Development of the HOOS_global to Assess Patient-Reported Outcomes in Patients Undergoing Hip Preservation Procedures

Background: The creation of a single patient-reported outcome (PRO) platform validated across hip preservation, osteoarthritis (OA), and total hip arthroplasty (THA) populations may reduce barriers and streamline the routine collection of PROs in clinical practice. As such, the purpose of this study was to determine if augmenting the Hip disability and Osteoarthritis Outcome Score–Joint Replacement (HOOS, JR) with additional HOOS questions would result in a PRO platform that could be used across a wider spectrum of hip patient populations. Hypothesis: The HOOS, JR would demonstrate a notable ceiling effect, but by augmenting the HOOS, JR with additional HOOS questions, a responsive PRO platform could be created. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Using preoperative and postoperative HOOS responses from a sample of 304 patients undergoing periacetabular osteotomy (PAO), additional items were identified to augment the HOOS, JR. The psychometric properties of a newly created PRO tool (HOOS_global) were then compared with the HOOS, JR and other PRO instruments developed for patients with hip OA and/or undergoing THA. Results: By augmenting the HOOS, JR with 2 additional questions, the HOOS_global was more responsive than all other included PRO tools and had significantly fewer maximum postoperative scores than the HOOS, JR (P <.0001), HOOS–Physical Function Short form (P <.0001), Western Ontario and McMaster Universities Osteoarthritis Index (P =.02), University of California, Los Angeles activity scale (P =.0002), and modified Harris Hip Score (P =.04). The postoperative HOOS_global score threshold associated with patients achieving the patient acceptable symptom state (PASS) was 62.5. Conclusion: The HOOS_global is a valid and responsive PRO tool after PAO and may potentially provide the orthopaedic community with a PRO platform to be used across hip-related subspecialties. For patients undergoing PAO, a postoperative HOOS_global score ≥62.5 was associated with patients achieving the PASS.