Patients With Increased Anxiety and Depression Scores Are at Greater Risk of Not Achieving a Meaningful Improvement in Patient-Reported Outcomes After Hip Arthroscopy for Femoroacetabular Impingement Syndrome.

Abstract

To evaluate whether patients undergoing arthroscopic intervention for femoroacetabular impingement syndrome with preoperative anxiety or depression potentially experience reduced benefit from arthroscopic surgery. All patient pathways (hips) over 18 years entered into the UK Non-Arthroplasty Hip Registry between 2012 and 2024 who underwent arthroscopic intervention for femoroacetabular impingement syndrome were included. Exclusions were revision procedures, planned 1^st/2^nd of a two-stage procedure. Patient demographics, EuroQol 5-Dimension 5-Level, and International Hip Outcome Tool-12 (iHOT-12) scores preoperatively and 1-year were recorded. EuroQol 5-Dimension 5-Level question 5 was used as a surrogate for anxiety/depression. The iHOT-12 score was used to quantify outcomes of hip function. We identified 5109 hips that underwent hip arthroscopy for femoroacetabular impingement syndrome; 56% were female, with an average age of 35.3 (SD: 10.1) years. Mean preoperative iHOT-12 score was 33 (SD: 18) and at 1-year 59 (SD: 28) with a mean improvement of 26 (range: -61 to 93). There was a significant negative correlation between preoperative anxiety/depression and iHOT-12 at both baseline and 1 year (r = -0.309, P < .001). There was no significant correlation between change in iHOT-12 (ΔiHOT-12) (r = 0.0282, P = .206). Among female patients, 66% improved by minimally clinically important difference, whereas only 61% of males did (P = .049). Patients achieving minimally clinically important difference was significantly lower (47% vs 63%, P = .031) in the group with the highest preop anxiety scores. At 1 year, 33% of patients reported improvement, 49% showed no change, and 18% experienced worsening in their anxiety/depression scores. Patients with higher preoperative scores showed the greatest improvement. This study showed a negative correlation between increased anxiety/depression and iHOT-12 outcomes; however, this was not reflected in the relative improvement in outcomes. Those with greatest preoperative anxiety/depression were at greater risk of not achieving minimally clinically important difference yet were most likely to see an improvement in their anxiety/depression scores. Level III, retrospective comparative case series.