HSS Tackles Meaningful Outcomes After Hip Surgery

What constitutes a meaningful difference when it comes to outcomes after arthroscopy for femoral acetabular impingement?

Researchers from Hospital for Special Surgery (HSS) in New York recently delved into this question. Their work, “Minimal Clinically Important Difference and Substantial Clinical Benefit After Revision Hip Arthroscopy,” was published in the June 18, 2018 edition of Arthroscopy.

Benedict U. Nwachukwu M.D., M.B.A., an orthopedic surgery resident at HSS and study co-author told OTW, “There is increasing interest in understanding what represents a meaningful outcome after orthopaedic interventions. We now understand that what is statistically significant may not be clinically significant.”

“My co-authors and I have used the hip preservation registry at HSS to create an important body of work on defining meaningful outcome after arthroscopic treatment of FAI [femoral acetabular impingement].”

“The current study is an extension of that FAI work since patients undergoing revision hip arthroscopy are a unique patient population for several reasons. First, it is unclear the degree to which they improve after surgery and furthermore we are unsure about what degree of improvement is required for them to register meaningful outcome improvement (if at all).”

“In the study we demonstrated that clinically significant outcome can be achieved with revision hip arthroscopy and we defined what values represent ‘minimal clinically important difference’ (MCID) and ‘substantial clinical benefit’ (SCB) after this procedure. This is an important result by itself.”

“Additionally, we showed that the MCID values were comparable to our prior work but that the SCB values for revision patients were higher.”

“This finding suggests that the same degree of improvement is needed for revision hip arthroscopy patients to notice themselves feeling improved but a larger degree of improvement (compared to traditional patients) is needed for them to feel the most improvement (i.e., SCB).”

“Finally, the reason patients need a revision hip arthroscopy procedure is also an important determinant. Specifically, patients who’ve had an impingement that was not addressed at their first surgery are the most likely to have a clinically meaningful outcome. This can be helpful pre-operatively for identifying the patients most likely to do well with revision surgery.”

“Patients undergoing revision hip arthroscopy can indeed achieve clinically significant outcome improvement. A large degree of improvement is needed for them to feel significantly better however this is still possible. Surgeons can have practical conversations with patients post-operatively about their patient reported outcome scores and what this means for their overall degree of improvement.”

“Patient reported outcome measures are being increasingly adopted in orthopedic surgery. There is an important need for studies like this to begin trying to define what represents clinically meaningful outcome in other areas of orthopedic surgery.”