Is There an Association Between Preoperative Expectations and Patient-Reported Outcome After Hip Arthroscopy for Femoroacetabular Impingement Syndrome?

Purpose: To determine the relationship between preoperative patient expectation and postoperative satisfaction and overall patient-reported outcome (PRO) of patients undergoing hip arthroscopy for femoroacetabular impingement syndrome. Methods: Patients who underwent hip arthroscopy for femoroacetabular impingement syndrome completed the validated Hip Preservation Surgery Expectations Survey (21 questions; 0-100 range), as well as multiple PROs before surgery. High expectation was defined as an expectation score greater than 1 standard deviation above the mean. Patients with osteoarthritis, dysplasia, and those having undergone previous hip surgery were excluded. At 1 year postoperatively, patient visual analog scale (VAS) satisfaction, VAS pain, and PROs were assessed. Univariable and multivariate analyses were performed. Results: One-hundred fifty-three subjects (mean age 34.4 ± 12.6 years, female: 114 [71.3%], body mass index: 25.9 ± 5.3 kg/m²) participated. The mean expectation score was 84.5 ± 12.3. Significant correlations between high expectation scores (>96.7) and achieving the minimal clinical important difference (MCID) for modified Harris Hip Score (mHHS; r = 0.339; P = .043) and patient acceptable symptomatic state (PASS) for Hip Outcome Score-Activities of Daily Living Subscale (HOS-ADL; r = 0.207; P = .032) were observed. There were no significant correlations between high expectation scores and preoperative or postoperative PROs or patient satisfaction scores. χ² analysis demonstrated patients with greater expectations had increased rates of reaching MCID mHHS (92.3% vs 74.7%; P = .08), PASS mHHS (85.7% vs 69.7%; P = .046), and PASS HOS-ADL (93.8% vs 67.4%; P = .031). Conclusions: High preoperative expectation is associated with increased rates of MCID/PASS achievement on mHHS and increased rate of PASS achievement on HOS-ADL. Preoperative expectations did not have an impact on Hip Outcome Score-Sports Subscale; however, patients with high preoperative expectations also have a high baseline Hip Outcome Score-Sports Subscale. In addition, preoperative expectations are not associated with postoperative VAS satisfaction scores. Level of Evidence: III; non-randomized cohort, therapeutic.