Distinct recovery phenotypes after hip arthroscopy reveal dissociation between daily function and sports performance.
retrospective_cohort · Level III
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- Also identified by DOI 10.1177/11207000261464126.
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Abstract
Hip arthroscopy outcomes for femoroacetabular impingement remain heterogeneous. The Hip Outcome Score (HOS) comprises 2 distinct subscales measuring activities of daily living and sports performance, yet their dissociation after surgery remains poorly characterised. To identify distinct recovery phenotypes after hip arthroscopy using unsupervised machine learning and determine preoperative predictors of phenotype membership. We analysed 326 consecutive patients with complete 1-year HOS-ADL and HOS-Sports data. K-means clustering was performed on 5 outcome variables with Gaussian Mixture Model validation. Multinomial logistic regression identified preoperative predictors. 4 phenotypes emerged: Complete Responders (41.7%), ADL-Dominant Responders (27.3%), Slow Progressors (19.0%), and Non-Responders (12.0%). ADL-Dominant phenotype was predicted by age >40 years (OR 3.42, <i>p</i> < 0.001), Tegner <5 (OR 2.87, <i>p</i> = 0.001), and Outerbridge III-IV (OR 2.41, <i>p</i> = 0.005). 4 robust recovery phenotypes exist, with 27% demonstrating ADL-sports dissociation predicted by older age, lower activity, and greater chondral damage. Recognition enables personalised preoperative counselling.