Lower Modified Harris Hip Score Predicts Revision

Hip arthroscopy patients with lower modified Harris Hip Scores after the procedure are more likely to need revision surgery or a conversion to hip replacement, researchers say.

In the case-control study, “Can Patient-Reported Outcomes Predict the Need for Secondary Surgeries After Hip Arthroscopy?” published on December 1, 2020 in The American Journal of Sports Medicine, the researchers examined patient-reported outcomes at 3 months and 1 year after primary hip arthroscopy.

The researchers wrote, “Patient-reported outcomes (PROs) capture the postoperative period and reflect the patient’s perspective of one’s own recovery. However, it is unknown if PROs can reflect and predict the need for secondary surgeries after a primary hip arthroscopy.”

They wanted to see if patient reported outcomes after primary hip arthroscopy correlated with future reoperations and what the critical threshold would be.

Data was collected on 911 consecutive patients who underwent primary hip arthroscopy between February 2008 and August 2018. All the patients had the following PROs preoperative and at 3 months and 1 year postoperatively: modified Harris Hip Score, Nonarthritic Hip Score and Visual Analog Scale for pain.

Patients were split into two groups depending on whether they had a second surgery or not. Then the researchers compared patient variables, intraoperative labral treatment, preoperative PROs and postoperative PROS between the two groups.

Overall, while age, body mass index, labral treatment, and 3-month and 1-year follow-up modified Harris Hip Score, Nonarthritic Hip Score and Visual Analog Scale were significant in the bivariate analysis, the multivariate logistic regression analysis only found 1-year modified Harris Hip Score to be significant in the final model (p < .05).

The researchers wrote, “The ROC [receiver operator characteristic] curve for 1-year modified Harris Hip Score demonstrated acceptable discrimination between patients requiring secondary surgery and patients not requiring secondary surgery with an area under the curve of 0.73. Using the Youden index, a threshold of 80.5 was determined for the 1-year modified Harris Hip Score.”

They added, “The risk for secondary procedures may be evaluated with modified Harris Hip Score at 1 year after primary hip arthroscopy. Surpassing a score of 80.5 may be associated with a 74.4% reduction in risk for either a revision hip arthroscopy or a conversion to hip replacement.”