Mental Health Medication Use Correlates with Poor Outcome After Femoroacetabular Impingement Surgery in a Military Population

Ernat, Justin J.; Song, Daniel J.; Brugman, Sean; Shaha, Steven H.; Tokish, John M.; Lee, G.Y.

doi:10.2106/jbjs.o.00043

Cited by 35 publications

(40 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Psychological markers have ranged from billing diagnosis codes to scores on screening questionnaires, and clinical outcomes have ranged from pain control in the postanesthesia care unit to return-to-duty status 2 years later. 5,16,21,25 The purpose of this study was to synthesize current evidence regarding the association between baseline psychological impairment and postintervention outcomes in patients with prearthritic hip disorders. A secondary purpose was to describe the heterogeneity in reporting and develop standardized reporting recommendations to improve future investigation into this topic.…”

mentioning

confidence: 99%

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

et al. 2019

View full text Add to dashboard Cite

Background: Recent studies have suggested that mental health disorders negatively affect postoperative outcomes in patients with femoroacetabular impingement (FAI). However, the outcome measures reported and the effect sizes have varied. Furthermore, it is unknown whether similar effects are present in young adults with other hip disorders such as acetabular dysplasia. Purpose: To synthesize current evidence regarding the effect of baseline psychological impairment on postintervention outcomes in patients with prearthritic hip disorders. Study Design: Systematic review and meta-analysis. Methods: In February 2019, the Ovid Medline, Embase, Scopus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and ClinicalTrials.gov databases were searched for longitudinal studies that evaluated the effect of baseline psychological impairment (such as depression or anxiety) on a postintervention clinical outcome in patients with prearthritic hip disorders including FAI, acetabular dysplasia, and/or acetabular labral tears. Descriptive measures of study quality and bias were recorded, and studies that reported statistically comparable outcomes were analyzed in meta-analyses through use of random effects models. Results: We identified 12 eligible studies, all of which specifically evaluated patients with FAI after hip arthroscopy. No eligible studies described patients with acetabular dysplasia. Of the included studies, 8 studies reported odds ratios (ORs). The other 4 studies reported mean postoperative scores on patient-reported outcome measures (PROMs), all of which were scored from 0 to 100, with higher numbers being favorable. Patients with psychological impairment were less likely to achieve a favorable outcome after arthroscopy (OR, 0.74; 95% CI, 0.62 to 0.88; P < .001), and they reported worse postoperative PROM scores compared with nonimpaired patients (weighted mean difference, −20.2 points; 95% CI, −32.9 to −7.5; P < .001). Conclusion: Baseline psychological impairment is associated with clinically significantly worse outcomes in patients with femoroacetabular impingement who undergo hip arthroscopy. More standardized reporting would facilitate improved understanding of this important, potentially modifiable risk factor. Registration: CRD42019124836 (PROSPERO).

show abstract

mentioning

confidence: 99%

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

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Unfortunately, the literature is sparse, with only a handful of studies (mostly Level IV and 1 Level III) on this important subject. [2][3][4][5][6] Their conclusions are soft because of the limited data available, but my intuition based on my own experience agrees with their summation: about three fourths may resume service duties in some fashion, with about half expecting to return without limitations; yet, many may continue to have some symptoms. However, this only tells part of the story.…”

Section: See Related Article On Page 2713mentioning

confidence: 70%

Editorial Commentary: The Warrior Athlete: An Illustrative Microcosm in the War Against Hip Femoroacetabular Impingement

Byrd¹

2018

Arthroscopy: The Journal of Arthroscopic & Related Surgery

View full text Add to dashboard Cite

From an orthopaedic perspective, our military personnel truly are warrior athletes. Distilling the information available in these subjects provides an enlightening microcosm of the management of femoroacetabular impingement (FAI). Symptoms associated with damage caused by FAI represent the culmination of a process present since childhood. Thus, while arthroscopic correction can result in significant improvement, it does not invariably result in full restoration of function. Numerous factors influence an individual's response to injury and recovery from surgery, including subjective parameters such as resiliency. Thus, function is not always based simply on objective parameters. In view of compelling literature to support the efficacy of arthroscopic correction and treatment of FAI, servicemen and women have historically been discriminated against by unilateral lack of coverage. This trend has only partly been reversed as it is now deemed acceptable for active-duty personnel but arbitrarily not for their dependent family members. The war on FAI goes on in terms of better understanding of the FAI enemy, better techniques and technology to use during the war, and better solicitation of the homeland resources for continuing this important battle.

show abstract

“…To determine the prevalence of the various types of PTMs, we assigned each PTM that a patient was taking into 1 of the following therapeutic drug categories based on whether it was classified as an antidepressant, antipsychotic, anxiolytic (antianxiety), ADHD, or mood-stabilizing medication. 2,3,9,12 Commonly prescribed medications in each of these categories are (1) antidepressants: Prozac, Wellbutrin, and Lexapro; (2) antipsychotics: Clozaril, Risperdal, Zyprexa; (3) ADHD drugs: Adderall, Dexedrine, Ritalin; (4) antianxiety medications: Ativan, Xanax; and (5) mood stabilizers: lithium, Tegretol, and Lamictal.…”

Section: Methodsmentioning

confidence: 99%

“…9,12 In the United States, the psychotropic medications (PTMs) most commonly taken are anti-depressants, followed by antianxiety, attention-deficit/hyperactivity disorder (ADHD), mood-stabilizing, and anti-psychotic medications. 2,3,9,12 Over the past 2 decades, the use of PTMs by American adults has increased 3-fold, and currently 20% of adult females and 10% of adult males take 1 or more of these antidepressant, antipsychotic, and mood-altering drugs. 4,10,12 However, to date, the prevalence of PTM use in patients undergoing hip arthroscopy and the results of hip arthroscopy in patients taking PTMs have not been reported.…”

mentioning

confidence: 99%

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

2018

View full text Add to dashboard Cite

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.

show abstract

Mental Health Medication Use Correlates with Poor Outcome After Femoroacetabular Impingement Surgery in a Military Population

Cited by 35 publications

References 25 publications

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

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

Editorial Commentary: The Warrior Athlete: An Illustrative Microcosm in the War Against Hip Femoroacetabular Impingement

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

Contact Info

Product

Resources

About