Association of Preoperative Walking Speed With 1-Year Outcomes After Hip Arthroscopy for Femoroacetabular Impingement Syndrome

Abstract

Background:

Previous studies have identified demographic, radiographic, and intraoperative predictors of outcomes after hip arthroscopy for femoroacetabular impingement syndrome, yet few studies have identified whether preoperative gait metrics can predict outcomes.

Hypothesis:

Increased preoperative step count, walking speed, step length, and gait symmetry will be associated with better outcomes after surgery.

Study Design:

Retrospective cohort study.

Level of Evidence:

Level 4.

Methods:

Patients who underwent hip arthroscopy between 2019 and 2022 and downloaded the smartphone app rHip, allowing for retroactive access of gait metric data, were identified. Preoperative gait metrics, age, sex, body mass index (BMI), and exercise participation were analyzed via multivariate stepwise linear regression for a relationship with 1-year postoperative patient-reported outcomes (PROs), including Hip Outcome Scale-Activities of Daily Living (HOS-ADL); HOS-Sports Subscale (HOS-SS), and 12-item international Hip Outcome Tool (iHOT-12). Thresholds for preoperative gait metrics were analyzed via receiver operator characteristic curve. A subgroup analysis was performed to compare those who did and did not reach this threshold.

Results:

A total of 43 patients (86% female; age, 33.1 ± 13.7 years; BMI, 23.9 ± 4.4 kg/m²) met inclusion criteria. Multivariate regression found that preoperative walking speed was significantly associated with postoperative HOS-ADL, HOS-SS, and iHOT-12 (P ≤ .01). A preoperative walking speed threshold of 1.065 m/s was predictive of outcome achievement. Those who failed to achieve this threshold were significantly older, of greater BMI, and less active (P ≤ .04). They also showed significantly worse 1-year postoperative scores (P ≤ .02) and lower PASS achievement for HOS-ADL, HOS-SS, and iHOT-12 (P ≤ .04).

Conclusion:

Preoperative walking speed is significantly associated with 1-year outcomes after hip arthroscopy. Patients who averaged <1.065 m/s show significantly worse outcomes after surgery.

Clinical Relevance:

Assessment of preoperative walking speed may allow physicians to better counsel patients regarding expected outcomes after hip arthroscopy.

Keywords

FAIS gait metrics hip arthroscopy

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References

Akpinar

Vasavada

Rynecki

Owusu-Sarpong

Youm

Hip spine syndrome negatively impacts arthroscopic outcomes in the management of femoroacetabular impingement syndrome: a systematic review. Arthroscopy. 2023;39(6):1552-1564.

Alasfour

Almarwani

The effect of innovative smartphone application on adherence to a home-based exercise programs for female older adults with knee osteoarthritis in Saudi Arabia: a randomized controlled trial. Disabil Rehabil. 2022;44(11):2420-2427.

Basques

Waterman

Ukwuani

, et al. Preoperative symptom duration is associated with outcomes after hip arthroscopy. Am J Sports Med. 2019;47(1):131-137.

Bernstein

Nwachukwu

Bozic

KJ.

Value-based health care: moving beyond “minimum clinically important difference” to a tiered system of evaluating successful clinical outcomes. Clin Orthop Relat Res. 2019;477(5):945-947.

Bodendorfer

DeFroda

Clapp

Newhouse

Nwachukwu

Nho

SJ.

Defining clinically significant improvement on the patient-reported outcomes measurement information system test at 1-year follow-up for patients undergoing hip arthroscopy for the treatment of femoroacetabular impingement syndrome. Am J Sports Med. 2021;49(9):2457-2465.

Bohannon

Wang

YC.

Four-meter gait speed: normative values and reliability determined for adults participating in the NIH toolbox study. Arch Phys Med Rehabil. 2019;100(3):509-513.

Clapp

Nwachukwu

Beck

Jan

Gowd

Nho

SJ.

Comparing outcomes of competitive athletes versus nonathletes undergoing hip arthroscopy for treatment of femoroacetabular impingement syndrome. Am J Sports Med. 2020;48(1):159-166.

Cvetanovich

Farkas

Beck

, et al. Squat and gait biomechanics 6 months following hip arthroscopy for femoroacetabular impingement syndrome. J Hip Preserv Surg. 2020;7(1):27-37.

Fenn

Horner

Ingawa

Hevesi

Beals

Nho

SJ.

High-level competitive athletes who undergo hip arthroscopy demonstrate durable 5-year outcomes and lower subjective pain: a propensity-matched analysis. Sports Health. 2024;16(4):606-615.

10.

Hamid

Nwachukwu

Bozic

KJ.

Decisions and incisions: a value-driven practice framework for academic surgeons. J Bone Joint Surg Am. 2017;99(10):e50.

11.

Hung

Baumhauer

Licari

Voss

Bounsanga

Saltzman

CL.

PROMIS and FAAM minimal clinically important differences in foot and ankle orthopedics. Foot Ankle Int. 2019;40(1):65-73.

12.

Kannan

Hartwell

Grace

, et al. Correlating biomechanical gait analysis with patient-reported outcomes after hip arthroscopy for femoroacetabular impingement syndrome. Orthop J Sports Med. 2022;10(9):23259671221121352.

13.

Kunze

Polce

Clapp

Alter

Nho

SJ.

Association between preoperative patient factors and clinically meaningful outcomes after hip arthroscopy for femoroacetabular impingement syndrome: a machine learning analysis. Am J Sports Med. 2022;50(3):746-756.

14.

Lubowitz

Brand

Rossi

MJ.

Our measure of medical research should be appreciable benefit to the patient. Arthroscopy. 2019;35(7):1943-1944.

15.

Major

Alford

Validity of the iPhone M7 motion co-processor as a pedometer for able-bodied ambulation. J Sports Sci. 2016;34(23):2160-2164.

16.

Mandrekar

JN.

Receiver operating characteristic curve in diagnostic test assessment. J Thorac Oncol. 2010;5(9):1315-1316.

17.

McBride

Morrissey

Molloy

GJ.

Patients’ experiences of using smartphone apps to support self-management and improve medication adherence in hypertension: qualitative study. JMIR Mhealth Uhealth. 2020;8(10):e17470.

18.

Middleton

Fritz

Lusardi

Walking speed: the functional vital sign. J Aging Phys Act. 2015;23(2):314-322.

19.

Nolan

Mitchell

Doyle-Baker

PK.

Validity of the Apple iPhone® /iPod Touch® as an accelerometer-based physical activity monitor: a proof-of-concept study. J Phys Act Health. 2014;11(4):759-769.

20.

Nwachukwu

Rasio

Beck

, et al. Patient-reported outcomes measurement information system physical function has a lower effect size and is less responsive than legacy hip specific patient reported outcome measures following arthroscopic hip surgery. Arthroscopy. 2020;36(12):2992-2997.

21.

Perera

Patel

Rosano

, et al. Gait speed predicts incident disability: a pooled analysis. J Gerontol A Biol Sci Med Sci. 2016;71(1):63-71.

22.

Perets

Rybalko

Chaharbakhshi

Chen

Domb

BG.

Minimum five-year outcomes of hip arthroscopy for the treatment of femoroacetabular impingement and labral tears in patients with obesity: a match-controlled study.J Bone Joint Surg Am. 2018;100(11):965-973.

23.

Porter

ME.

What is value in health care?

N Engl J Med. 2010;363(26):2477-2481.

24.

Rossi

Brand

Lubowitz

JH.

Minimally clinically important difference (MCID) is a low bar. Arthroscopy. 2023;39(2):139-141.

25.

Shankar

Lan

Buzin

Youm

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. Arthroscopy. 2023;39(7):1630-1638.

26.

Sprau

Basil

Borowsky

Yoon

Wang

MY.

Patient participation with a mobile phone application for objective activity assessment before and after spinal fusion. Cureus. 2020;12(9):e10326.

27.

Studenski

Perera

Patel

, et al. Gait speed and survival in older adults. JAMA. 2011;305(1):50-58.

28.

Tabue-Teguo

Perès

Simo

, et al. Gait speed and body mass index: results from the AMI study. PLoS ONE. 2020;15(3):e0229979.

29.

Zhu

DeFroda

Browning

Clapp

Alter

Nho

SJ.

Collection of the International Hip Outcome Tool-12 using a smartphone application format is faster and preferred when compared with the paper version: a pilot study of rHip. ASMAR. 2021;3(5):e1401-e1405.