Early MCID achievement is associated with better long-term outcomes following arthroscopy for femoroacetabular impingement

IF 5 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy Pub Date : 2025-05-19 DOI:10.1002/ksa.12695

Karen Mullins, David Filan, Patrick Carton

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引用次数: 0

Abstract

Purpose

To determine whether early improvement is associated with long-term outcomes following arthroscopy for femoroacetabular Impingement and establish a threshold above which would indicate sustained improvement. It was hypothesised that those who display improvements early would report better long-term outcomes than those who did not report meaningful change at 1 year, allowing further targeted intervention where necessary.

Methods

An examination of patients (Tonnis 0,1) undergoing primary arthroscopy between January 2009 and March 2014, with 10-year review, was conducted. Four hundred and fifteen hip arthroscopy cases in 355 patients were included. The minimal clinically important difference (MCID) for the modified Harris Hip score (mHHS) at 1 year was calculated using the percentage of possible improvement (POPI) method. Patients were grouped as early improvers (EI) or non-improvers (NI) based on whether they achieved MCID at 1 year or not. Survival, revision rate, and the patient acceptable symptom state (PASS) were compared between groups using a Kaplan–Meier curve and chi-squared analysis.

Results

One year MCID achievement required an improvement from pre-operative mHHS of at least 47%; 79% of cases achieved MCID (EI), and 21% did not (NI). At 10 years, there were six total hip replacements in the EI group compared to 16 in the NI group (survival 98% vs. 82%, p < 0.001). Revision rates were lower in the EI group (6% vs. 12%, p = 0.005), and the EI group had higher levels of PASS achievement (86% vs. 68%, p < 0.001). Regression models indicated that MCID achievement at 1 year, reduced the odds of replacement and revision surgery while increasing the odds of PASS achievement at 10 years.

Conclusion

Higher survival rates, higher PASS rates and lower revision procedures were observed in EI. When accounting for other known confounding factors, improving by a minimum of 47% of what a patient could achieve in the mHHS at 1 year predicts superior outcomes long-term. For those patients failing to achieve this important improvement threshold, clinicians could consider introducing additional rehabilitation or interventions that may further improve recovery and potentially increase the likelihood of a better longer-term outcome.

Level of Evidence

Level IV.

Abstract Image

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早期实现MCID与股骨髋臼撞击关节镜术后较好的长期预后相关。

目的：确定早期改善是否与股骨髋臼撞击关节镜术后的长期预后相关，并建立一个阈值，高于该阈值表明持续改善。假设那些早期表现出改善的人比那些在1年后没有表现出有意义的变化的人报告的长期结果更好，允许在必要时进一步有针对性的干预。方法：对2009年1月至2014年3月接受初级关节镜检查的患者（Tonnis 0,1）进行10年回顾。纳入355例患者的415例髋关节镜检查病例。使用可能改善百分比（POPI）法计算1年时改良Harris髋关节评分（mHHS）的最小临床重要差异（MCID）。根据患者在1年是否达到MCID，将患者分为早期改善者（EI）和非改善者（NI）。采用Kaplan-Meier曲线和卡方分析比较两组患者的生存率、改版率和患者可接受症状状态（PASS）。结果：实现一年的MCID需要比术前mHHS改善至少47%；79%的病例达到了MCID (EI)， 21%没有（NI）。10年时，EI组有6例全髋关节置换术，而NI组有16例(生存率98% vs 82%， p结论：EI组有更高的生存率、更高的通过率和更少的翻修手术。当考虑到其他已知的混杂因素时，患者在1年的mHHS中所能达到的至少47%的改善预示着长期的良好结果。对于那些未能达到这一重要改善阈值的患者，临床医生可以考虑引入额外的康复或干预措施，以进一步改善康复，并潜在地增加更好的长期结果的可能性。证据等级：四级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Knee Surgery, Sports Traumatology, Arthroscopy 医学-外科

CiteScore

8.10

自引率

18.40%

发文量

418

审稿时长

2 months

期刊介绍： Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Ranked among the top 33% of journals in both Orthopedics and Sports Sciences, the goal of this European journal is to publish papers about innovative knee surgery, sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication. The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. Although this is largely a clinical journal, it is also open to basic research with clinical relevance. Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards. Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).