How Can We Define Clinically Important Improvement in Pain Scores After Hip Arthroscopy for Femoroacetabular Impingement Syndrome? Minimum 2-Year Follow-up Study

2019 ◽  
Vol 47 (13) ◽  
pp. 3133-3140 ◽  
Author(s):  
Edward C. Beck ◽  
Benedict U. Nwachukwu ◽  
Kyle N. Kunze ◽  
Jorge Chahla ◽  
Shane J. Nho
Keyword(s):  
Pain Score ◽  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Alpha Angle ◽  
Impingement Syndrome ◽  
Important Improvement ◽  
Femoroacetabular Impingement Syndrome ◽  
Clinically Significant ◽  
Preoperative Predictors ◽  
Pain Improvement

Background: Patient postoperative pain is being increasingly reported in the field of hip preservation surgery. The visual analog scale (VAS) for pain is one of the most commonly utilized measures for perioperative pain assessment. Currently, there is limited understanding of clinically significant improvement in VAS pain. Purpose: (1) To define the substantial clinical benefit (SCB), patient acceptable symptomatic state (PASS), and minimal clinically important difference (MCID) for the VAS pain score in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome after 2 years from surgery and (2) to identify preoperative predictors of achieving each outcome endpoint. Study Design: Case series; Level of evidence, 4. Methods: Data from consecutive patients who underwent primary hip arthroscopy between November 2014 and March 2017 were collected and analyzed. Baseline data and postoperative patient-reported outcome scores were recorded at 2 years postoperatively. To quantify clinical significance of outcome achievement for the VAS pain score, the MCID, PASS, and SCB were calculated. Results: A total of 976 patients were included in the final analysis. The VAS pain score threshold for achieving the MCID was defined as a decrease of 14.8; the PASS was defined as achieving a 2-year postoperative score of 21.6 points; and the SCB was defined as a decrease of 25.5 or a score of 15.4 points at 2 years. The rates of achieving the MCID, PASS, and SCB were 97.6%, 66.4%, and 71.2%, respectively. Regression analysis demonstrated that sports involvement, low body mass index, smaller preoperative alpha angle, and absence of articular damage and chondromalacia were predictive of achieving the PASS (all P < .05). Preoperative predictors for achieving the SCB included being male, no smoking history, smaller alpha angle, higher modified Harris Hip Score, and lower VAS pain score (all P < .05). Conclusion: This study identified scores for VAS pain that can be used to define clinically significant outcome after arthroscopic treatment of femoroacetabular impingement syndrome. Specifically, a decrease in pain score of 14.8 was a clinically important improvement in VAS pain, while an absolute score <15.4 or a change of 25.5 represented the upper threshold of VAS pain improvement. Additionally, there were both modifiable and nonmodifiable factors that predicted achieving clinically significant levels of postoperative pain improvement.

scholarly journals Defining Meaningful Functional Improvement on the Visual Analog Scale for Satisfaction at 2-years After Hip Arthroscopy for Femoroacetabular Impingement Syndrome

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0043
Author(s):  
Edward Beck ◽  
Benedict Nwachukwu ◽  
Nabil Mehta ◽  
Kyleen Jan ◽  
Kelechi Okoroha ◽  
...  
Keyword(s):  
Visual Analog Scale ◽  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Alpha Angle ◽  
Impingement Syndrome ◽  
Analog Scale ◽  
Important Improvement ◽  
Femoroacetabular Impingement Syndrome ◽  
Clinically Significant ◽  
Preoperative Predictors

Objectives: Patient satisfaction is being increasingly reported in orthopaedic sports medicine and the field of hip preservation surgery. The Visual Analog Scale (VAS) for Satisfaction is most commonly utilized. Currently there is limited understanding for what should be considered as clinically important improvement on the VAS Satisfaction. The purpose of this study is to 1) define Substantial Clinical Benefit (SCB), Patient Acceptable Symptomatic State (PASS), and Minimal Clinically Important Difference (MCID) for the VAS Satisfaction in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS), and 2) identify preoperative predictors of achieving each outcome end-point. Methods: Data from consecutive patients who underwent primary hip arthroscopy between November 2014 and January 2017 were collected and analyzed. Baseline data and postoperative patient-reported outcome (PRO) scores were recorded at 2-years postoperatively. In order to quantify clinical significance of outcome achievement on the VAS Satisfaction we calculated MCID, PASS and SCB for this outcome measure. A multivariate logistic regression analysis was used to identify preoperative predictors of achieving SCB, PASS, and MCID satisfaction. Results: A total of 335 patients were included in the final analysis, with an average age and body mass index (BMI) of 32.8(SD+12.4) years and 25.2(SD+5.3) respectively. The values on the VAS satisfaction were identified to represent MCID, PASS and SCB respectively: 12.3, 80.9 and 89.7. The rates of achieving clinically significant improvement on the VAS Satisfaction was 97.1%, 68.1% and 56.9% for MCID, PASS and SCB respectively. A larger preoperative alpha angle was predictive for achieving SCB (OR:1.076; p =0.046), while lower BMI (OR:0.955; p =0.047) and larger preoperative alpha angle (OR:1.12; p-value=0.025) were predictors for achieving PASS. Conclusions: This study identifies scores on the VAS Satisfaction that can be used to define clinically significant outcome after arthroscopic treatment of FAIS. Specifically, an improvement of 12.3 points is a clinically important improvement in satisfaction, while an absolute score above 89.7 represents the upper threshold of Satisfaction performance. Almost all patients (97.1%) demonstrated a clinically important improvement in satisfaction. Additionally, there are both modifiable and non-modifiable factors that predict achieving a clinically significant level of post-operative satisfaction on the VAS Satisfaction.

scholarly journals Clinically Significant Outcome Improvement After Hip Arthroscopy in Patients With Femoroacetabular Impingement Syndrome and Severe Femoral Torsion

2021 ◽  
Vol 9 (10) ◽  
pp. 232596712110345
Author(s):  
Steven F. DeFroda ◽  
Thomas D. Alter ◽  
Blake M. Bodendorfer ◽  
Alexander C. Newhouse ◽  
Felipe S. Bessa ◽  
...  
Keyword(s):  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Impingement Syndrome ◽  
Harris Hip Score ◽  
Femoral Torsion ◽  
Outcome Score ◽  
Femoroacetabular Impingement Syndrome ◽  
Patient Reported ◽  
Outcome Improvement ◽  
Clinically Significant

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.

scholarly journals Effect of prior ipsilateral lower extremity surgery on 2-year outcomes following hip arthroscopy for femoroacetabular impingement syndrome

2019 ◽  
Vol 6 (3) ◽  
pp. 241-248
Author(s):  
Kyle N Kunze ◽  
Edward C Beck ◽  
Kelechi R Okoroha ◽  
Jorge Chahla ◽  
Sunikom Suppauksorn ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Patient Reported Outcomes ◽  
Impingement Syndrome ◽  
Prior History ◽  
Femoroacetabular Impingement Syndrome ◽  
Patient Reported ◽  
History Of ◽  
Clinically Significant

Abstract The purpose of this study was to determine the influence of prior lower extremity surgery on patient reported outcomes following hip arthroscopy for femoroacetabular impingement syndrome (FAIS). Consecutive patients who underwent hip arthroscopy for FAIS and a prior history of ipsilateral lower extremity surgery were identified and matched 2:1 by age, gender, and body mass index (BMI) to controls without a history of lower extremity surgery. The minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) were calculated for HOS–ADL, HOS–SS, and mHHS. Preoperative and 2-year postoperative patient reported outcomes of both groups were compared, and logistic regression was performed to determine whether lower extremity surgery influenced achieving MCID and PASS. A total of 102 patients (24.94%) with prior history of ipsilateral lower extremity surgery were identified. Ipsilateral orthopaedic knee surgery accounted for more than half (53.92%) of all prior surgeries. Patients with a history of ipsilateral lower extremity surgery had significant lower 2-year PROs, satisfaction, and greater pain when compared to patients without lower extremity surgery (P &lt; 0.001 all). A history of ipsilateral lower extremity surgery was a negative predictor of achieving MCID for HOS–ADL and HOS–SS, as well as PASS for HOS–ADL, HOS–SS, and mHHS (P &lt; 0.001 all). In conclusion, patients with prior lower extremity surgery were found to have inferior outcome scores and a lower likelihood of achieving clinically significant outcome improvement compared to patients without a history of lower extremity surgery at two years postoperatively.

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

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.

Development of a Predictive Algorithm for Symptomatic Hip Abductor Tears in Patients Undergoing Primary Hip Arthroscopy

2021 ◽  
Vol 49 (2) ◽  
pp. 497-504
Author(s):  
Philip J. Rosinsky ◽  
Samantha C. Diulus ◽  
John P. Walsh ◽  
Mitchell B. Meghpara ◽  
Jacob Shapira ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Predictive Model ◽  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Alpha Angle ◽  
Impingement Syndrome ◽  
Stepwise Logistic Regression ◽  
Female Sex ◽  
Femoroacetabular Impingement Syndrome ◽  
Hip Abductor

Background: Patients presenting with lateral hip pain may pose a difficult diagnostic challenge, as pain can be due to various causes. Purpose/Hypothesis: The purpose was to identify risk factors and predictors for symptomatic hip abductor tears in a cohort of patients undergoing primary hip arthroscopy for femoroacetabular impingement syndrome. We hypothesized that body mass index (BMI), female sex, age, and presence of chondral damage would be significant predictors of hip abductor pathologies. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Data were prospectively collected and retrospectively reviewed. Patients were included if they underwent primary hip arthroscopy between March 2009 and December 2019. Patients with Tönnis grade >1, previous hip conditions, incomplete radiographic data, or open procedures were excluded. All demographic variables, intraoperative measurements, and radiographic measurements were assessed using a bivariate analysis. A stepwise logistic regression was used to determine predictive variables. Results: In total, 255 hips with a hip abductor tear that underwent hip arthroscopy and 2106 hips without a tear that underwent hip arthroscopy were included. The stepwise logistic regression successfully created a predictive model using age, sex, BMI, lateral joint space, and alpha angle as variables. The efficiency of the predictive model was 90.7%, with an area under the curve of 0.894. The odds of having a hip abductor tear were 7.41 times higher in females (odds ratio [OR], 7.41; 95% CI, 4.61-11.9). Each additional year of age was associated with a 13.7% (OR, 1.137; 95% CI, 1.12-1.16) increase in the odds of having a tear. Similarly, with each 1-unit increase in BMI, the odds of having a tear increased by 3.4% (OR, 1.034; 95% CI, 1.01-1.06). Conclusion: This study successfully created a predictive model that identified female sex (OR, 7.41), increasing age (OR, 1.137 for each year), and increased BMI (OR, 1.034 for each unit of BMI) as significant independent predictors of the presence of hip abductor tears in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome. This model can be used in support of physical examination and imaging suggestive of hip abductor pathology to preoperatively identify the probability of a symptomatic hip abductor tear in these patients.

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