Improved Mental Health Status and Patient-Reported Outcomes After Hip Arthroscopy for Femoroacetabular Impingement

Abstract

Background:

Femoroacetabular impingement (FAI) is often a chronic problem, which can lead to a decrease in mental well-being.

Purpose/Hypothesis:

The purpose of this study was to determine patient mental health improvement after hip arthroscopy and if this improvement correlated with improved outcomes. It was hypothesized that patients with low mental health (LMH) status would improve after hip arthroscopy for FAI and that their patient-reported outcomes (PROs) would significantly improve after surgery.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

Patients who underwent hip arthroscopy with labral repair between 2008 and 2015 were included. The minimum follow-up was 2 years. PROs included the modified Harris Hip Score (mHHS), Hip Outcome Score–Activities of Daily Living (HOS-ADL), HOS–Sports (HOS-Sports), and 12-Item Short Form Health Survey (SF-12). The minimal clinically important difference and Patient Acceptable Symptom State (PASS) were determined for HOS-ADL, HOS-Sports, and the mHHS based on previously published studies. Patients who scored <46.5 on the SF-12 Mental Component Summary (MCS) were in the LMH group, and those who scored ≥46.5 were in the high mental health (HMH) group.

Results:

In total, 120 (21%) of the 566 patients were in the LMH group and 446 (79%) patients were in the HMH group preoperatively. There was no difference in age or sex between groups. Patients in the LMH group had lower mHHS, HOS-ADL, and HOS-Sports at the mean 4-year follow-up and were less likely to reach PASS for the scores. Postoperatively, 84% (478/566) of the entire group was in the HMH group. A total of 88 (73%) of the LMH group improved to HMH. A multiple linear regression model for change in MCS identified independent predictors of changes in preoperative MCS to be LMH group preoperatively, change in HOS-Sports, and change in mHHS (r² = 0.4; P < .001).

Conclusion:

HMH was achieved in 84% of the patients after hip arthroscopy for FAI. Improvement in MCS was correlated with function and activity, as indicated by a significant correlation with HOS-ADL and HOS-Sports. A small percentage of patients did see a decline in their MCS score. This study showed that patients with LMH scores before hip arthroscopy for FAI can improve to normal/high mental health, and this correlated with higher PROs.

Keywords

femoroacetabular impingement mental health hip arthroscopy patient outcomes

Get full access to this article

View all access options for this article.

References

Anderson

Haraldsdottir

Watson

. Mindfulness in athletes. Curr Sports Med Rep. 2021;20(12):655-660.

Bair

Robinson

Katon

Kroenke

. Depression and pain comorbidity: a literature review. Arch Int Med. 2003;163(20):2433-2445.

Block

Ohnmeiss

Guyer

Rashbaum

Hochschuler

. The use of presurgical psychological screening to predict the outcome of spine surgery. Spine J. 2001;1(4):274-282.

Bozic

Chan

Valone

III Feeley

Vail

. Trends in hip arthroscopy utilization in the United States. J Arthroplasty. 2013;28(8)(suppl):140-143.

Brander

Stulberg

Adams

, et al. Predicting total knee replacement pain: a prospective, observational study. Clin Orthop Rel Res. 2003;416:27-36.

Butler

Rosenzweig

Myers

Barrack

. The Frank Stinchfield Award: the impact of socioeconomic factors on outcome after THA: a prospective, randomized study. Clin Orthop Rel Res. 2011;469(2):339-347.

Chahal

Van Thiel

Mather

III , et al. The patient acceptable symptomatic state for the modified Harris Hip Score and Hip Outcome Score among patients undergoing surgical treatment for femoroacetabular impingement. Am J Sports Med. 2015;43(8):1844-1849.

Cheng

Schwabe

Doering

Colditz

Prather

. The effect of psychological impairment on outcomes in patients with prearthritic hip disorders: a systematic review and meta-analysis. Am J Sports Med. 2020;48(10):2563-2571.

Clohisy

Baca

Beaule

, et al. Descriptive epidemiology of femoroacetabular impingement: a North American cohort of patients undergoing surgery. Am J Sports Med. 2013;41(6):1348-1356.

10.

Coronado

Brintz

McKernan

, et al. Psychologically informed physical therapy for musculoskeletal pain: current approaches, implications, and future directions from recent randomized trials. Pain Rep. 2020;5(5):e847.

11.

Daley

Griffith

Milewski

Christino

. The mental side of the injured athlete. J Am Acad Orthop Surg. 2021;29(12):499-506.

12.

Dick

Smith

Bankes

MJK

George

. The impact of mental health disorders on outcomes following hip arthroscopy for femoroacetabular impingement syndrome: a systematic review. J Hip Preserv Surg. 2020;7(2):195-204.

13.

Difiori

Benjamin

Brenner

, et al. Overuse injuries and burnout in youth sports: a position statement from the American Medical Society for Sports Medicine. Br J Sports Med. 2014;48:287-288.

14.

Flanigan

Everhart

Glassman

. Psychological factors affecting rehabilitation and outcomes following elective orthopaedic surgery. J Am Acad Orthop Surg. 2015;23(9):563-570.

15.

Griffin

Dickenson

O’Donnell

, et al. The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. Br J Sports Med. 2016;50(19):1169-1176.

16.

Griffin

Dickenson

Wall

PDH

, et al. Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome (UK FASHIoN): a multicentre randomised controlled trial. Lancet. 2018;391(10136):2225-2235.

17.

Houston

Hoch

Van Lunen

Hoch

. The impact of injury on health-related quality of life in college athletes. J Sport Rehabil. 2017;26(5):365-375.

18.

Jacobs

Burnham

Jochimsen

Molina

Hamilton

Duncan

. Preoperative symptoms in femoroacetabular impingement patients are more related to mental health scores than the severity of labral tear or magnitude of bony deformity. J Arthroplasty. 2017;32(12):3603-3606.

19.

Jochimsen

Noehren

Mattacola

Di Stasi

Duncan

Jacobs

. Preoperative psychosocial factors and short-term pain and functional recovery after hip arthroscopy for femoroacetabular impingement syndrome. J Athl Train. 2021;56(10):1064-1071.

20.

Lebus

Briggs

Dornan

McNamara

Philippon

. Acetabular labral reconstruction: development of a tool to predict outcomes. Am J Sports Med. 2018;46(13):3119-3126.

21.

Leunig

Huff

Ganz

. Femoroacetabular impingement: treatment of the acetabular side. Instr Course Lect. 2009;58:223-229.

22.

Lynch

Oak

Cossell

, et al. Effect of baseline mental health on 1-year outcomes after hip arthroscopy: a prospective cohort study. Orthop J Sports Med. 2021;9(8):23259671211025526.

23.

Maradit Kremers

Schilz

Van Houten

, et al. Trends in utilization and outcomes of hip arthroscopy in the United States between 2005 and 2013. J Arthroplasty. 2017;32(3):750-755.

24.

Martin

Christoforetti

McGovern

, et al. The impact of depression on patient outcomes in hip arthroscopic surgery. Orthop J Sports Med. 2018;6(11):2325967118806490.

25.

Martin

Philippon

. Evidence of reliability and responsiveness for the Hip Outcome Score. Arthroscopy. 2008;24(6):676-682.

26.

Menge

Briggs

Dornan

McNamara

Philippon

. Survivorship and outcomes 10 years following hip arthroscopy for femoroacetabular impingement: labral debridement compared with labral repair. J Bone Joint Surg Am. 2017;99(12):997-1004.

27.

Minkara

Westermann

Rosneck

Lynch

. Systematic review and meta-analysis of outcomes after hip arthroscopy in femoroacetabular impingement. Am J Sports Med. 2019;47(2):488-500.

28.

Nisar

Augustine

Horrey

Craig

Meek

Patil

. Psychosocial aspects of hip disease in the young adult. Hip Int. 2013;23(4): 417-423.

29.

Palmer

Malak

Broomfield

, et al. Past and projected temporal trends in arthroscopic hip surgery in England between 2002 and 2013. BMJ Open Sport Exerc Med. 2016;2(1):e000082.

30.

Saadat

Martin

Thornhill

Brownlee

Losina

Katz

. Factors associated with the failure of surgical treatment for femoroacetabular impingement: review of the literature. Am J Sports Med. 2014;42(6):1487-1495.

31.

Saks

Glein

Jimenez

, et al. Patients obtain meaningful clinical benefit after hip arthroscopy despite preoperative psychological distress: a propensity-matched analysis of mid-term outcomes. Arthroscopy. 2022;38(3):773-782.

32.

Sochacki

Brown

Cenkus

Di Stasi

Harris

Ellis

. Preoperative depression is negatively associated with function and predicts poorer outcomes after hip arthroscopy for femoroacetabular impingement. Arthroscopy. 2018;34(8):2368-2374.

33.

Trief

Grant

Fredrickson

. A prospective study of psychological predictors of lumbar surgery outcome. Spine (Phila Pa 1976). 2000;25(20):2616-2621.

34.

Trief

Ploutz-Snyder

Fredrickson

. Emotional health predicts pain and function after fusion: a prospective multicenter study. Spine (Phila Pa 1976). 2006;31(7):823-830.

35.

Vilagut

Forero

Pinto-Meza

, et al. The mental component of the Short-Form 12 Health Survey (SF-12) as a measure of depressive disorders in the general population: results with three alternative scoring methods. Value Health. 2013;16(4):564-573.

36.

Ware

Jr Kosinski

Keller

. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34(3):220-233.

37.

Wyles

Norambuena

Howe

, et al. Cam deformities and limited hip range of motion are associated with early osteoarthritic changes in adolescent athletes: a prospective matched cohort study. Am J Sports Med. 2017;45(13):3036-3043.