Predicting minimal clinically important difference after hip arthroscopy: logistic regression versus machine learning

Clinical Snapshot

Key Findings

• P Value: p < 0.001 for both significant predictors

• Effect Size: 68.7% achieved MCID; Lower preoperative HOS-ADL (OR 0.911) and lower BMI (OR 0.846) predicted success

• Primary Outcome: Achievement of MCID (≥9-point improvement in HOS-ADL)

• Nnt Or Sensitivity: AUC 0.819 on external validation with 81.4% accuracy

• Confidence Interval: HOS-ADL OR 95% CI 0.883-0.940; BMI OR 95% CI 0.771-0.928

Clinical Application

Highly feasible - uses routine preoperative variables available in standard clinical assessment Relevant to Australian orthopaedic practice. Hip arthroscopy increasingly performed in private sector. Model could inform patient counselling and Medicare item number justification for complex cases Patients with FAI considering hip arthroscopy, particularly those with higher preoperative functional scores and elevated BMI

Abstract

PURPOSE: Hip arthroscopy outcomes for femoroacetabular impingement (FAI) remain heterogeneous, with 30-40% of patients failing to achieve meaningful improvement. We aimed to develop and validate a predictive model for achievement of minimal clinically important difference (MCID) using routine preoperative variables, and to compare logistic regression with machine learning algorithms. METHODS: We retrospectively analyzed 310 consecutive patients undergoing hip arthroscopy for FAI (2010-2024) at a single institution. Predictor variables included age, sex, body mass index (BMI), morphological etiology, preoperative pain (VAS), and Hip Outcome Score-Activities of Daily Living (HOS-ADL). The outcome was achievement of MCID (≥ 9-point improvement in HOS-ADL). We developed logistic regression, random forest, and gradient boosting models. Internal validation used 10-fold stratified cross-validation. Temporal external validation used 80% of patients for training and 20% for testing. RESULTS: Mean age was 39.7 ± 12.0 years; 59.7% were male. MCID was achieved by 213 patients (68.7%). Lower preoperative HOS-ADL (OR 0.911, 95% CI 0.883-0.940, p < 0.001) and lower BMI (OR 0.846, 95% CI 0.771-0.928, p < 0.001) independently predicted MCID achievement. Logistic regression achieved AUC 0.804 (95% CI 0.76-0.85) on internal validation and AUC 0.819 on temporal external validation (accuracy 81.4%). Logistic regression outperformed random forest (AUC 0.787) and gradient boosting (AUC 0.777). Calibration was excellent. CONCLUSION: A parsimonious logistic regression model using routine preoperative variables demonstrated excellent and externally validated discriminative ability for predicting MCID after hip arthroscopy. The model outperformed machine learning algorithms while maintaining superior interpretability. The developed nomogram provides a practical tool for individualized outcome prediction.

References

1. 1.Vázquez-Gómez, M., Seijas-Vázquez, R., Laiz-Boada, P., Ferré-Aniorte, A., Escutia-Marí, L., Alvarez-Diaz, P., & Cugat-Bartomeu, R. (2026). Predicting minimal clinically important difference after hip arthroscopy: logistic regression versus machine learning. European Journal of Orthopaedic Surgery & Traumatology. https://doi.org/10.1177/0272989X06295361