Predictors of Persistent Postoperative Pain at Minimum 2 Years After Arthroscopic Treatment of Femoroacetabular Impingement

Abstract

Background: Hip arthroscopy for femoroacetabular impingement syndrome (FAIS) is a rapidly expanding field, and preoperative factors predictive of persistent postoperative pain are currently unknown. Purpose: To identify predictors for persistent postoperative pain at the site of surgery after hip arthroscopy for FAIS. Study Design: Case-control study; Level of evidence, 3. Methods: Patients who underwent hip arthroscopy for FAIS and had a minimum 2-year follow-up with patient-reported outcomes (PROs) were included in this study. Patients with previous open hip surgery and diagnoses other than FAIS were excluded. Patients were grouped by visual analog scale scores for pain as limited (<30) and persistent (≥30). Patient factors and outcomes were analyzed with univariate and correlation analyses to build a logistic regression model to identify predictors of persistent postoperative pain. Results: The limited pain (n = 514) and persistent pain (n = 174) groups totaled 688 patients (449 females). There was a statistically significant difference in age between groups, with the persistent pain group being older than the low pain group (35.9 ± 12.2 vs 32.4 ± 12.6, respectively; P = .002). Patients with persistent postoperative pain demonstrated significantly lower preoperative PRO scores in the Hip Outcome Score–Activities of Daily Living (57.6 ± 21.2 vs 67.7 ± 16.8), Hip Outcome Score–Sport Specific (35.9 ± 23.9 vs 44.1 ± 22.7), modified Harris Hip Score (51.6 ± 16.2 vs 59.6 ± 12.9), and International Hip Outcome Tool (32.0 ± 16.8 vs 40.0 ± 17.82) but no significant differences in preoperative visual analog scale scores for pain (7.3 ± 1.8 vs 7.2 ± 1.7). Mean postoperative PRO differences between pain groups were all statistically significant. Bivariate logistic regression analysis demonstrated that history of anxiety or depression (odds ratio, 1.8; 95% CI, 1.02-3.32; P = .042), revision hip arthroscopy (odds ratio, 8.6; 95% CI, 1.79-40.88; P = .007), and a low preoperative modified Harris Hip Score (odds ratio, 0.97; 95% CI, 0.95-0.99; P = .30) were predictors of persistent postoperative pain. Conclusion: Independent predictors for persistent postoperative pain include revision hip arthroscopy and mental health history positive for anxiety and depression. Our analysis demonstrated significant improvements in pain and functional PROs in the limited pain and persistent pain groups; however, those with persistent pain demonstrated significantly lower PRO scores.

Preoperative Predictors of Achieving Clinically Significant Athletic Functional Status After Hip Arthroscopy for Femoroacetabular Impingement at Minimum 2-Year Follow-Up

“…The 2year PASS value was then identified by using an receiver operating characteristic (ROC) curve analysis as previously done in prior studies (analysis provided in Appendix 1). 3,23,24,[27][28][29] A sensitivity and specificity of 0.80 was used as the cut-off for determining an acceptable HOS-SS PASS score. Patients were classified as achieving PASS if PASS was achieved on any of the included outcome measures.…”

“…1,2 These procedures aim to reduce pain and improve function in younger, active patients and are highly successful. 3,4 FAIS with labral repair and osteochondroplasty leads to a high patient satisfaction rate and return to sports. [5][6][7][8][9] The success has been attributed to less soft tissue damage and a more rapid recovery.…”

What is the Role of Kinesiophobia and Pain Catastrophizing in Outcomes After Hip Arthroscopy for Femoroacetabular Impingement Syndrome?

“…12,13 It recently has been shown that psychological factors such as depression and distress are predictors of lower preoperative patient-reported outcome scores, chronic postoperative pain, and poor outcomes following hip arthroscopy. [14][15][16][17][18] However, the effects of specific components of psychological distress such as kinesiophobia and pain catastrophizing have not been widely studied in the hip arthroscopy literature.…”

Clinical predictors of outcome following hip arthroscopy

“…Pre-operative PROMs [174,210], age, symptom duration, body mass index (BMI), chondromalacia in the affected hip [174] and surgical history are predictive factors that may be useful in determining prognosis and operative indications for hip arthroscopy [47]. However, very little other evidence exists on clinically assessable factors such as hip strength and ROM.…”

“…This highlights the need to investigate whether baseline hip strength or ROM predicts improvement in postoperative PROMs after hip arthroscopy. An understanding of modifiable patient impairments that may contribute to success or failure after hip arthroscopic surgery is important to improve patient selection for this procedure and reduce the number of inferior outcomes after surgery [210].…”