J Curley
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois, USA
- American Hip Institute, Chicago, Illinois, USA
| |
Collapse
|