Clinically Relevant Thresholds for Hip Arthroscopy Vary: A Systematic Review.

Area of Science:

• Orthopedic Surgery
• Patient-Reported Outcomes
• Clinical Trial Methodology

Background:

• Hip arthroscopy outcomes are assessed using patient-reported outcome measures (PROMs).
• Establishing clear thresholds for patient acceptable symptom state (PASS) and substantial clinical benefit (SCB) is crucial for evaluating treatment success.
• Variability in these thresholds complicates interpretation of study results.

Purpose of the Study:

• To systematically identify and synthesize reported PASS and SCB thresholds for hip arthroscopy.
• To provide guidance on selecting appropriate thresholds for clinical decision-making and research.

Main Methods:

• Systematic review of PubMed and MEDLINE databases (August 2024).
• Inclusion of Level I-IV evidence studies defining PASS or SCB thresholds for hip arthroscopy.
• Exclusion of case reports, reviews, technique articles, and non-English literature.

Main Results:

• 35 studies yielded 102 PASS and 82 SCB thresholds across 13 PROMs.
• Hip Outcome Score-Sport-Specific Subscale (HOS-SSS) was frequently reported for PASS.
• International Hip Outcome Tool (iHOT) was commonly used for SCB.

Conclusions:

• Significant heterogeneity exists in PASS and SCB thresholds for hip arthroscopy.
• Factors influencing variability include anchor questions, responder criteria, follow-up duration, sample size, and patient demographics.
• Surgeons should select thresholds aligning with the specific procedure's follow-up time for accurate comparisons.