Predictors and rate of satisfactory response to nonoperative management for nonarthritic hip-related pain.
Academic Article
Overview
abstract
BACKGROUND: Although surgery provides symptomatic relief for many patients with nonarthritic hip-related pain, not all patients are ideal surgical candidates, are interested in pursuing surgery, or require surgery for symptomatic relief. Nevertheless, evidence is limited regarding patients' satisfaction with nonoperative management. OBJECTIVE: To identify the rate of satisfactory response to nonoperative management for nonarthritic hip-related pain at 12-month follow-up. A secondary purpose was to identify possible predictors of response to nonoperative management. DESIGN: Pragmatic, prospective cohort study. SETTING: Two U.S. tertiary medical centers. PATIENTS: Participants ranging in age from 15-40 years who were diagnosed by a surgical or nonsurgical orthopedic clinician with nonarthritic hip-related pain and were advised to initiate nonoperative management. INTERVENTIONS: Participants received brief instruction on movement pattern related activity modifications for hip-related pain. They otherwise followed the standard care treatment plan recommended by their treating clinician. MAIN OUTCOME MEASUREMENTS: The proportion of patients at 12-month follow-up who endorsed both (1) not having scheduled or undergone hip surgery and (2) answering "Yes" to "Taking into account all the activities you have during your daily life, your level of pain, and also your functional impairment, do you consider that your current state is satisfactory?" RESULTS: Among 88 patients (mean [SD] age 27 [8] years, 71 [81%] female), 59% (95% confidence interval [CI] 48%-70%) (n = 45/76) who completed follow-up reported satisfactory symptom response with nonoperative management at 12-month follow-up. Predictors of not achieving a satisfactory response included worse baseline symptom severity (odds ratio [OR] 1.04 per International Hip Outcome Tool-12 point [95% CI 1.01-1.07], p = .023) and a preference at baseline for procedural treatment such as injection or surgery (OR 0.13 [95% CI 0.04-0.46], p = .001). CONCLUSIONS: In a pragmatic analysis of patients presenting for tertiary orthopedic care, 59% of patients with nonarthritic hip-related pain were satisfied with their response to nonoperative management at 12-month follow-up. This information can be shared with patients to facilitate informed decision making. STUDY REGISTRATION: ClinicalTrials.gov, NCT04069507.
