Walsh Elizabeth G, McCarroll Tyler R, Kuhns Benjamin D, Kahana-Rojkind Ady H, Quesada-Jimenez Roger, Domb Benjamin G
American Hip Institute Research Foundation, Chicago, Illinois, USA.
American Hip Institute, Chicago, Illinois, USA.
Am J Sports Med. 2025 Jul;53(9):2208-2216. doi: 10.1177/03635465251345823. Epub 2025 Jun 14.
Clinically relevant thresholds have been utilized to provide insight into postoperative functional status and patient satisfaction.
To define and evaluate the minimal clinically important difference (MCID), Patient Acceptable Symptom State (PASS), and substantial clinical benefit (SCB) thresholds over the 2-, 5-, and 10-year timepoints for the modified Harris Hip Score (mHHS), Hip Outcome Score-Sports-Specific Subscale (HOS-SSS), and International Hip Outcome Tool (iHOT12).
Case series; Level of evidence, 4.
Data were retrospectively reviewed for patients who underwent primary hip arthroscopy from 2008 to 2021. The inclusion criteria comprised complete patient-reported outcome scores with anchor questions at the 2-, 5-, or 10-year timepoints. Groups were propensity score-matched 1 to 1 to 1 for these 3 timepoints to limit confounding variables. The PASS, SCB, and MCID thresholds were defined using the anchor-based method for the mHHS, HOS-SSS, and iHOT12.
A total of 414 hips were included in the study. Area under the curve for all defined thresholds indicated acceptable to excellent discrimination. The thresholds for achieving the PASS, defined at the 2-, 5-, and 10-year respectively, were as follows: mHHS: 77.5, 85.5, and 78.5; HOS-SSS: 82.7, 76.4, and 67.7; and iHOT12: 67.4, 76.9, and 62.9. The percentage of patients achieving the PASS increased from 2 to 10 years, with the highest percentage at 10 years. The threshold for achieving the SCB was defined as follows: mHHS: 95, 99, and 88; HOS-SSS: 97, 80.9, and 90.5; and iHOT12: 89.4, 94.1, and 82.5. The percentage of patients achieving the SCB increased from 2 to 10 years. The mean changes required to achieve the MCID were defined as follows: mHHS: 7, 7.1, and 7.4; HOS-SSS: 10.6, 10.7, and 11.2; and iHOT12: (9.6, 9.7, -). The MCID and the percentage of patients achieving the MCID remained constant over 2 to 10 years.
Patients met the MCID, PASS, and SCB thresholds at high rates over 10 years. Based on the PASS and SCB thresholds, patient expectations for function evolved. Lower expectations at long-term follow-ups may result in a higher percentage of patients meeting certain thresholds, as evidenced in the mHHS, HOS-SSS, and iHOT12 in this cohort. Understanding the evolution of patient expectations may help interpret clinically relevant thresholds in future studies.
临床相关阈值已被用于深入了解术后功能状态和患者满意度。
定义并评估改良Harris髋关节评分（mHHS）、髋关节结局评分-运动特定子量表（HOS-SSS）和国际髋关节结局工具（iHOT12）在2年、5年和10年时间点的最小临床重要差异（MCID）、患者可接受症状状态（PASS）和显著临床获益（SCB）阈值。
病例系列；证据等级，4级。
对2008年至2021年接受初次髋关节镜检查的患者数据进行回顾性分析。纳入标准包括在2年、5年或10年时间点有完整的患者报告结局评分及锚定问题。在这3个时间点，将各组按倾向得分1:1:1进行匹配，以限制混杂变量。采用基于锚定的方法为mHHS、HOS-SSS和iHOT12定义PASS、SCB和MCID阈值。
本研究共纳入414个髋关节。所有定义阈值的曲线下面积显示出可接受至优秀的区分度。分别在2年、5年和10年定义的达到PASS的阈值如下：mHHS：77.5、85.5和78.5；HOS-SSS：82.7、76.4和67.7；iHOT12：67.4、76.9和62.9。达到PASS的患者百分比从2年到10年有所增加，10年时百分比最高。达到SCB的阈值定义如下：mHHS：95、99和88；HOS-SSS：97、80.9和90.5；iHOT12：89.4、94.1和82.5。达到SCB的患者百分比从2年到10年有所增加。达到MCID所需的平均变化定义如下：mHHS：7、7.1和7.4；HOS-SSS：10.6、10.7和11.2；iHOT12：（9.6、9.7、-）。MCID以及达到MCID的患者百分比在2年至10年期间保持不变。
在10年期间，患者达到MCID、PASS和SCB阈值的比例较高。基于PASS和SCB阈值，患者对功能的期望发生了变化。长期随访中较低的期望可能导致更高比例的患者达到某些阈值，本队列中的mHHS、HOS-SSS和iHOT12就证明了这一点。了解患者期望的演变可能有助于在未来研究中解释临床相关阈值。
