EP8.3 Comparing Minimal Clinically Important Difference Thresholds Calculated using Distribution-Based or Anchor-Based Estimations: A Systematic Review and Meta-Analysis

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ID: 331345
2026
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Abstract
Abstract Introduction In the orthopedic literature, the minimal clinically important difference (MCID) is a common threshold used to estimate the smallest change in a patient-reported outcome measure (PROM) that a patient would perceive as an improvement after treatment. However, thresholds in hip arthroscopy can vary widely and are calculated in two ways: distribution- or anchor-based methods. The purpose of this study was to review the existing literature and compare MCID thresholds calculated by these different methods. Methods PubMed, Scopus, and Embase were queried in April 2025 for studies that calculated MCID values for the modified Harris Hip Score (mHHS) and the Visual Analog Pain Score (VAS). Inclusion criteria included patients who underwent hip arthroscopy for the treatment of femoroacetabular impingement. Studies were excluded if they did not calculate their own MCID value. Anchor-based thresholds were defined as approaches that used an external anchoring question about postoperative changes and then calculated the average improvement at which patients reported a benefit. Distribution-based thresholds were calculated from half of the standard deviation of either the preoperative PROM score (Preop) or the change in PROM scores (Delta). Results Of the 609 unique studies identified in our search, 13 studies (5547 hips) were included. Both Delta and Preop distribution-based methods produced similar thresholds for mHHS at 1-year follow-up (7.70 [6.77-8.62], P=0.856). At 2-year follow-up, distribution-based estimates of MCID for mHHS (7.28 [6.84-7.72], P=0.924) and VAS (1.14 [1.06-1.23], P=0.992) were similar. The only anchor-based thresholds reported were 4.2, 16.0, and 5.3 for 1-year mHHS, 2-year mHHS, and 2-year VAS, respectively. Therefore, anchor-based thresholds were underpowered for intragroup comparisons. However, when performing intergroup comparisons, anchor-based thresholds were always outside the pooled 95% confidence interval of distribution-based thresholds. Furthermore, even within the same study sample, distribution-based methods always yielded different MCID thresholds than the corresponding anchor-based approaches. Conclusion Anchor-based MCID methods yielded different thresholds than distribution-based methods. This trend was evident across both time points, PROM scales, and within the same study population. Therefore, these methods do not produce equal MCID thresholds for hip arthroscopy and should not be considered interchangeable.
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Authors Brandon Allen, Jackson Woodrow, Maya Dubrovsky, Rachel Poutre, Rishi Earla, Jeffrey S. Mun, Stephen Gillinov, Bilal S. Siddiq, Nathan J. Cherian, Aidan Crawford, Adarsh Aratikatla, Scott David Martin, Solomon Williams
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Journal Journal of hip preservation surgery
Year 2026
DOI
10.1093/jhps/hnag043.385
URL
https://doi.org/10.1093/jhps/hnag043.385
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