Maximal Outcome Improvement Willingness Thresholds Are Predictive of a Patient's Willingness to Undergo the Same Surgery, in Retrospect, Given the Known Outcome of Their Primary Hip Arthroscopy

David R Maldonado; James D Fox; Cynthia Kyin; Andrew E Jimenez; Benjamin R Saks; Andrew J Curley; Ajay C Lall; Benjamin G Domb

doi:10.1016/j.asmr.2022.02.004

Maximal Outcome Improvement Willingness Thresholds Are Predictive of a Patient's Willingness to Undergo the Same Surgery, in Retrospect, Given the Known Outcome of Their Primary Hip Arthroscopy

Arthrosc Sports Med Rehabil. 2022 Apr 20;4(3):e1007-e1013. doi: 10.1016/j.asmr.2022.02.004. eCollection 2022 Jun.

Authors

David R Maldonado¹, James D Fox¹, Cynthia Kyin¹, Andrew E Jimenez¹, Benjamin R Saks¹, Andrew J Curley¹, Ajay C Lall^{1

2}, Benjamin G Domb^{1

2}

Affiliations

¹ American Hip Institute Research Foundation, Chicago, Illinois, U.S.A.
² American Hip Institute, Chicago, Illinois, U.S.A.

Abstract

Purpose: To determine the percent maximal outcome improvement willingness thresholds (MOWTs) for the Nonarthritic Hip Score (NAHS) and the visual analog scale (VAS) for pain that were associated with a patient's willingness to undergo surgery, in retrospect, given the known outcome of their primary hip arthroscopy with concomitant endoscopy for gluteus medius (GM) tear repair.

Methods: An anchor question was provided to patients who underwent primary hip arthroscopy for femoroacetabular impingement syndrome with concomitant endoscopic GM tear repair between April 2008 to April 2020. Patients were included if they answered the anchor question and had baseline and postoperative minimum 1-year follow-up scores for the NAHS and VAS. Patients were excluded if they had a previous ipsilateral hip surgery, Tönnis grade >1, hip dysplasia, previous hip conditions, or a preoperative score that was already at the maximum value for the NAHS and VAS scores. Receiver operating characteristic (ROC) analysis was used to determine the MOWT. Significance was indicated by a P value <.05.

Results: A total of 107 patients (107 hips) were included, with 101 (94.4%) females and 6 (5.6%) males. The average age and body mass index was 56.20 ± 9.88 years and 28.80 ± 4.92 kg/m², respectively. The average follow-up time was 54.89 ± 29.52 months. The ROC analysis determined that the MOWT for the mHHS and VAS were 54.7%, and 62.6%, respectively. The probability of a patient being willing to undergo surgery again if they met the MOWT was 85.8% and 85.6% for the NAHS and VAS, respectively.

Conclusion: The MOWTs that were predictive of willingness to undergo surgery again following primary hip arthroscopy with concomitant endoscopy for GM tear repair were 54.7% and 62.6% for the NAHS, and VAS, respectively.

Clinical relevance: Outcome assessment has been a point of increasing emphasis in hip preservation surgery. Having a tool to measure whether patients would go through the process of surgery again knowing their current outcome status is important to understanding outcomes after surgery.