Effect of Baseline Mental Health on 1-Year Outcomes After Hip Arthroscopy: A Prospective Cohort Study

Abstract

Background: Patient factors, including mental health, sex, and smoking, have been found to be more predictive of preoperative hip pain and function than intra-articular findings during hip arthroscopy for femoroacetabular impingement (FAI); however, little is known about how these factors may influence patients’ postoperative outcomes. Hypothesis: We hypothesized that lower patient-reported mental health scores would be significant risk factors for worse patient-reported outcomes (PROs) 1 year after arthroscopic hip surgery for FAI and that baseline intra-articular pathology would fail to demonstrate an association with outcomes 1 year after FAI surgery. Study Design: Cohort study; Level of evidence, 2. Methods: A prospective cohort of patients undergoing hip arthroscopy for FAI were electronically enrolled. Baseline and 1-year follow-up PROs were collected, including Hip disability and Osteoarthritis Outcome Score for pain (HOOS-Pain), HOOS–Physical Function Short Form (HOOS-PS), and Veterans RAND 12-Item Health Survey–Mental Component Score (VR-12 MCS). Intra-articular operative findings and treatment were documented at the time of surgery. Proportional odds logistic regression models were built for 1-year outcomes (HOOS-Pain, HOOS-PS, and VR-12 MCS). Risk factors included patient characteristics and intraoperative anatomic and pathologic findings. Results: Overall, 494 patients underwent hip arthroscopy for FAI, and 385 (78%) were evaluated at 1 year with at least 1 PRO. The median patient age was 33 years, mean body mass index was 25.5 kg/m2, and 72% were female. Multivariable analysis demonstrated that better baseline HOOS-Pain, HOOS-PS, and VR-12 MCS were significantly associated with improvement in the 1-year scores for each PRO. Higher VR-12 MCS was significantly associated with better 1-year HOOS-Pain and HOOS-PS, while current and former smokers had worse 1-year outcomes than those who never smoked. In ranking each variable’s relative importance, baseline HOOS-Pain and HOOS-PS and baseline VR-12 MCS were identified as the strongest predictors of 1-year HOOS-Pain and HOOS-PS in our multivariable model. Conclusion: During hip arthroscopy for FAI, patient factors, including baseline hip pain and function, mental health, and smoking, were independently associated with 1-year PROs of hip pain and function, while intra-articular pathology such as the presence of labral tear and its treatment, tear size, tear location, and anchors placed were not independently associated.

What the papers say

“…In this study, Lynch et al. [ 4 ] report that the patient factors, including mental health, sex and smoking, have been found to be more predictive of preoperative hip pain and function than intra-articular findings during HA for FAI. However, little is known about how these factors may influence patients’ postoperative outcomes.…”

The History and Applications of the Veterans RAND 12-Item Health Survey (VR-12)

“…Following total lower extremity joint replacement, a 1-point increase in the preoperative PCS or MCS score is associated with an 8% and 4% reduction in being in the worst (25th percentile score) Hip/Knee Osteoarthritis Outcome Scores (HOOS/KOOS) groups, respectively (Bienstock et al, 2019). In addition, a 1-point increase in baseline MCS is associated with a 3% reduction in the likelihood of having a worse HOOS-PS score 1 year after surgery (higher scores indicate worse hip function) following arthroscopic hip surgery for a labral tear (Lynch et al, 2021d).…”

Improved Mental Health Status and Patient-Reported Outcomes After Hip Arthroscopy for Femoroacetabular Impingement

“…The American Journal of Sports Medicine 2023;51 (6):1525-1530 DOI: 10.1177/03635465231160289 Ó 2023 The Author(s) hip pain/function. 8,12,18,19,22,24,31,32 Preoperative depression or low mental health (LMH) scores have been shown to be associated with decreased function, increased pain, and lower satisfaction postoperatively at 3 months, 1 year, 2 years, and 5 years, 19,22,24,31 which has been supported by 2 systematic reviews. 8,12 However, few studies have investigated mental health improvement after arthroscopic intervention for FAI and if this improvement is associated with improved outcomes.…”