International Hip Outcome Tool （ iHOT ） For Hip Preservation Surgery International Hip Outcome Tool （ iHOT ） For Hip Preservation Surgery Zhang Hong, M.D Joint Department 1st Affiliated Hospital of PLA General Hospital

 Mild hip pain after activity  Mild impairment on sports and working ability  Rarely limping and limited ROM Pre-op Symptoms for DDH Patients

 Decreased frequency and severity of hip pain  Reduced impact on sports and working ability  Reduced impact on physiology 、 psychology and social activity Post-op Symptoms for DDH Patients

Background  Mostly designed for fractures or THA  Ceiling effect  Limited evaluation effect for young and energetic patients Current problems for hip scoring system

Background WOMAC 、 Harris 、 Charnley scores  Emphasizing on everyday life activities  Lack of reflexion on improvement for sports and working ability  Lack of reflexion on severity of pain and its impact on patient’s psychological status SF-36 、 SF-12 scores  Impact on patient’s physiology and psychology  Complex Conversion method  No distinguishment on diseased areas Current problems for hip scoring system

Harris score Harris Hip Score  Pain score 44  Functional activity 14  Walking ability 33  Range of motion 9 Total 100

Harris score Relatively high pain scores for DDH patients indicated for hip preservation surgeries

Relatively high walking scores for DDH patients indicated for hip preservation surgeries Harris score

Relatively high functional scores for DDH patients indicated for hip preservation surgeries Harris score

Relatively normal ROM for DDH patients indicated for hip preservation surgeries without obvious deformity

Also relatively high score for DDH patients indicated for hip preservation surgeries Charnley score Charnley score – commonly used in Europe  Pain 6 points  Activity 6 points  Walking 6 points

VAS score VAS pain score Disadvantage  Items for pain only  Pain score ﹤ 3 points for all the early-stage DDH patients

Ceiling effect Ceiling effect Background =?

Examples for Ceiling effect Examples for Ceiling effect Pre Post Harris score 96 iHOT-12 score 65 Qu 33y F Wang 39y F Post Harris score 92 iHOT-12 score 52

iHOT-33 emerged Mohtadi introduced it in 2012 Designed for energetic patients without obvious pain, deformity, or limited ROM

iHOT Scoring System Last month status, indicate with a slash e.g. how often constantly never  Far left means feeling pain frequently  Far right means feeling pain rarely  Distance indicates ratioPatient

SECTION 1:SYMPTOMS AND FUNCTIONAL LIMITATIONS Question 1 to 16 ask symptoms in the hip Question 1 to 16 ask symptoms in the hip

SECTION 1:SYMPTOMS AND FUNCTIONAL LIMITATIONS

Question 17 to 22 ask about your hip when you participate in sports and recreational activities Question 17 to 22 ask about your hip when you participate in sports and recreational activities SECTION 2:SPORTS AND RECREATIONAL ACTIVITIES

Answer questions according to the past month SECTION 3:JOBS RELATED CONCERNS

Objective feelings over the past month SECTION 4:SOCIAL, EMOTIONAL AND LOFESTYLE CONCERNS

The form seems never-ending ……

With regard to importance, four of the iHOT-33 questions cover 99% of the dispersion !  Make regression analysis after considering balancing of the four parts  Add 8 indicators to the original 4 items

Griffin et al. published iHOT-12 in the same year iHOT-12

 Less controversial items  Precisely showing severity of the disease  Emphasizing on evaluation of everyday life, sports and impact on psychological activity  Single statistics comparison and one-on-one comparison  Same efficacy as iHOT-33  Avoiding Ceiling effect and Floor effect iHOT-12-- pros

 95.9% of latter’s confidence interval  More suitable for the first post-op follow-up  Lack of minimum clinical difference （ Minimal Clinically Important Difference. MCID ） iHOT-12-- cons iHOT-12 VS iHOT-33

 Mild pre-op symptoms  High level of sports and working activity  Young patients with abundant social activities iHOT-12-- application Scope of application Evaluation and comparison for hip preservation surgery

Paper and Online version of iHOT-12 that we use

24 cases of PAO self comparison—pre-op VS post-op scores(n=24 ， x±SD) WOMACHarrisiHOT-12 Pre-op score 17.29± ± ±23.57 Post-op score 12.54± ± ±20.40 T value P value （ Bilateral ） Our results Improved post-op scores with significant difference

148 cases of hip surgeries—pre-op, post-op group comparison(n=148 ， x±SD) WOMACHarrisiHOT-12 pre-op （ n=87 ） 14.70± ± ±21.15 post-op （ n=61 ） 13.19± ± ±20.49 F value P value Our results WOMAC 、 Harris score can’t show functional improvement after PAO, while iHOT-12 can

Thanks