Hip arthroscopy has drastically grown over the past decade as a result of improvements in techniques and better understanding of underlying hip pathologies. Baseline mental health has been shown to affect preoperative functional status in hip arthroscopy patients, but there is limited literature regarding its effect on postoperative outcomes. The purpose of this study was to analyze the association between baseline depression and anxiety and postoperative patient reported outcomes (PROs) 2 years after hip arthroscopy. We hypothesized that patients with worse depression and anxiety would have worse functional status, pain and satisfaction.
An orthopaedic registry at a single institution was retrospectively analyzed. 62 patients who underwent hip arthroscopy from 2015 to 2020, and had 2 year follow up data were included in this study. Patients were administered Patient-Reported Outcomes Measurement Information System (PROMIS) in six domains (Physical Function, Pain Interference, Fatigue, Social Satisfaction, Anxiety, and Depression), Numeric Pain Score, Musculoskeletal Outcomes Data Evaluation and Management System (MODEMS) expectations domains and Surgical Satisfaction Questionnaire (SSQ8) pre-operatively and at 2 years postoperatively. Patients completed a “completely better” anchor question at two years after surgery. Bivariate analysis was used to determine associations between preoperative factors and baseline PROMIS Anxiety and Depression. Associations between preoperative PROMIS Anxiety and Depression and two-year PROs were analyzed through Spearman’s coefficient (rho).
Worse baseline anxiety or depression was associated with female gender, clinical history of anxiety or depression, and an increased number of comorbidities. Increased preoperative PROMIS Anxiety scores were associated with worse 2-year PROMIS Fatigue and Depression and Tegner Activity Scale (rho = 0.45, p-value=0.0002; rho = 0.38, p-value=0.018; rho = -0.27, p-value=0.039, respectively). Greater preoperative PROMIS Depression was associated with worse 2-year PROMIS Fatigue and Anxiety and Numeric Pain Scale – Whole Body (rho = 0.53, p-value<0.0001; rho = 0.56, p-value<0.0001; rho = 0.37, p-value=0.003, respectively). There were no significant associations between baseline PROMIS Anxiety or Depression and change from baseline in all PROs.
Worse baseline anxiety and depression were associated with greater fatigue, anxiety, depression, and whole body pain at two years for patients following hip arthroscopy. However, there was no association between baseline anxiety and depression and function, pain interference, satisfaction or met expectations at two years postoperatively. Worse preoperative mental health may not be a barrier to achieving adequate functional outcomes and satisfaction following hip arthroscopy.