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Revision Hip Arthroscopy Results in Meaningful Clinical Improvement, Better Measured by Some Thresholds Than Others
David R Maldonado1, Keya Patel2, Omkar N Prabhavalkar2
1Department of Orthopaedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, U.S.A.
Purpose:
To report minimum 2-year follow-up patient-reported outcomes and clinically meaningful outcome achievement rates following revision hip arthroscopy and to further characterize substantial clinical benefit (SCB) in the revision setting.
Methods:
Prospectively collected data were retrospectively reviewed for patients who underwent revision hip arthroscopy between April 2017 and July 2020. Patients with baseline and minimum 2-year post-operative scores for the Modified Harris Hip Score (mHHS); Nonarthritic Hip Score (NAHS); Hip Outcome Score-Sports Subscale (HOS-SSS), visual analog scale for pain (VAS), and International Hip Outcome Tool-12 (i-HOT-12) were included. The thresholds for SCB were calculated using an anchor question. Receiver operating characteristic analysis with the area under the curve was used to identify optimal values of the SCB. The minimal clinical important difference (MCID) and the patient acceptable symptom state (PASS) were reported.
Results:
Sixty-eight patients were included (72.1% females) with a mean age of 32.9 ± 13 years. Significant improvement was reported for all PROMs collected (P < .0001). MCID achievement rates were mHHS 79.41%, NAHS 83.82%, iHOT-12 88.24%, HOS-SSS 80.33%, and VAS 79.41%. PASS achievement rates were mHHS 52.94%, NAHS 64.71%, iHOT-12 60.29%, HOS-SSS 46.27%, and VAS 58.82%. The SCB thresholds were 85 (net change 22) for the mHHS, 86.25 (net change 16.25) for the NAHS, 91.6 (net change 36.51) for the HOS-SSS, 1.58 (net change 4) for VAS, and 81.27 (net change 58.78) for the iHOT-12. The absolute SCB achievement rates for the mHHS, NAHS, HOS-SSS, VAS, and i-HOT-12 were 44.1%, 41.2%, 25%, 36.7%, and 35.3% respectively. The net SCB achievement rates for the mHHS, NAHS, HOS-SSS, VAS, and i-HOT-12 were 52.9%, 66.1%, 44.1%, 42.6%, and 19.1% respectively.
Conclusions:
Revision hip arthroscopy resulted in significant improvement for all patient-reported outcomes collected at minimum 2-year follow-up, with high MCID and satisfactory PASS achievement rates. SCB was achieved less consistently in the revision setting.
Level Of Evidence:
Level IV, retrospective case series.