HISTORY OF HipSTR

The human hip joint is complex joint that bears great loads, yet has to be mobile - in fact it is one of the most mobile joints in the human body. However, the hip joint is deep, surrounded by muscles and other tissues, making it difficult to examine, and thus, hard to identify specific causes of pain or injury. But recent advances, including MRI and hip arthroscopy, have increased our interest in the hip, expanding our knowledge about hip function and injury, particularly problems of the hip that are not related to hip arthritis.

Many orthopedic conditions affecting the hip joint, however, often require surgery as the primary intervention. These procedures are becoming more common in patients suffering from chronic hip pain. Although individual research continues in surgical hip outcomes, unlike other orthopedic procedures, there is not a consensus on which procedures provides the best long-term patient outcomes. This may result in patients requiring multiple operations in the future.

In 2006, an international group (mostly based in the USA) came to study hip arthroscopy and evaluate how our patients were doing. The first task was to have a common measurement instrument, a patient reported outcomes score, that was designed to assess a patient’s ability to return to an active lifestyle through their symptoms, as well as emotional and social health status in individuals without hip arthritis. This was achieved by the group designing, testing and publishing the iHOT (International Hip Outcomes Tool). Interestingly, a group in Denmark set out to do the same thing, resulting in another outcomes measure, confirming the need for a patient generated measurement of how one’s hip is doing.

In 2012, The British Hip Society created a Non-Arthroplasty Hip Registry (NAHR) to improve the quality of hip surgery in the United Kingdom, while the same year, the Danish Hip Arthroscopy Registry (DHAR) was also begun. The era of registries for hip arthroscopy started, as they had been in existence, and shown to be beneficial to guide treatment and identify bad products, for hip and knee replacements, and have been used with other surgeries such as ACL Reconstruction. In 2018, at the Annual Congress of the International Society of Hip Arthroscopy and Preservation in Melbourne, Australia, several North American members felt the US and North America were behind and needed to have their own registry, as more hip arthroscopies were performed in North America, than the rest of the world, combined.

The HipSTR (Hip Surgical Treatment Registry), developed over several years and released in 2022, is the first of its kind in North America or the United States. The goal is to capture all hip arthroscopies performed in North America, the region with the most hip arthroscopies in the world. HipSTR tracks both intra-operative data points as well as patient reported outcomes measures during recovery.

Surgical registries provide unique value for both orthopedic surgeons as well as their patients. HipSTR uses leading edge software and data analytics to provide its users actionable insight throughout the recovery process. Pre-operative factors, provided by patients, combined with an easy intra-operative recording platform when combined with patient reported outcomes (PROs) at various time points will allow for identification of risk factors and potential predictors of patient outcomes. Further, when aggregated, surgeons can evaluate how their patients are doing, individually, or group by different parameters, and be able to compare them to the national average. The built in statistical packages in our platform will allow surgeons to look closely at their patients’ outcomes, which will be important as CMS and insurance companies continue the path to value based reimbursement. Importantly, newer techniques and procedures can more easily be tracked and studied to determine success in a much quicker way using a registry. Thus, participating orthopedic surgeons can receive timely and relevant data and feedback based on what they are doing in the OR. HipSTR also provides patients of participating groups with curated outcomes data that are utilized at many different stages in the recovery process.

ANATOMY OF HipSTR

HipSTR was designed to leverage leading-edge medical technology and data analytics to provide clinicians with curated outcomes data on many different surgical conditions. Over 300 data points are currently implemented and collected by both clinicians and patients.

Participating clinicians use HipSTR to review comprehensive outcomes data for all their patients. HipSTR leverages the IHOT-12 and EQ-5D as outcome measures. Unique to our program, HipSTR-OR tracks important intra-operative data to provide surgeons important and actionable information. Providing clinicians and patients relevant recovery data, HipSTRs PROs are collected at multiple time points after surgery. Patients are informed of their progress that is benchmarked against national statistics.

Annual reports include aggregate prevalence statistics are provided to participating surgeons. Additionally, patients can follow their progress by viewing aggregate outcomes data through our innovative data platform.

HipSTR’s OUTCOME MEASURES

HipSTR utilizes two popular, validated outcome measures to track recovery after hip arthroscopy, the International Hip Outcome Tool (IHOT-12), and the EQ-5D, a popular quality of life measure. In addition, HipSTR introduces a unique intra-operative measure called HipSTR-OR. Designed to collect important data points during surgery, HipSTR-OR provides participating surgeons actionable data they can leverage immediately in their practice.

Using industry leading patient reported outcome (PRO) technology and state-of-the-art statistical tools, participating physicians track post-operative recovery progress at multiple time points after hip surgery. Below is a brief visualization.