PMID- 28298057
OWN - NLM
STAT- MEDLINE
DCOM- 20171027
LR  - 20220409
IS  - 1552-3365 (Electronic)
IS  - 0363-5465 (Linking)
VI  - 45
IP  - 6
DP  - 2017 May
TI  - Defining the "Substantial Clinical Benefit" After Arthroscopic Treatment of 
      Femoroacetabular Impingement.
PG  - 1297-1303
LID - 10.1177/0363546516687541 [doi]
AB  - BACKGROUND: The minimal clinically important difference (MCID) has been defined 
      in orthopaedics and is the smallest change that a patient considers meaningful. 
      Less is known about improvements that the patient perceives as clinically 
      considerable, or the substantial clinical benefit (SCB). For the young, highly 
      functioning patient cohort with femoroacetabular impingement (FAI), the SCB is an 
      important measure of clinical success. PURPOSE: To derive the SCB for FAI 
      treatment and identify outcome score thresholds and patient variables predictive 
      of the SCB. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 2. 
      METHODS: The modified Harris Hip Score (mHHS), the Hip Outcome Score activities 
      of daily living (HOS-ADL) and sport (HOS-Sport) subscales, and the international 
      Hip Outcome Tool (iHOT-33) were prospectively administered to 364 patients with a 
      minimum 1-year follow-up. At 1 year postoperatively, patients graded their hip 
      function based on several anchor responses such as "no change" and "much 
      improved." The SCB was defined as the change on each outcome tool that equated to 
      the difference between "no change" and "much improved" on the health transition 
      question. Receiver operating characteristic analysis with area under the curve 
      (AUC) was used to identify optimal values that were most representative of the 
      SCB. Multivariable analysis identified patient variables predictive of the SCB. 
      RESULTS: The net change in outcome scores corresponding to the SCB for the mHHS, 
      HOS-ADL, HOS-Sport, and iHOT-33 was 19.8, 10.0, 29.9, and 24.5, respectively. The 
      following postoperative outcome scores demonstrated excellent distinction (AUC 
      >0.8) between "no change" and "much improved" and thus were considered absolute 
      values for the postoperative SCB: 82.5 (mHHS), 93.3 (HOS-ADL), 84.4 (HOS-Sport), 
      and 63.5 (iHOT-33). Preoperative scores on the HOS-ADL (83.3) and HOS-Sport 
      (50.0) were significant threshold cutoffs, above which attaining the SCB became 
      less likely. Younger age and lower Outerbridge grade were predictive of achieving 
      the SCB. CONCLUSION: The SCB has not been previously defined in the hip 
      preservation literature and is complementary to the MCID as the upper bound for 
      clinically significant improvement. We identified predictive preoperative and 
      diagnostic postoperative outcome scores for the SCB that can be used to manage 
      patient expectations and grade outcomes. These findings are objective criteria 
      for defining clinical success after arthroscopic FAI treatment.
FAU - Nwachukwu, Benedict U
AU  - Nwachukwu BU
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 - Fields, Kara
AU  - Fields K
AD  - Hospital for Special Surgery, New York, New York, USA.
FAU - Rebolledo, Brian J
AU  - Rebolledo BJ
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 - 20170201
PL  - United States
TA  - Am J Sports Med
JT  - The American journal of sports medicine
JID - 7609541
SB  - IM
MH  - *Activities of Daily Living
MH  - Adult
MH  - *Arthroscopy
MH  - Female
MH  - Femoracetabular Impingement/*surgery
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Patient Satisfaction/*statistics & numerical data
MH  - Postoperative Period
MH  - Prospective Studies
MH  - Sports/statistics & numerical data
MH  - Treatment Outcome
MH  - Young Adult
OTO - NOTNLM
OT  - epidemiology
OT  - femoroacetabular impingement
OT  - hip arthroscopic surgery
OT  - outcome
OT  - quality of life
OT  - substantial clinical benefit
EDAT- 2017/03/17 06:00
MHDA- 2017/10/28 06:00
CRDT- 2017/03/17 06:00
PHST- 2017/03/17 06:00 [pubmed]
PHST- 2017/10/28 06:00 [medline]
PHST- 2017/03/17 06:00 [entrez]
AID - 10.1177/0363546516687541 [doi]
PST - ppublish
SO  - Am J Sports Med. 2017 May;45(6):1297-1303. doi: 10.1177/0363546516687541. Epub 
      2017 Feb 1.