Decision-making in borderline hip dysplasia and concomitant femoracetabular impingement syndrome: using a discrete choice experiment to explore patient preferences.
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2024-07
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Decision-making regarding surgical treatment of patients showing radiographic evidence of femoroacetabular impingement syndrome (FAIS) in the setting of borderline hip dysplasia (BHD) remains a challenge as there is no consensus on treatment in current literature. When medical evidence is unclear, understanding patient preferences becomes particularly important in deciding the optimal treatment for each patient. The purpose of this study was to measure the patient-determined importance of factors surrounding surgical treatment of FAIS in BHD. Patients aged 18-65 with hip pain and BHD (defined as lateral center edge angle 18-25 or Tonnis angle 10-15) morphology were given a discrete-choice experiment (DCE) focusing on attributes that differ between treatment options: Length of Hospital Stay, Major Complication Rate, Chance of Needing Reoperation within 2 Years and Time to Return to Regular Exercise. This DCE was used to calculate treatment preferences, relative attribute importance and preference weights. A total of 101 patients fully completed the DCE. The most important attribute (average importance weight, 95% CI) was Chance of Reoperation (60.16, 56.99-63.34), while the least important was Hospital Stay (6.57, 5.73-7.41). Only 6 Months to Resume Regular Exercise and 2% Chance of Reoperation (P < 0.05) significantly impacted treatment choice. When presented with fixed choice parameters, 50.5% of subjects preferred PAO and arthroscopy while 49.5% opted for arthroscopy alone. When no clear surgical treatment is indicated, patient preferences have an amplified role in patient decision-making. Our results confirm variation in attribute importance within treatments as well as treatment choice, highlighting the importance in understanding patient preferences in decision-making for FAIS in BHD. More patient-specific generalizable outcomes of surgical treatment options are needed in the literature.
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Cabell, Grant H, Nicholas F Kwon, Christopher Shultz, Carolyn A Hutyra, Brian D Lewis, Steven A Olson, Michael J Salata, Shane J Nho, et al. (2024). Decision-making in borderline hip dysplasia and concomitant femoracetabular impingement syndrome: using a discrete choice experiment to explore patient preferences. Journal of hip preservation surgery, 11(3). pp. 167–175. 10.1093/jhps/hnae002 Retrieved from https://hdl.handle.net/10161/34846.
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Brian David Lewis
I am an assistant professor in the department of orthopaedics. My sub-specialty interest is in hip surgery including arthroplasty and non-arthoplasty hip surgery. This includes the treatment of osteoarthritis, hip dysplasia, hip impingement, labral tears, as well as various tendon disorders around the hip.
The research interests include outcomes research for hip surgeries, hip movement disorders related to hip conditions, and factors influencing opioid use in post-surgical patients.
Steven Arthur Olson
As an Orthopedic Surgeon my primary focus of research is joint preservation. My primary clinical interests are Orthopedic Trauma and Hip Reconstruction.
In Orthopedic Trauma my research interests are 1) Basic science investigations of articular fractures with two current animal models in use. 2) Clinical research includes evaluation of techniques to reduce and stabilize articular fractures, as well as management of open fractures.
In the area of Hip Reconstruction my areas of research are 1) Hip Arthroscopy and treatment of hip disorders, and treatment of labral tears in the treatment of hip pain. 2) Periacetabular osteotomy for the treatment of hip dysplasia.
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