Arthroscopy - 2026-09-22 - Journal Article
Ehlers-Danlos Patients Achieve High Satisfaction and Clinically Meaningful Outcomes After Combined Hip Arthroscopy and Periacetabular Osteotomy: A Comparative Study With Non-Ehlers-Danlos Syndrome Patients.
Kollmorgen R, Wilson H, Martin R, Young DJ, Shkoukani ZM, Zhang Y, Ellis T
Topics
Key Takeaway
EDS patients undergoing combined HA+PAO achieve >80% satisfaction at 2 years but only 43% reach absolute PROMIS-PF PASS at 1 year versus 78% of non-EDS controls.
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Summary
This study evaluated iHOT-12 and PROMIS outcomes after HA+PAO in EDS versus matched non-EDS hip dysplasia patients at tertiary preservation centers. Both cohorts exceeded 80% satisfaction at 1 and 2 years, and MCID achievement was comparable between groups. However, EDS patients showed substantially lower absolute PASS rates for PROMIS-PF (43% vs 78%) while paradoxically outperforming non-EDS patients on PROMIS-Depression PASS (87% vs 57.5%).
Key Limitation
EDS diagnosis was made by outside providers without standardized genetic or clinical subtyping, conflating hypermobile EDS (nongenetic, most common) with rarer genetic subtypes that carry fundamentally different tissue and healing biology.
Original Abstract
PURPOSE
To define clinically meaningful outcomes after hip arthroscopy (HA) with periacetabular osteotomy (PAO), HA + PAO in patients with Ehlers-Danlos syndrome (EDS) using the Patient-Reported Outcomes Measurement Information System (PROMIS) and International Hip Outcome Tool 12 (iHOT-12) and compare these with a non-EDS cohort.
METHODS
Prospectively collected data from patients undergoing HA + PAO between 2018 and 2023 at tertiary hip preservation centers with dedicated referral populations for EDS were retrospectively analyzed. Patients with hip dysplasia or instability and ≥2-year follow-up were included. All patients in the EDS cohort had been diagnosed by an outside provider with either a nongenetic or genetic subtype of EDS. The non-EDS group was constructed as a comparison cohort selected to approximate the EDS group. Outcome measures included iHOT-12 and PROMIS computer adaptive tests: Physical Function (PF), Global Physical Health, Global Mental Health, and Pain Interference. Minimal Clinically Important Difference, Patient Acceptable Symptom State (PASS), and Maximal Outcome Improvement were calculated for these measures.
RESULTS
The non-EDS cohort included 103 patients, and the EDS cohort included 26. The mean ± standard deviation age was 25.1 ± 4.2 and 28.7 ± 6.2 (P = .01) for the non-EDS and EDS groups, respectively. Both groups reported >80% satisfaction at 1 and 2 years. Minimal Clinically Important Difference values for the iHOT-12, PROMIS-PF, and PROMIS-Depression in the non-EDS cohort were 13.7, 4.4, and 4.4 at 1 year and 11.2, 3.5, and 4.6 at 2 years, respectively. Minimal Clinically Important Difference agreement analysis was comparable between groups. However, EDS patients showed lower absolute PASS and Maximal Outcome Improvement agreement, particularly for PROMIS-PF, with 43% of EDS patients achieving 1-year absolute PASS compared with 78% of non-EDS patients. PROMIS-Depression outcomes showed a higher absolute PASS agreement in EDS patients with 87% achieving this outcome compared with 57.5% in the non-EDS cohort.
CONCLUSIONS
Patients with EDS undergoing HA + PAO achieve significant improvements in function, pain, and mental health, as measured by iHOT-12, PROMIS-PF, and PROMIS-Pain Interference. Despite lower PROMIS-PF gains compared with non-EDS patients, satisfaction and clinically meaningful outcomes are comparable.
LEVEL OF EVIDENCE
Level III, comparative retrospective study.