TY - JOUR
T1 - Class I Obesity Delays Achievement of Patient-Acceptable Symptom State but Not Minimum Clinically Important Difference or Substantial Clinical Benefit After Primary Hip Arthroscopy for Femoroacetabular Impingement Syndrome
AU - Shankar, Dhruv S.
AU - Bi, Andrew S.
AU - Lan, Rae
AU - Buzin, Scott
AU - Youm, Thomas
N1 - Publisher Copyright:
© 2023 Arthroscopy Association of North America
PY - 2023/7
Y1 - 2023/7
N2 - Purpose: To identify differences in the time taken to achieve the minimum clinically important difference (MCID), substantial clinical benefit (SCB), and patient-acceptable symptom state (PASS) following primary hip arthroscopy for the treatment of femoroacetabular impingement syndrome (FAIS) among patients of different body mass index (BMI) categories. Methods: We conducted a retrospective comparative study of hip arthroscopy patients with minimum 2-year follow-up. BMI categories were defined as normal (18.5 ≤ BMI < 25.0), overweight (25.0 ≤ BMI <30.0), or class I obese (30.0≤BMI<35.0). All subjects completed the modified Harris Hip Score (mHHS) prior to surgery and at 6 months, 1 year, and 2 years postoperative. MCID and SCB cutoffs were defined as pre-to-postoperative increases in mHHS by ≥8.2 and ≥19.8, respectively. PASS cutoff was set at postoperative mHHS ≥74. Time to achievement of each milestone was compared using the interval-censored EMICM algorithm. The effect of BMI was adjusted for age and sex using an interval-censored proportional hazards model. Results: 285 patients were included in the analysis: 150 (52.6%) normal BMI, 99 (34.7%) overweight, and 36 (12.6%) obese. Obese patients had lower mHHS at baseline (P =.006) and at 2-year follow-up (P =.008). There were no significant intergroup differences in time to achievement for MCID (P =.92) or SCB (P =.69), but obese patients had longer time to PASS than normal BMI patients (P =.047). Multivariable analysis found obesity to be predictive of longer time to PASS (HR =.55; P =.007) but not MCID (HR = 0.91; P =.68) or SCB (HR = 1.06; P =.30). Conclusions: Class I obesity is associated with delays in achieving a literature-defined PASS threshold after primary hip arthroscopy for FAIS. Level of Evidence: Level III, retrospective comparative study.
AB - Purpose: To identify differences in the time taken to achieve the minimum clinically important difference (MCID), substantial clinical benefit (SCB), and patient-acceptable symptom state (PASS) following primary hip arthroscopy for the treatment of femoroacetabular impingement syndrome (FAIS) among patients of different body mass index (BMI) categories. Methods: We conducted a retrospective comparative study of hip arthroscopy patients with minimum 2-year follow-up. BMI categories were defined as normal (18.5 ≤ BMI < 25.0), overweight (25.0 ≤ BMI <30.0), or class I obese (30.0≤BMI<35.0). All subjects completed the modified Harris Hip Score (mHHS) prior to surgery and at 6 months, 1 year, and 2 years postoperative. MCID and SCB cutoffs were defined as pre-to-postoperative increases in mHHS by ≥8.2 and ≥19.8, respectively. PASS cutoff was set at postoperative mHHS ≥74. Time to achievement of each milestone was compared using the interval-censored EMICM algorithm. The effect of BMI was adjusted for age and sex using an interval-censored proportional hazards model. Results: 285 patients were included in the analysis: 150 (52.6%) normal BMI, 99 (34.7%) overweight, and 36 (12.6%) obese. Obese patients had lower mHHS at baseline (P =.006) and at 2-year follow-up (P =.008). There were no significant intergroup differences in time to achievement for MCID (P =.92) or SCB (P =.69), but obese patients had longer time to PASS than normal BMI patients (P =.047). Multivariable analysis found obesity to be predictive of longer time to PASS (HR =.55; P =.007) but not MCID (HR = 0.91; P =.68) or SCB (HR = 1.06; P =.30). Conclusions: Class I obesity is associated with delays in achieving a literature-defined PASS threshold after primary hip arthroscopy for FAIS. Level of Evidence: Level III, retrospective comparative study.
UR - https://www.scopus.com/pages/publications/85150287539
U2 - 10.1016/j.arthro.2023.01.106
DO - 10.1016/j.arthro.2023.01.106
M3 - Article
C2 - 36809817
AN - SCOPUS:85150287539
SN - 0749-8063
VL - 39
SP - 1630
EP - 1638
JO - Arthroscopy - Journal of Arthroscopic and Related Surgery
JF - Arthroscopy - Journal of Arthroscopic and Related Surgery
IS - 7
ER -