Patients Obtain Meaningful Clinical Benefit After Hip Arthroscopy Despite Preoperative Psychological Distress: A Propensity-Matched Analysis of Mid-Term Outcomes

Saks, Benjamin R.; Glein, Rachel M.; Jimenez, Andrew E.; Ankem, Hari K.; Sabetian, Payam W.; Maldonado, David R.; Lall, Ajay C.; Domb, Benjamin G.

doi:10.1016/j.arthro.2021.05.010

Cited by 7 publications

(7 citation statements)

References 53 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Different questionnaires have been used to diagnose depression in patients (LMH), with Sochacki et al using the Beck Depression Inventory-II (BDI-II), which is able to detect and score the severity of depression. Saks et al 31 showed that patients with LMH scores had lower preoperative PROs; these differences were not seen at 2 and 5 years after hip arthroscopy when using the 12-Item International Hip Outcome Tool and mHHS. This study did have smaller groups, which may be responsible for the differences between our studies.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

mentioning

confidence: 92%

See 1 more Smart Citation

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

et al. 2023

View full text Add to dashboard Cite

Background: Femoroacetabular impingement (FAI) is often a chronic problem, which can lead to a decrease in mental well-being. Purpose/Hypothesis: The purpose of this study was to determine patient mental health improvement after hip arthroscopy and if this improvement correlated with improved outcomes. It was hypothesized that patients with low mental health (LMH) status would improve after hip arthroscopy for FAI and that their patient-reported outcomes (PROs) would significantly improve after surgery. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent hip arthroscopy with labral repair between 2008 and 2015 were included. The minimum follow-up was 2 years. PROs included the modified Harris Hip Score (mHHS), Hip Outcome Score–Activities of Daily Living (HOS-ADL), HOS–Sports (HOS-Sports), and 12-Item Short Form Health Survey (SF-12). The minimal clinically important difference and Patient Acceptable Symptom State (PASS) were determined for HOS-ADL, HOS-Sports, and the mHHS based on previously published studies. Patients who scored <46.5 on the SF-12 Mental Component Summary (MCS) were in the LMH group, and those who scored ≥46.5 were in the high mental health (HMH) group. Results: In total, 120 (21%) of the 566 patients were in the LMH group and 446 (79%) patients were in the HMH group preoperatively. There was no difference in age or sex between groups. Patients in the LMH group had lower mHHS, HOS-ADL, and HOS-Sports at the mean 4-year follow-up and were less likely to reach PASS for the scores. Postoperatively, 84% (478/566) of the entire group was in the HMH group. A total of 88 (73%) of the LMH group improved to HMH. A multiple linear regression model for change in MCS identified independent predictors of changes in preoperative MCS to be LMH group preoperatively, change in HOS-Sports, and change in mHHS ( r2 = 0.4; P < .001). Conclusion: HMH was achieved in 84% of the patients after hip arthroscopy for FAI. Improvement in MCS was correlated with function and activity, as indicated by a significant correlation with HOS-ADL and HOS-Sports. A small percentage of patients did see a decline in their MCS score. This study showed that patients with LMH scores before hip arthroscopy for FAI can improve to normal/high mental health, and this correlated with higher PROs.

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 92%

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

et al. 2023

View full text Add to dashboard Cite

show abstract

“…Notably, no outcome scores that accounted for pre- or postoperative mental health were evaluated. Depression and other mental health conditions have been associated with underweight BMI, which may have the potential to influence outcomes; however, in recent literature, Saks et al 46 established that patients with baseline psychological distress still gain meaningful clinical benefit after hip arthroscopy with midterm outcomes that were comparable to a control group of patients without preoperative psychological distress. 26 The influence of underweight BMI on outcomes after hip arthroscopy is understudied in the literature, and further investigation with long-term follow-up is warranted.…”

Section: Discussionmentioning

confidence: 99%

Low Body Mass Index in Females May Portend Inferior Outcomes After Primary Hip Arthroscopy: A Propensity-Matched Analysis With Minimum 2-Year Follow-up

et al. 2022

Self Cite

View full text Add to dashboard Cite

Background: There is a paucity of literature evaluating the effect of low body mass index (BMI) in female patients undergoing primary hip arthroscopy. Purpose: (1) To report minimum 2-year patient-reported outcome scores for female patients with low BMI who underwent primary hip arthroscopy for femoroacetabular impingement syndrome and (2) to compare these results with a propensity-matched control group of female patients with normal BMI. Study Design: Cohort study; Level of evidence, 3 Methods: Data were collected on all female patients who had low BMI (<18.5) and underwent primary hip arthroscopy between April 2008 and January 2019. Patients were excluded if they had a previous hip arthroscopy; had workers’ compensation; were unwilling to participate in the study; or had Tönnis osteoarthritis grade >1, acetabular dysplasia, or a previous hip condition. Minimum 2-year patient-reported outcomes were collected for the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score, Hip Outcome Score–Sport Specific Subscale (HOS-SSS), visual analog scale for pain, and satisfaction. The percentage of patients achieving the minimal clinically important difference (MCID), Patient Acceptable Symptom State (PASS), and maximum outcome improvement satisfaction threshold (MOIST) was also recorded. These patients were propensity matched in a 1:2 ratio to female patients with normal BMI for comparison. Results: A total of 43 patients (49 hips) were included with a mean ± SD follow-up of 26.9 ± 8.3 months, age of 24.1 ± 12.6 years, and BMI of 17.7 ± 0.67. These patients demonstrated significant improvement from presurgery to minimum 2-year follow-up for the mHHS, Non-Arthritic Hip Score, HOS-SSS, and visual analog scale ( P < .05). When outcomes were compared with 93 control patients (97 hips), female patients with low BMI demonstrated lower rates of achieving the PASS for the mHHS (61.2% vs 77.3%; P = .041) and HOS-SSS (39.5% vs 57.1%; P = .031). Rates of achieving the MCID and MOIST were similar between the groups ( P > .05). Female patients with low BMI also had higher rates of revision when compared with the control group, but this did not reach statistical significance (14.2% vs 7.2%; P = .171). Conclusion: Female patients with low BMI undergoing primary hip arthroscopy for femoroacetabular impingement syndrome demonstrated significant improvement in patient-reported outcomes at minimum 2-year follow-up. When compared with a propensity-matched control group with normal BMI, these patients demonstrated lower rates of achieving the PASS for the mHHS and HOS-SSS. Low BMI in females undergoing primary hip arthroscopy for FAIS may adversely affect outcomes at short-term follow-up.

show abstract

“…Conversely, these servicemembers demonstrated significant improvements on several PROs (NAHS, VAS, and HOS-ADL), indicating that patients with PSYs can derive at least some benefit from hip arthroscopy. In a study comparing postoperative PROs between psychologically distressed patients and those with no psychological distress, Saks et al 33 reported that both groups achieved similar MCID and PASS rates on the modified Harris Hip Score, NAHS, and 12-item International Hip Outcome Tool at minimum 2- and 5-year follow-up. However, the Short Form Health Survey Mental Component Summary results did not improve until a 5-year follow-up.…”

Section: Discussionmentioning

confidence: 99%

Low Back Pain, Psychiatric Disorders, and a Combination of Both Negatively Affect Hip Arthroscopy Outcomes in Servicemembers

Kearney

2022

Am J Sports Med

View full text Add to dashboard Cite

Background: Hip arthroscopy for femoroacetabular impingement (FAI) in athletes, including military servicemembers, has resulted in variable outcomes. The prevalence of low back pain (LBP) and psychiatric disorders (PSYs) is high among patients undergoing hip arthroscopy. Purpose: To determine the effect of LBP, PSYs, and the combination of both on outcomes in servicemembers treated arthroscopically for FAI. Study Design: Cohort study; Level of evidence, 2. Methods: Between April 2016 and June 2020, a total of 108 consecutive active-duty servicemembers underwent hip arthroscopy by a single surgeon at a single military medical center. Servicemembers were grouped according to the presence of preoperative LBP (Group LBP), a PSY (Group PSY), or both (Group Both), and outcomes were compared with those of servicemembers without these comorbidities (Group None). The minimum follow-up was 6 months. The primary outcome measure was return to duty (RTD). Secondary outcomes included the Nonarthritic Hip Score (NAHS), Hip Outcome Score–Activities of Daily Living (HOS-ADL) subscale, and Hip Outcome Score–Sports (HOS-S) subscale. Results: All servicemembers’ final duty status was confirmed, with a mean follow-up of 2 years (range, 6 months–4.3 years). The prevalence of preoperative LBP and PSY was 27% and 39%, respectively. RTD was 59% (10/17) in Group LBP, 10% (3/30) in Group PSY, 0% (0/12) in Group Both, and 47% (23/49) in Group None. Compared with Group None, the risk of discontinuing military service was statistically higher in Group PSY (relative risk [RR], 1.70 [95% CI, 1.41-1.99]) and Group Both (RR, 1.88 [95% CI, 1.62-2.15]) but not in Group LBP (RR, 0.78 [95% CI, 0.15-1.40]). The mean preoperative secondary outcomes all significantly improved postoperatively in Group None (NAHS, 58 to 75 [ P < .001]; HOS-ADL, 63 to 74 [ P < .001]; HOS-S, 44 to 57 [ P < .001]). Among the comorbid groups, the mean HOS-S did not significantly improve (Group LBP, 45 to 48 [ P = .71]; Group PSY, 36 to 44 [ P = .22]; Group Both 43 to 45 [ P = .75]), and <50% of these servicemembers achieved HOS-S meaningful clinical benefit metrics. Conclusion: Preoperative LBP, PSY, and a combination of both negatively affected outcomes after hip arthroscopy. Preoperative counseling is crucial in setting realistic outcome expectations.

show abstract

Patients Obtain Meaningful Clinical Benefit After Hip Arthroscopy Despite Preoperative Psychological Distress: A Propensity-Matched Analysis of Mid-Term Outcomes

Cited by 7 publications

References 53 publications

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

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

Low Body Mass Index in Females May Portend Inferior Outcomes After Primary Hip Arthroscopy: A Propensity-Matched Analysis With Minimum 2-Year Follow-up

Low Back Pain, Psychiatric Disorders, and a Combination of Both Negatively Affect Hip Arthroscopy Outcomes in Servicemembers

Contact Info

Product

Resources

About