Introduction
Contextualizing patient-reported outcomes (PROs) can help to differentiate meaningful outcomes. Measures such as patient acceptable symptom state and minimum clinically important difference have been investigated in recent years. Assessment of patients’ perception of being “completely better” (CB) after hip arthroscopy has not been investigated and may be of particular value. The purpose of this study was to assess the rate of patient-reported CB status 2 years after hip arthroscopy and determine associations with PROs.
Methods
An orthopaedic registry at a single institution was retrospectively analyzed. All patients who underwent hip arthroscopy from 2015 to 2020, and had 2 year follow up data were included in this study. Patients were administered Patient-Reported Outcomes Measurement Information System (PROMIS) in six domains, Numeric Pain Score, Musculoskeletal Outcomes Data Evaluation and Management System (MODEMS) expectations domains and Surgical Satisfaction Questionnaire (SSQ8) pre-operatively and at 2 years postoperatively. Patients completed a CB anchor question at 2 years after surgery. Threshold values for PRO scores associated with achieving a CB status were identified with approximately 90% specificity. Variables were selected a posteriori for inclusion into multivariable analysis based off Area Under Curve (AUC) greater than 0.80 on a receiver operating characteristic (ROC) curve.
Results
Overall, 29 of the 62 patients (46.8%) reported their condition CB at 2 years postoperatively. There were no differences in demographics including age, sex, BMI, race, prior hip surgery, pre-op narcotic use, or smoking status between the CB and non-CB groups. The 2-year and change in PROMIS Physical Function, PROMIS Pain Interference, Social Satisfaction, Fatigue, and Anxiety were significantly better in the CB group than in the non-CB group. Numeric Pain Score in the operative hip, MODEMS Postoperative Met Expectations, and SSQ8 were significantly better at 2 years in the CB group. There were no differences in pre-treatment expectations between groups. Thresholds of 2-year PROMIS PF =51.3, change in PROMIS PF =12, 2-year PROMIS PI =46.6, change in PROMIS PI = -12.2, 2-year Numeric Pain Score – operative hip =1.0, MODEMS Postoperative Met Expectations =95.0, and 2-year SSQ8 =87.5 were the best predictors of achieving CB status. Multivariate analysis of CB status demonstrated that SSQ8 and change in PROMIS Physical Function were independent predictors of CB status when controlling for potential confounding variables.
Conclusion
Almost half of hip arthroscopy patients reported being completely better at 2 years after surgery. Multiple PROs including physical function, pain, and satisfaction were significant associated with CB status. Improvement in PROMIS Physical Function and two-year satisfaction were independently predictive of CB status. This is the first study to assess CB status 2 years after hip arthroscopy and provides contextualization to PROs for orthopaedic surgeons and researchers.