Prediction of intra-articular pathology and arthroscopic outcomes for femoroacetabular impingement and labral tear based
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LETTER TO THE EDITOR
Prediction of intra‑articular pathology and arthroscopic outcomes for femoroacetabular impingement and labral tear based on the response to preoperative anaesthetic hip joint injections Mingjin Zhong1 · Kan Ouyang1 · Weimin Zhu1 Received: 29 April 2020 / Accepted: 5 September 2020 © Springer-Verlag France SAS, part of Springer Nature 2020
We had the opportunity to read the article by Chinzei et al. [1] and we did it with great interest, as the authors addressed a relevant question regarding whether the preoperative response to intra-articular injections is associated with intra-articular pathological findings and arthroscopy outcomes. The authors stated that the response to preoperative intra-articular injection may indicate the presence of intra-articular pathology and have predictive value to determine post-operative outcomes following hip arthroscopy for femoroacetabular impingement (FAI) and labral tear. We think this finding is of value for clinicians in decisionmaking. However, there are several concerns that need to be addressed. First, all patients were only assessed at the time of preoperation and 1-year after surgical intervention based on the modified Harris Hip Score (mHHS). However, the early clinical outcomes were not evaluated in this study. Although each operation was performed by the same surgeon, eliminating performance bias, the long-term clinical outcome for surgery is multifactorial. Hip arthroscopy for FAI yields significant improvements occurs within 3 months after surgery [2]. Therefore, in clinically, post-operative 3-month and 6-month time frame were usually chosen as a clinically relevant benchmark for both the clinicians and the patients because it were felt to be important frames of reference for decisions affecting a patient’s return to sports, work, or recreational activities [3, 2]. Second, as shown in Table 3 [1], mHHS revealed significant improvement in both good response and poor response * Mingjin Zhong [email protected] 1
Department of Orthopaedics and Sports Medicine, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People’s Hospital, 3002 Sungang West Road, Futian District, Shenzhen 518000, Guangdong province, China
groups compared with baseline scores. The good response group showed significantly better mHHS than the poor response group at the time of 1-year follow-up. Although, the statistically significant relation was identified, the minimum clinically important difference (MCID) and change in mHHS were not considered in this study. Previous studies have demonstrated that statistical significance of patientreported outcomes (PROs) improvement is not necessarily equivalent to clinical meaningfulness [4]. In the operative setting, MCID represents the smallest difference between pre- and postoperative PRO measurements that signifies an important improvement or worsening of symptoms. Nwachukwu et al. [4] found that patients who had higher preoperative PROs including mHHS and who underwent at least
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