PMID- 27765733
OWN - NLM
STAT- MEDLINE
DCOM- 20171010
LR  - 20220409
IS  - 1552-3365 (Electronic)
IS  - 0363-5465 (Linking)
VI  - 45
IP  - 3
DP  - 2017 Mar
TI  - Preoperative Outcome Scores Are Predictive of Achieving the Minimal Clinically 
      Important Difference After Arthroscopic Treatment of Femoroacetabular 
      Impingement.
PG  - 612-619
LID - 10.1177/0363546516669325 [doi]
AB  - BACKGROUND: There is increasing interest in defining meaningful improvement in 
      patient-reported outcomes. Knowledge of the thresholds and determinants for 
      successful femoroacetabular impingement (FAI) outcomes is evolving. PURPOSE: To 
      define preoperative outcome score thresholds and determine clinical/demographic 
      patient factors predictive for achieving the minimal clinically important 
      difference (MCID) after arthroscopic FAI surgery. STUDY DESIGN: Cohort study 
      (diagnosis); Level of evidence, 2. METHODS: A prospective institutional hip 
      preservation registry was reviewed to identify patients undergoing arthroscopic 
      FAI surgery. The modified Harris Hip Score (mHHS), the Hip Outcome Score (HOS), 
      and the international Hip Outcome Tool (iHOT-33) were administered at baseline 
      and 1 year postoperatively. The MCID was calculated using a distribution-based 
      method. Receiver operating characteristic (ROC) analysis was used to calculate 
      cohort-based threshold values predictive of achieving the MCID. The area under 
      the curve (AUC) was used to define predictive ability, with AUC >0.7 considered 
      acceptably predictive. Multivariable analysis identified patient factors 
      associated with achieving the MCID. Sensitivity analysis was performed to derive 
      the MCID by an alternative anchor-based method. RESULTS: There were 364 patients 
      (mean [+/-SD] age, 32.5 +/- 10.3 years), and 57.1% were female. The MCID for the 
      mHHS, HOS-Activities of Daily Living (HOS-ADL), HOS-Sports, and iHOT-33 was 8.2, 
      8.3, 14.5, and 12.1, respectively. ROC analysis findings (threshold, percentage 
      achieving the MCID, and strength of association) for these tools were as follows: 
      mHHS (60.5, 77.2%, and 0.68, respectively), HOS-ADL (83.3, 68.1%, and 0.85, 
      respectively), HOS-Sports (58.3, 65.9%, and 0.76, respectively), and iHOT-33 
      (53.9, 81.9%, and 0.65, respectively). The likelihood for achieving the MCID 
      significantly declined above these thresholds. In multivariable analysis, a 
      higher sagittal center-edge angle (CEA) (odds ratio [OR], 1.04; 95% CI, 
      1.01-1.08) was a positive predictor of achieving the MCID on the iHOT-33, while a 
      higher Outerbridge grade for the acetabulum was a negative predictor (OR, 0.56; 
      95% CI, 0.32-0.99) on the mHHS. Sensitivity analysis confirmed these variables 
      and identified relative femoral retroversion as another negative predictor (OR, 
      0.40; 95% CI, 0.17-0.94). CONCLUSION: The HOS had excellent predictive ability 
      for identifying patient thresholds of achieving the MCID; patients with 
      preoperative scores below identified thresholds were most likely to achieve the 
      MCID. Additionally, anterior acetabular undercoverage, chondral injuries, and 
      relative femoral retroversion were clinically significant negative modifiers of 
      outcomes. These findings have implications for managing preoperative expectations 
      of FAI surgery.
FAU - Nwachukwu, Benedict U
AU  - Nwachukwu BU
AD  - Hospital for Special Surgery, New York, New York, USA.
FAU - Fields, Kara
AU  - Fields K
AD  - Hospital for Special Surgery, New York, New York, USA.
FAU - Chang, Brenda
AU  - Chang B
AD  - Hospital for Special Surgery, New York, New York, USA.
FAU - Nawabi, Danyal H
AU  - Nawabi DH
AD  - Hospital for Special Surgery, New York, New York, USA.
FAU - Kelly, Bryan T
AU  - Kelly BT
AD  - Hospital for Special Surgery, New York, New York, USA.
FAU - Ranawat, Anil S
AU  - Ranawat AS
AD  - Hospital for Special Surgery, New York, New York, USA.
LA  - eng
PT  - Journal Article
DEP - 20161023
PL  - United States
TA  - Am J Sports Med
JT  - The American journal of sports medicine
JID - 7609541
SB  - IM
MH  - Adult
MH  - *Arthroscopy
MH  - Female
MH  - Femoracetabular Impingement/*surgery
MH  - Humans
MH  - Male
MH  - *Minimal Clinically Important Difference
MH  - Postoperative Period
MH  - Prospective Studies
MH  - Young Adult
OTO - NOTNLM
OT  - epidemiology
OT  - femoroacetabular impingement
OT  - hip arthroscopic surgery
OT  - minimal clinically important difference
OT  - outcome
OT  - quality of life
EDAT- 2016/10/22 06:00
MHDA- 2017/10/11 06:00
CRDT- 2016/10/22 06:00
PHST- 2016/10/22 06:00 [pubmed]
PHST- 2017/10/11 06:00 [medline]
PHST- 2016/10/22 06:00 [entrez]
AID - 0363546516669325 [pii]
AID - 10.1177/0363546516669325 [doi]
PST - ppublish
SO  - Am J Sports Med. 2017 Mar;45(3):612-619. doi: 10.1177/0363546516669325. Epub 2016 
      Oct 23.