Editorial Commentary: PASSing the Test Versus Acing It: Understanding Clinically Significant Outcome Improvement in Arthroscopic Hip Surgery

Background: The influence of femoral torsion on clinically significant outcome improvement after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) has not been well-studied. Purpose: To quantify femoral torsion in FAIS patients using magnetic resonance imaging (MRI) and explore the relationship between femoral torsion and clinically significant outcome improvement after hip arthroscopy. Study Design: Cohort study; Level of evidence, 3. Methods: Included were patients who underwent hip arthroscopy for FAIS between January 2012 and August 2018 and had 2-year follow-up and preoperative MRI scans containing transcondylar slices of the knee. Participants were categorized as having severe retrotorsion (SR; <0°), normal torsion (NT; 0°-25°), and severe antetorsion (SA; >25°) as measured on MRI. Patient-reported outcomes (PROs) included the Hip Outcome Score–Activities of Daily Living, Hip Outcome Score–Sports Subscale, modified Harris Hip Score, 12-item International Hip Outcome Tool (iHOT-12), and visual analog scale (VAS) for pain and satisfaction. Achievement of Patient Acceptable Symptom State (PASS) and substantial clinical benefit (SCB) were analyzed among cohorts. Results: Included were 183 patients (SR, n = 13; NT, n = 154; SA, n = 16) with a mean age, body mass index, and femoral torsion of 30.6 ± 12.1 years, 24.0 ± 4.4 kg/m2, and 12.55° ± 9.58°, respectively. The mean torsion was –4.5° ± 2.6° for the SR, 12.1° ± 6.8° for the NT, and 31.0° ± 3.6° for the SA group. There were between-group differences in the proportion of patients who achieved PASS and SCB on the iHOT-12, pain VAS, and any PRO ( P < .05). Post hoc analysis indicated that the SA group achieved lower rates of PASS and SCB on the iHOT-12 and pain VAS, and lower rates of PASS on any PRO versus the SR group ( P < .05); the SR group achieved higher rates of PASS and SCB on pain VAS scores versus the NT group ( P = .003). Conclusion: The orientation and severity of femoral torsion during hip arthroscopy influenced the propensity for clinically significant outcome improvement. Specifically, patients with femoral retrotorsion and femoral antetorsion had higher and lower rates of clinically significant outcome improvement, respectively.

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Editorial Commentary: Doctor, Will My Contralateral Hip Surgery Go as Well as the First One?

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2019.03.012 ◽

2019 ◽

Vol 35 (6) ◽

pp. 1845-1846 ◽

Cited By ~ 1

Author(s):

Arpad Konyves

Keyword(s):

Hip Surgery ◽

Editorial Commentary

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Editorial Commentary: The Alphabet Soup of Understanding Clinical Shoulder Research: MCID (Minimal Clinically Important Difference), PASS (Patient Acceptable Symptomatic State), SCB (Substantial Clinical Benefit), and Now . . . MOI (Maximal Outcome Improvement)

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2020.04.004 ◽

2020 ◽

Vol 36 (7) ◽

pp. 1811-1812

Author(s):

Robert Tashjian

Keyword(s):

Clinical Benefit ◽

Minimal Clinically Important Difference ◽

Editorial Commentary ◽

Clinically Important Difference ◽

Substantial Clinical Benefit ◽

Outcome Improvement

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Complete Capsule Closure Provides Clinically Significant Outcome Improvement and Higher Survivorship After Hip Arthroscopy at Minimum 5-year Follow-up

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2021.01.035 ◽

2021 ◽

Author(s):

Edward C. Beck ◽

Benedict U. Nwachukwu ◽

Jorge Chahla ◽

Ian Clapp ◽

Kyleen Jan ◽

...

Keyword(s):

Hip Arthroscopy ◽

Outcome Improvement ◽

Clinically Significant

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Effect of Capsular Closure After Hip Arthroscopy for Femoroacetabular Impingement Syndrome on Achieving Clinically Meaningful Outcomes: A Meta-analysis of Prospective and Comparative Studies

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211017467 ◽

2021 ◽

Vol 9 (6) ◽

pp. 232596712110174

Author(s):

Kyle N. Kunze ◽

Amar Vadhera ◽

Annie Devinney ◽

Benedict U. Nwachukwu ◽

Bryan T. Kelly ◽

...

Keyword(s):

Femoroacetabular Impingement ◽

Comparative Studies ◽

Hip Arthroscopy ◽

Meta Analysis ◽

Impingement Syndrome ◽

Harris Hip Score ◽

Femoroacetabular Impingement Syndrome ◽

Outcome Improvement ◽

Clinically Significant

Background: Recent literature has demonstrated conflicting evidence as to whether capsular closure after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) results in superior outcomes compared with capsulotomy without repair. Additionally, these studies have not explored the effect of capsular management on clinically significant outcome improvement. Purpose: To perform a meta-analysis of prospective and comparative studies to determine whether capsular management influences the rate of clinically significant outcome improvement after hip arthroscopy for FAIS. Study Design: Systematic review; Level of evidence, 3. Methods: PubMed, OVID/Medline, EMBASE, and Cochrane databases were queried in September 2020 for studies with evidence levels 1 to 3 that directly compared capsular management cohorts and reported rates of achieving the minimal clinically important difference (MCID) at a minimum follow-up of 2 years. Studies of level 4 evidence, those not describing or directly comparing capsular management techniques as well as those not reporting the MCID were excluded. Methodological quality was assessed using the methodological index for nonrandomized studies tool. Mantel-Haenszel fixed-effects models were constructed to quantitatively evaluate the association between capsular management and achievement of the MCID by generating effect estimates in the form of relative risk (RR) with 95% CIs. Results: A total of 6 studies with 1611 patients were included. The overall pooled rate of MCID achievement for the modified Harris Hip Score (mHHS), Hip Outcome Score Activities of Daily Living (HOS-ADL), and HOS Sports Subscale (HOS-SS) were 84.4%, 80.3%, and 82.5%, respectively, at a mean follow-up of 40.8 months (range, 24-87.6 months). Capsular closure was associated with a significantly higher rate of MCID achievement for the mHHS (RR, 1.06; 95% CI, 1.01-1.10; P = .001) and trended toward statistical significance for the HOS-ADL (RR, 1.11; 95% CI, 1.0-1.24; P = .055) and the HOS-SS (RR, 1.09; 95% CI, 0.99-1.21; P = .094). Conclusion: Although capsular closure appeared to result in higher rates of clinically significant outcome improvement in hip function, there was no definitively increased likelihood of achieving clinically significant improvement in relevant hip outcome scores with capsular closure.

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