Summary

This study examined threshold MCID, PASS, SCB and MOIST values for the HOS-SSS in athletes undergoing hip arthroscopy for FAIS at minimum 2-year follow-up.

Abstract

Background

The minimal clinically important difference (MCID), patient acceptable symptomatic state (PASS), substantial clinical benefit (SCB), and maximum outcome improvement satisfaction threshold (MOIST) for the Hip Outcome Score-Sports Specific Subscale (HOS-SSS) have not been established in athletes undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS).

Purpose

To determine threshold MCID, PASS, SCB and MOIST values for the HOS-SSS in
athletes undergoing hip arthroscopy for FAIS at minimum 2-year follow-up.

Methods

Anchor questions were administered to all athletes who underwent primary hip
arthroscopy for FAIS between May 2015 and March 2019. Patients were included if they were <50 years old, answered the anchor questions and had preoperative and minimum 2-year follow up for the HOS-SSS, modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), and Visual Analog Scale (VAS) for pain. Exclusion criteria were Tönnis grade > 1, hip dysplasia (lateral center-edge angle < 18°), and previous ipsilateral hip surgery/conditions. Receiver operating characteristic (ROC) analysis was utilized to determine PASS, SCB and MOIST for the HOS-SSS. Two distribution methods were used to calculate MCID for HOS-SSS.

Results

A total of 225 athletes who underwent primary hip arthroscopy met the inclusion criteria. Of those athletes, 200 (88.9%) with minimum 2-year follow-up and information regarding return to sport (RTS) were included. The cohort included 124 (62.0%) females and 76 (38.0%) males with a mean age of 29.4 ± 10.4 years, BMI of 25.6 ± 5.4 kg/m2, and mean follow up of 29.5 ± 5.1 months. Athletes experienced significant improvements in HOS-SSS, mHHs, NAHS, and VAS from preoperative to latest postoperative follow-up (P < 0.001) and mean satisfaction was 8.2. The RTS rate was 83.7%. ROC analysis determined the PASS, MOIST, SCB absolute score, SCB change score, and MCID (baseline/change score methods) for the HOS-SSS were 77.0, 44.3%, 92.7, 30.6, and 10.6, respectively, with athletes achieving thresholds at high rates (80.0%, 80.5%, 45.0%, 54.0%, 79.5%, respectively).

Conclusion

This study identified values for the HOS-SSS that can be used to define clinically
meaningful outcomes in athletes following primary hip arthroscopy for FAIS. The PASS, MOIST, SCB absolute score, SCB change score, and MCID for the HOS-SSS at minimum 2-year follow-up in athletes following primary hip arthroscopy were 77.0, 44.3%, 92.7, 30.6, and 10.6, respectively.