Abstract
Objectives:
Over the last two decades, several studies have aimed to assess the impact of pre-operative patient factors on post-operative patient reported outcomes (PROs) in patients undergoing hip arthroscopy for femoroacetabular impingement (FAI). Recently, the effect of mental health on PROs following hip arthroscopy has been a topic of interest. However, current studies are limited in scope as they focus on primary hip arthroscopy and often rely on anxiety and depressive symptoms to assess patient mental health rather than a prior psychiatric diagnosis per the DSM-criteria (Diagnostic & Statistical Manual of Mental Disorders). As a result, the aim of this study was to report the prevalence of psychiatric diagnosis in patients undergoing revision hip arthroscopy as well as report the attainment of MCID and PASS in patients undergoing primary and revision hip arthroscopy who have a psychiatric diagnosis.
Methods:
All primary and revision hip arthroscopy cases performed by the senior author between 2017 and 2024 were retrospectively reviewed. Patients were included if they underwent primary or revision hip arthroscopy for FAI and a complete history and physical with the on-site board-certified Internal Medicine physician prior to surgery. Patients without a complete history and physical or subsequent surgery on the ipsilateral side were excluded from the study. Pre-operative psychiatric diagnosis, demographic and radiographic parameters, and PROs were collected during retrospective chart view and from our institution’s internal database. A patient was deemed to have a psychiatric disorder if they presented to our institution with a prior psychiatric diagnosis per DSM-criteria and/or a current prescription for pharmacologic treatment of their psychiatric diagnosis.
Results:
A total of 1642 patients, including 1318 primary and 324 revision hip arthroscopy cases, were identified between 2017 and 2024. Psychiatric diagnoses were more prevalent in the revision hip arthroscopy cohort compared to the primary hip arthroscopy cohort (34% vs. 14% respectively, p<0.001). Additionally, psychiatric diagnoses were more prevalent in females compared to males (p<0.001).
Of the 1642 patients, 1315 patients met inclusion criteria for post-operative PRO collection with a total of 766 (58.3%) patients having completed two-year follow up. In this cohort, the median age at time of surgery was 35 years (Range: 23-47) and most patients were female (n=467, 60%) Additionally, 609 patients were primary cases and 157 were revision cases with a psychiatric diagnosis prevalence of 12% and 38% respectively. There was no significant difference in demographic or surgical factors between patients with a psychiatric diagnosis and those without when controlling for primary and revision surgery (Table 2). Furthermore, most patients with a psychiatric diagnosis were able to achieve mHHS, HOS-Sport, and HOS-ADL MCID (Table 3). However, a smaller percentage of patients reported achieving HOS-ADL, HOS-Sport, and mHHS PASS. Notably, patients undergoing revision hip arthroscopy demonstrated a low PASS attainment regardless of the presence of a psychiatric diagnosis (Table 3).
Conclusions:
To our knowledge, this is the first study reporting on the prevalence of psychiatric disorders and PROs in patients undergoing revision hip arthroscopy. Although the prevalence rate of psychiatric disorders in revision hip arthroscopy patients is more than double that of primary hip arthroscopy patients, most patients were able to achieve MCID. Interestingly, our data suggests patients undergoing revision hip arthroscopy achieve PASS at a lower rate regardless of the presence of a psychiatric disorder. Additional next steps include bolstering patient follow-up and conducting a multivariable regression analysis to better understand the association between a history of psychiatric diagnosis and PROs, independent of other patient-specific factors. In doing so, clinicians and patients can utilize the present study’s findings to guide clinical decision making and better set patient expectations when patients present with hip pathology alongside a psychiatric diagnosis.
