Abstract
OBJECTIVES: Symptom severity in patients with femoroacetabular impingement (FAI) has been demonstrated to have a stronger association with mental health status than pathology. However, there is limited data on the relationship between mental health status and postoperative outcomes in FAI patients. This study aims to evaluate the relationship of mental health status and structural hip pathology to pain and quality of life. METHODS: This was a retrospective review of patients from a single surgeon’s hip outcomes registry. Mental health status was evaluated using the Patient-Reported Outcomes Measurement Information System (PROMIS)-Anxiety and PROMIS-Depression scores. Pain was evaluated with Single Assessment Numerical Evaluation Score for Activities of Daily Living (SANE ADL) while quality of life (QOL) was evaluated with the International Hip Outcome Tool (iHOT-12). Repeated measures mixed modeling was used to evaluate the association between hip pathology (size of labral tear, grade of chondral damage, preoperative alpha angle), pain, QOL, anxiety, and depression pre- and postoperatively. RESULTS: A total of 337 patients were included in this study. The degree of preoperative alpha angle, intra-operative cartilage damage and size of labral tear did not influence postoperative improvements in pain or QOL (p>0.05). However, higher levels of anxiety and depression were significantly associated with lower SANE-ADL scores (anxiety estimate: -0.608, SE (0.079), p<0.0001), (depression estimate: -0.677, SE (0.086), p<0.0001), and lower iHOT-12 scores (anxiety estimate: -0.709, SE (0.069), p<0.0001), (depression estimate: -0.706, SE (0.077), p<0.0001). These associations were seen both preoperatively and up to 2 years postoperatively. Furthermore, anxiety and depression do not appear to moderate the relationship between hip pathology and patient outcomes. CONCLUSIONS: All patients had similar improvements in pain scores and QOL following hip arthroscopy for FAI suggesting this surgery is beneficial for varying degrees of hip pathology. Additionally, preoperative anxiety and depression are associated with greater pain and decreased QOL both pre- and postoperatively regardless of the degree of hip pathology. This may suggest a need for pre- and postoperative psychological interventions in patients with anxiety and depression, and clinicians should prioritize mental health treatment at or above the level of the hip pathology itself.