Summary

Patients continued to meet MCID, PASS, and SCB at high rates over a 10-year period, suggesting that patients’ expectations change over time leading to continued patient satisfaction.

Abstract

Purpose

Clinimetric outcome thresholds have been utilized to provide insight into post-operative functional status and patient satisfaction. The purpose of this study is to define and evaluate minimal clinically important difference (MCID), patient acceptable symptomatic state (PASS), and substantial clinical benefit (SCB) thresholds over the 2-, 5-, and 10-year timepoints for modified Harris Hip Score (mHHS), Hip Outcome Score Sports-Specific Subscale (HOS-SSS), and the International Hip Outcome Tool (iHOT12).

Methods

Data was retrospectively reviewed for patients who underwent primary hip arthroscopy from 2008-2021. Inclusion criteria included complete patient reported outcome (PRO) scores with anchor questions at either the 2-, 5-, or 10-year timepoint. Groups were propensity-score matched 1:1:1 based on age, body mass index (BMI), sex, lateral center edge angle, and surgical procedure. Thresholds were defined using the anchor-based method for PRO scores at the follow-up timepoints.

Results

135 hips matched in each group. Area under the curve for all defined thresholds indicated excellent discrimination. The threshold for achieving PASS, defined at the 2-, 5-, and 10-year follow-up respectively, were as follows: mHHS (82.0, 87.5, 78.5), HOS-SSS (63.2, 76.4, 67.7), and iHOT12 (76.2, 76.9, 57.4). The percentage of patients achieving PASS increased over time, with the highest percentage at 10-years. The threshold for achieving SCB were defined as follows: mHHS (93.0, 96.5, 93.0), HOS-SSS (97.1, 92.7, 90.5), and iHOT12 (90.0, 96.4, 82.5). The percentage of patients achieving SCB increased from 2- to 10-years. The mean changes required to achieve MCID were defined as follows: mHHS (7.883, 7.375, 7.487), HOS-SSS (10.904, 10.794, 11.115), and iHOT12 (9.567, 10.553, -). The percentage of patients achieving MCID remained constant over 2- to 10-years.

Conclusion

Patients continued to meet MCID, PASS, and SCB at high rates over a 10-year period. Our findings suggest that patients’ expectations change over time leading to continued patient satisfaction.