Developing a risk prediction model for the functional outcome after hip arthroscopy

Abstract

BackgroundHip arthroscopic treatment is not equally beneficial for every patient undergoing this procedure. Therefore, the purpose of this study was to develop a clinical prediction model for functional outcome after surgery based on preoperative factors.MethodsProspective data was collected on a cohort of 205 patients having undergone hip arthroscopy between 2011 and 2015. Demographic and clinical variables and patient reported outcome (PRO) scores were collected, and considered as potential predictors. Successful outcome was defined as either a Hip Outcome Score (HOS)-ADL score of over 80% or improvement of 23%, defined by the minimal clinical important difference, 1 year after surgery. The prediction model was developed using backward logistic regression. Regression coefficients were converted into an easy to use prediction rule.ResultsThe analysis included 203 patients, of which 74% had a successful outcome. Female gender (OR: 0.37 (95% CI 0.17–0.83); p = 0.02), pincer impingement (OR: 0.47 (95% CI 0.21–1.09); p = 0.08), labral tear (OR: 0.46 (95% CI 0.20–1.06); p = 0.07), HOS-ADL score (IQR OR: 2.01 (95% CI 0.99–4.08); p = 0.05), WHOQOL physical (IQR OR: 0.43 (95% CI 0.22–0.87); p = 0.02) and WHOQOL psychological (IQR OR: 2.40 (95% CI 1.38–4.18); p = < 0.01) were factors in the final prediction model of successful functional outcome 1 year after hip arthroscopy. The model’s discriminating accuracy turned out to be fair, as 71% (95% CI: 64–80%) of the patients were classified correctly.ConclusionsThe developed prediction model can predict the functional outcome of patients that are considered for a hip arthroscopic intervention, containing six easy accessible preoperative risk factors. The model can be further improved trough external validation and/or adding additional potential predictors.

Psychological Healthcare Burden Lessens After Hip Arthroscopy for Those With Comorbid Depression or Anxiety

“…A strong body of literature has demonstrated the interaction of mental health on perception of pain and function prior to, and following, hip arthroscopy. 3,4,[6][7][8][9][10][11] Less studied is the impact of hip arthroscopy on psychological comorbidities. Following hip arthroscopy for FAIS, Sochacki et al showed that 66.2% of patients had a minimal, clinically important difference in reduction scores from preoperative to 1 year postoperative on the Beck Depression Inventory-II.…”

“…5 For patients undergoing hip arthroscopy, poor mental health has been correlated with worse preoperative patient-reported outcomes, 3,4,6 persistent postoperative pain, 7 and decreased postoperative patient reported outcomes (PROs). 4,6,[8][9][10][11] However, it remains unknown whether there is a potential bidirectional relationship between hip pain and poor mental health, as there is a paucity of research devoted to understanding how mental health disorders may be affected by surgical treatment of musculoskeletal conditions. Although not specific to those with preoperative depression or anxiety, Sochacki et al demonstrated 66.2% of patients had minimal clinically important decreases in depressive symptoms following hip arthroscopy for femoral acetabular impingement syndrome (FAIS).…”

“… 5 For patients undergoing hip arthroscopy, poor mental health has been correlated with worse preoperative patient-reported outcomes, 3 , 4 , 6 persistent postoperative pain, 7 and decreased postoperative patient reported outcomes (PROs). 4 , 6 , 8 , 9 , 10 , 11 …”

Recent advances and future trends in hip arthroscopy

“…This identified several pre-operative risk factors: (1) gender, indication: (2) pincer and (3) labral tear, along with pre-operative PROM scores including measures of psychological health. [54] Without taking into account intra-operative parameters, this model successfully predicted outcome in 71% of cases.…”

CORR Insights®: Acetabular Labral Tears Are Common in Asymptomatic Contralateral Hips With Femoroacetabular Impingement

“…The shift to personalized medicine, which involves decision-making based on the unique characteristics of each specific patient, is the next step in improving results of our treatments. Several recent studies in the field of hip arthroscopy [8,10] have created predictive algorithms and models to predict patient-reported outcomes as well as the risk of hip preservation failure. We recently published a model based on pre and intraoperative findings to predict risk of conversion of an arthroscopic labral repair to a THA [8].…”