Now select the "mild pain" answer. This one corresponds to having moderate levels of pain for non-average/daily activities. You may still be taking aspirin as a gentle pain killer to function. Now scroll down and look at your score. You have just earned 20 points. Would still having pain and needing to take pain killers be considered a success for you?
You could also select "none or ignores it" as your answer and see your score jump to a total of 44 points! Imagine if at follow up your doctor asks you, "how is the pain?" and you say, "Well, it's still there, still annoying, but I can ignore it and move on with my life." You just earned top marks and the surgery would be a smashing success.
Now reset your questionnaire and look at the section on "limp." Select "severe" and look at your score. You should see a zero. Then select "slight." Scroll down. You just earned 3 points.
So let's say you go from marked pain with a severe limp down to mild pain with a slight limp. Is that a success to you? It's an improvement of 23 points; the surgery is considered an absolute unquestioned
success based on the Harris Hip Score.
So let's say you go from marked pain with a severe limp down to mild pain with a slight limp. Is that a success to you? It's an improvement of 23 points; the surgery is considered an absolute unquestioned success based on the Harris Hip Score.
The reality in this study is that the improvement in quality of life did not need to be very pronounced for the surgery to be considered a success.
You have to ask yourself whether this level of "improvement" is (1) worth the expense and time and (2) whether this kind of improvement supports or undermines the idea that surgery is actually addressing the root cause of the problem.
How can you measure success of FAI surgery better? Patient expectations versus outcomes...
If metrics like the Harris Hip Score don't accurately reflect the expectations and desires of patients, the easiest way to get patients' opinions is to find out about their satisfaction.
Another study done in 2012 called Fulfilment of patient-rated expectations predicts the outcome of surgery for femoroacetabular impingement looked at 86 patients' experience with surgery to fix their FAI. They studied the patient motivations and expectations for surgery to see how motivations and expectations affected the patients' outcomes.
In this study, the patients had very common, familiar motivations for surgery.
The top most important reason to get surgery was to alleviate pain. The second and third were preventing worsening of the situation and improvement in physical capabilities respectively.
57% of the patients expected their hip pain would get "much better" and that a further 40% expected it to be "better" post-surgery. 46% expected their ability to do sport to be "much better," and 37% expected it to be "better."
These are pretty normal expectations. People want to get their lives back! They want to get back to activities they love without hip pain.
Does surgery for FAI get you back to your activities?
In the study mentioned above, the results were not good after 12 months. Patients were asked whether their expectations were met by the surgery. As you can see in the graph to the left, there was a lot of disappointment.
56% of patients did not have their expectations met for hip pain. 61% were disappointed by the improvement in sport. 53% were disappointed in terms of general function. 33-45% were disappointed in terms of independence, mental well-being, and walking capacity.
For those who are interested in returning to their sports, the numbers are very disconcerting. 61% of the patients did NOT have their expectations met in terms of sport.
Even general function failed to deliver for 53% of the patients! That means more than half were disappointed in the outcome in terms of general daily life.
How did patients rate the overall effectiveness of surgery?
29% believed it helped a lot. We can say these people were probably pretty satisfied. But what about the others?
39% thought it helped some. That means the surgery didn't actually solve all their issues.
21% said it helped only a little. For 1 out of 5 patients in this study, this would probably not be considered successful (though it's debatable).
9% said it did not help at all. This is definitely not a good outcome.
2% reported that it made things worse. This would be the worst outcome of all.
To reiterate, only 29% though the surgery was a big help. 71% thought it was somewhat of a help down to the worst-case scenario of the surgery making things worse. More than half were disappointed by their improvement in daily function and sports.
Those are not stellar results.
Do recent studies show that patients are satisfied with surgery for FAI?
A study published in 2016, Multicenter outcomes of arthroscopic surgery for femoroacetabular impingement in the community hospital setting, looked at patient satisfaction after 2 years.
At the 2 year mark, only 64% of patients were satisfied. The study concludes that "arthroscopic surgery for symptomatic femoroacetabular impingement in the community setting provides safe and successful outcomes."
If you only read the conclusion, you might think the study really strongly supports the use of surgery for FAI. But let's put the results into perspective.
36% of the patients were not satisfied. That's roughly one out of every three people in that study not satisfied with the surgery.
It's also interesting to realize that being "satisfied" may not mean the surgery actually improved the patient's quality of life. Dr. David Hanscom, MD., a spinal surgeon, shares a very interesting statistic in his book on the perils of spine surgery that is relevant. In one study, 16% of patients who had poor results from surgery said they would choose to do the surgery again.
While the surgery may not even improve the situation, people can still be "satisfied" that they tried the only option that was presented to them.
This is very likely to be influencing hip surgery satisfaction rates as well.