Hip Preservation Appropriateness Guidelines May Be Limited

The American Academy of Orthopaedic Surgeons (AAOS) hip preservation surgery appropriateness classification system is driven almost entirely by age and radiographic hip osteoarthritis (OA) evaluation, according to a study published online Jan. 24 in Arthritis Care & Research.

Daniel L. Riddle, P.T., Ph.D., and Robert A. Perera, Ph.D., both from Virginia Commonwealth University in Richmond, evaluated the contribution of each of the variables used to predict the appropriateness of hip preservation surgery in the recently published AAOS hip preservation surgery appropriateness classification system.

The researchers found that patient age and radiographic hip OA evaluation were the main indications of appropriateness classification (e.g., odds ratio for age <40 years was >999.99, with age >65 years as the referent group, for "Appropriate/May be Appropriate" versus "Rarely Appropriate" vignettes). There was no meaningful contribution to final classification for hip range of motion, risk for negative outcome, and function-limiting pain.

"Patient age and radiographic osteoarthritis severity variables dominated prediction of hip preservation appropriateness and given the rudimentary nature of these variables for such a complex clinical syndrome, there appears to be substantial limitations associated with the AAOS hip preservation appropriateness system," the authors write.

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