Hip Outcome Score-Sports Subscale Research Articles

Predictors of Inferior Outcomes Following Hip Arthroscopy for Femoroacetabular Impingement

Objectives:Hip arthroscopy for femoroacetabular impingement (FAI) provides reliable pain relief and functional improvement in the majority of patients. Although a small percentage of patients will go on to subsequent revision hip arthroscopy or conversion to arthroplasty, some patients will also have inferior clinical outcome without revision surgery. The purpose of this study is to identify clinical and radiographic characteristics predictive of inferior outcomes 2-years following hip arthroscopy for FAI.Methods:A clinical repository containing patients undergoing primary hip arthroscopy for femoroacetabular impingement (FAI) between 1/1/2012-1/1/2014 with a minimum follow up of two years was queried to include patients in this study. Operative procedures generally included labral debridement and repair, acetabular rim trimming, femoral osteochondroplasty and capsular plication. The primary outcome measure was the Hip Outcome Score Activities of Daily Living (HOS-ADL) questionnaire. Secondary outcome measures included the Hip Outcome Score Sports Subscale (HOS-SS) and modified Harris Hip Score (MHHS). Patients requiring revision hip arthroscopy or hip arthroplasty were excluded from this study. Patients were organized into superior and inferior outcome groups based on the top and bottom quartiles of the postoperative HOS-ADL score. Demographic, preoperative, intraoperative and postoperative variables between these groups were compared to identify predictors for inferior outcomes using bivariate and multivariate analyses.Results:Of 482 patients undergoing hip arthroscopy for FAI there was two year outcome data for 392 patients (81.5%) with an average follow up of 2.3 ± 0.6 years. The superior group contained 98 patients with an HOS-ADL score of 97.06 or higher while the inferior group contained 98 patients with an HOS-ADL score of 80.5 or lower. Patients in the superior outcome group were younger (30.7 ± 12.8 vs 38.0 ± 11.8 p<0.001) with a lower BMI (24.1 ± 4.1 vs. 26.5 ± 5.1 p=0.005) and higher preoperative average joint space width (4.2 ± 0.5 mm vs. 3.7 ± 0.4 mm; p=0.009) and lower Tonnis grade (p<0.001; Table 1). Patients in the inferior outcome group also had a higher incidence of smoking (p=0.005), workers compensation claims (p=0.04) and prior psychiatric history (p=0.007). A stepwise multivariate logistic regression analysis revealed that older age (p=0.00674), higher BMI (p=0.02629), and smoking (p=0.01863) were independent predictive factors of inferior outcome (Table 1). Both groups demonstrated significant improvements in HOS-ADL, and MHHS scores, however the inferior outcome group did not have significantly improved HOS-SS scores (p=0.06).Table 1:Demographic and radiographic differences between superior and inferior outcome groups following hip arthroscopy for Femoroacetabular Impingement Inferior OutcomeSuperior OutcomepAge38.0 ± 11.830.7 ± 12.8 <0.0001 Tonnis Grade > 019 (22%)1 (1.1%) <0.0001 Postoperative Alpha Angle42.3 ± 4.438.4 ± 3.7 0.001 BMI26.5 ± 5.124.1 ± 4.1 0.005 Smoking14(14%)3 (3%) 0.005 Preoperative Joint Space (mm)4.2 ± 0.543.75 ± 0.41 0.009 Psychiatric History27 (28%)12(12%) 0.02 Workers Compensation8(8.4%)2 (2.0%) 0.04 Spine History18 (19%)11(11%)0.16Gender (%F)60(61%)55 (56%)0.47Postoperative LCEA29.4 ± 4.530.1 ± 4.00.56Preoperative LCEA32.54 ± 5.732.16 ± 0.530.62Preoperative Alpha Angle61.5 ± 10.361.2 ± 9.30.83Conclusion:Older age, higher BMI, and smoking were independent predictors of inferior clinical outcomes at 2-years following hip arthroscopy for FAI, although both superior and inferior outcome groups experienced significantly improved clinical outcome scores. In addition, lower preoperative joint space, workers compensation status, and psychiatric history were significant factors for inferior outcomes on bivariate analysis. These factors can be considered in preoperative patient counseling about the expected outcome of hip arthroscopy for FAI.

Revision Hip Arthroscopy

Background: As the number of hip arthroscopic surgeries being performed increases, so too does the prevalence of revision hip arthroscopic surgery. Hypothesis/Purpose: The purpose of this study was to compare outcomes in patients requiring revision hip arthroscopic surgery to patients undergoing primary hip arthroscopic surgery. The hypothesis was that patients undergoing revisions would demonstrate similar outcomes to those undergoing primary hip arthroscopic surgery. Study Design: Cohort study; Level of evidence, 2. Methods: Included in the study were patients undergoing revision hip arthroscopic surgery who did not have a history of prior open hip surgery. Each patient in the revision cohort was matched with 2 patients undergoing primary hip arthroscopic surgery. Preoperatively and at a minimum follow-up of 2 years, outcome scores were collected, including the Hip Outcome Score–Activities of Daily Living subscale (HOS-ADL), which was the primary outcome variable; modified Harris hip score (mHHS); Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC); Hip Outcome Score–Sports subscale (HOS-Sports); and the 12-Item Short Form Health Survey (SF12). At follow-up, scores from the Tegner activity scale and patient self-reported satisfaction with surgical outcome were also collected. Results: A total of 246 patients in the revision cohort were matched with 492 patients in the primary cohort. In the revision cohort, 183 patients had 1 prior surgery, 45 had 2 surgeries, and 18 had ≥3 prior surgeries. Subsequent hip arthroscopic surgery was reported in 39 of 492 (8%) patients in the primary cohort and 5 of 246 (2%) patients in the revision cohort (P = .001). Subsequent surgery was reported in 50 of 492 (10%) patients in the primary cohort and 15 of 246 (6%) patients in the revision cohort (P = .07). Both groups saw significant improvement in outcome scores from preoperation to follow-up. The HOS-ADL was lower in the revision cohort preoperatively (65 vs 70) and postoperatively (79 vs 87) (P = .001). This was also seen in the HOS-Sports, WOMAC, and SF12 physical component scores. Patients who had 1 prior hip arthroscopic procedure had higher postoperative mHHS (81 vs 75) compared with patients with >1 hip arthroscopic procedure; however, there was no difference in postoperative mHHS between the single-revision cohort and the primary cohort. In the revision group, patients whose HOS-ADL improved ≥10 points had greater joint space. Patients with greater improvement were more likely to have had a previous labral tear that was not repaired and to require capsular plication at revision. Conclusion: Patients who underwent revision hip arthroscopic surgery had significant improvement in outcome scores but did have lower scores compared with patients with primary hip arthroscopies. Patients with ≥2 revisions had lower outcomes. Improvement in the revision cohort was seen in patients with increased joint space, no prior labral repair, and capsular plication at revision.

The Patient Acceptable Symptomatic State for the Modified Harris Hip Score and Hip Outcome Score Among Patients Undergoing Surgical Treatment for Femoroacetabular Impingement

Background: There is minimal information available on the threshold at which patients consider themselves to be well for patient-reported outcome measures used in patients treated with hip arthroscopy for femoroacetabular impingement (FAI). Purpose: To determine the patient acceptable symptomatic state (PASS) for the modified Harris Hip Score (mHHS) and the Hip Outcome Score (HOS) in patients with FAI treated with arthroscopic hip surgery. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: A consecutive series of patients at a single institution with FAI who were treated with arthroscopic labral surgery, acetabular rim trimming, and femoral osteochondroplasty were eligible. The mHHS (score range, 0-100) and the HOS (score range, 0-100) were administered at baseline and at 12 months postoperatively. An external anchor question at 1 year postoperatively was utilized to determine PASS values: “Taking into account all the activities you have during your daily life, your level of pain, and also your functional impairment, do you consider that your current state is satisfactory?” Results: There were 130 patients (mean ± SD age, 35.6 ± 11.7 years), and 42.3% were male. Based on a receiver operator curve analysis, the PASS values—at which patients considered their status to be satisfactory—at 1 year after surgery were 74 (mHHS), 87 (HOS–activities of daily living subscale), and 75 (HOS–sports subscale). The PASS threshold was not affected by baseline scores across different instruments. However, patients with higher baseline scores were more likely to achieve the PASS (odds ratios: 3.36 [mHHS], 3.83 [HOS–activities of daily living], 3.38 [HOS-sports]). Age and sex were not significantly related to the odds of achieving the PASS for the mHHS or the HOS. Conclusion: This is the first study to determine the PASS for 2 commonly used hip joint patient-reported outcome measures in patients undergoing surgery for FAI. The study findings can allow researchers to determine if interventions related to FAI are meaningful to patients at the individual level across various domains and will also be useful for responder analyses in future randomized trials related to hip arthroscopy and the treatment of FAI.

Labral Base Repair Compared to Circumferential Suture Repair for Acetabular Labral Repair: A Matched-Paired Comparison of Clinical Outcomes

The goal of labral repair is to restore the function of the suction seal effect as the labrum makes contact with the femoral head. The benefits of repair versus debridement have been demonstrated but the ideal method of repair has yet to be determined. The purpose of this analysis is to determine if one labral repair technique is superior to another based on clinical outcomes measured by patient reported outcome (PRO) scores. From February 2008 to February 2012, of 1166 hip arthroscopies, 450 were labral repairs. Two pair-matched groups were created based on acetabular labral repair type, age, gender, radiographic findings, workers compensation and microfracture procedure. Data were prospectively collected and retrospectively reviewed. Patient demographics, intraoperative procedures and radiographic findings were compared to assure similar groups. PROs included visual analog scale (VAS), modified Harris hip score (mHHS), non-arthritic hip score (NAHS), hip outcome score – activities of daily living (HOS-ADL), and hip outcome score – sports subscale (HOS-SS). 110 patients met the inclusion criteria for labral base repair and were paired-matched to 110 who had circumferential repair. Average length of follow-up was 2.5 years for both groups. Patient demographics were statistically similar. Radiographic data were similar between the groups with respect to lateral center-edge angle, acetabular inclination, anterior center edge angle, alpha angle, and joint space width. Intraoperative procedures performed aside from labral repair were of similar frequency with respect to capsule repair/release, femoroplasty, and iliopsoas release. All pre-operative PRO scores were statistically similar. Both groups experienced significant improvement in all PRO's. Comparing group postoperative PRO scores, there was no statistical difference in PRO scores at latest follow-up. There was a similar rate of revision and conversion to arthroplasty. Based on two year PROs, there is no difference in outcomes based on the type of repair that is performed.

Arthroscopic Repair of Delaminated Acetabular Articular Cartilage in Femoroacetabular Impingement

Lesions to articular cartilage can be difficult to treat and directly impact surgical outcome in hip arthroscopy. This article describes a direct cartilage suture repair technique for a young, active individual with full-thickness acetabular cartilage delamination. Lesions of this type are commonly seen with femoroacetabular impingement. A 17-year-old boy presented with bilateral hip pain greater in the right than left. Arthroscopic intervention for the right hip included direct cartilage repair for the cartilage lesion, osteoplasty for femoroacetabular impingement, repair for an anterior labral tear, capsular plication for iliofemoral ligament laxity, and psoas lengthening. Twelve weeks postoperatively, a standard capsular plication, osteoplasty, and chondroplasty were performed on the left hip. At follow-up, the patient reported feeling 95% normal. He noted that the right and left hips were essentially the same. Symptoms consisted of stiffness after prolonged sitting and mild pain following sports. The patient reported being pain free 90% of the time, with pain 2/10 at worst. He scored a 96 on the modified Harris Hip Score, 93 on the Hip Outcome Score Activities of Daily Living subscale, and 81 on the Hip Outcome Score Sports subscale. Overall, the patient was satisfied with the outcome. The direct cartilage repair, in addition to osteoplasty, anterior superior labral repair, iliofemoral capsular plication, and psoas lengthening, produced an excellent outcome in this young, active patient.