Does the Use of Psychotropic Medication Adversely Affect the Outcomes of Hip Arthroscopy?

Abstract

Background: Over the past decade, the use of psychotropic medications (PTMs) in the United States has doubled, and currently 20% of adults are taking 1 or more of these antidepressant, antianxiety, antipsychotic, or mood-altering medications. To date, however, the incidence of PTM use in patients undergoing hip arthroscopy and the results of hip arthroscopy in these patients have not been reported. Purpose: To determine the prevalence of PTM use in patients undergoing hip arthroscopy and to compare the outcomes of patients taking PTMs versus those of patients not taking PTMs. Study Design: Cohort study; Level of evidence, 3. Methods: Medical records of 880 consecutive patients who underwent hip arthroscopy performed by the senior author were reviewed and data were collected, including the number and types of PTMs that these patients were taking at the time of their hip arthroscopy. All hips were assessed with the Byrd modified Harris Hip Score (mHHS) preoperatively; 709 patients (81%) had scores obtained at 12 months and 669 patients (76%) at 24 months after surgery. Demographic data and mHHS of patients taking psychotropic medications (PTM group) were compared with those of patients not taking PTMs (NPTM group). Results: Four hundred twenty-two (48%) of the 880 patients studied were taking PTMs at the time of their hip arthroscopy; significant differences between the PTM and NPTM groups were average age (48 vs 35 years, respectively), and the high percentage of females (53%) and low percentage of males (38%) in the PTM group. Preoperative scores for the PTM and NPTM groups were similar (41 vs 42 points, respectively), but postoperative scores of the PTM group were significantly lower at 6 months (72 vs 89 points), 12 months (77 vs 91 points), and 24 months (79 vs 88 points) after surgery (P = .01). In contrast, the scores of the subgroups of PTM and NPTM adolescents obtained at 3 months (92.5 vs 88.9 points), 6 months (92.1 vs 90.3 points), 12 months (89.5 vs 92.1 points), and 24 months (90.3 vs 90.1 points) after surgery did not significantly differ. Conclusion: The incidence of PTM use in this series of patients with hip arthroscopy was triple that reported for US adults (48% vs 17%, respectively) and adolescents (23% vs 6.3%), and the PTM group had significantly lower 12- and 24-month mHHS results than the NPTM group. These results suggest that (1) patients undergoing hip arthroscopy who are taking PTMs are at significantly higher risk for poor outcomes and (2) their use of PTMs should be identified and addressed before proceeding with hip arthroscopy.

The Effect of Psychological Impairment on Outcomes in Patients With Prearthritic Hip Disorders: A Systematic Review and Meta-analysis

“… a Unreported data points are denoted by a dash. For studies that did not report an overall mean age, 21,23,28 a weighted mean was calculated from the mean ages of the population subgroups that were reported. PROM, patient-reported outcome measure. …”

“…According to a survey of orthopaedic surgeons in 2017, many surgeons notice and potentially even discuss psychological health with their patients, but surgeons are less Unreported data points are denoted by a dash. For studies that did not report an overall mean age, 21,23,28 a weighted mean was calculated from the mean ages of the population subgroups that were reported. PROM, patient-reported outcome measure.…”

“…Four relevant studies were identified outside the database search strategy. 23,25,28 A total of 12 studies were eligible for inclusion. ¶ The reviewers independently extracted the following available variables from the eligible studies: study design, study institution, clinical setting, years of enrollment, follow-up duration, funding source, purpose of outcome stratification by psychological status (primary vs secondary goal), patient demographics, PAHD diagnoses included, intervention performed, definition of psychological impairment, proportion of the sample that had baseline psychological impairment, clinical outcome(s) measured, designation of the primary clinical outcome, and postintervention clinical outcome values.…”

Psychological Healthcare Burden Lessens After Hip Arthroscopy for Those With Comorbid Depression or Anxiety

“…[2][3][4] Additionally, it has been reported that 48% of patients are taking at least 1 psychotropic medication at the time of hip arthroscopy. 5 For patients undergoing hip arthroscopy, poor mental health has been correlated with worse preoperative patient-reported outcomes, 3,4,6 persistent postoperative pain, 7 and decreased postoperative patient reported outcomes (PROs). 4,6,[8][9][10][11] However, it remains unknown whether there is a potential bidirectional relationship between hip pain and poor mental health, as there is a paucity of research devoted to understanding how mental health disorders may be affected by surgical treatment of musculoskeletal conditions.…”

“… 2 , 3 , 4 Additionally, it has been reported that 48% of patients are taking at least 1 psychotropic medication at the time of hip arthroscopy. 5 For patients undergoing hip arthroscopy, poor mental health has been correlated with worse preoperative patient-reported outcomes, 3 , 4 , 6 persistent postoperative pain, 7 and decreased postoperative patient reported outcomes (PROs). 4 , 6 , 8 , 9 , 10 , 11 …”