Abstract
Introduction
Hip arthroscopy is recognised to offer therapeutic benefits for femoroacetabular Impingement (FAI). There is growing evidence demonstrating an association between mental health and outcomes in hip arthroscopy. However, many studies have been single-centre, single-surgeon studies with limited numbers. The purpose of this study was to use data from a large registry source to test the hypotheses that patients undergoing arthroscopic intervention for FAI with pre-operative anxiety/depression would: a) benefit less from arthroscopic intervention b) be at risk of not achieving minimally Clinically Important Difference (MCID) c) see an improvement anxiety/depression scores with improvement in functional scores.
Methods
Data were acquired from the UK Non-Arthroplasty Hip Registry dataset. Patients over 18 years who had a primary arthroscopic intervention for FAI were included. Patient demographics, EQ-5D-5L scores, and iHOT-12 scores at baseline and 1-year were recorded. EQ-5D question 5 (Q5) addresses anxiety/depression and was assigned a numerical value to be used as a surrogate marker for anxiety/depression. The iHOT-12 score was used to quantify outcomes of hip function.
Results
5,109 patients that underwent hip arthroscopy for FAI between 2012-2024 were identified. 56% were female and average age was 35.3 (SD:10.1) years. Mean pre-operative iHOT-12 score was 33(SD:18) and 59 (SD:28) at 1-year with a mean improvement of 26 (range: -61-93). There was a significant negative correlation between pre-operative anxiety/depression and iHOT-12 at both baseline and 1 year. There was no significant correlation between change in iHOT-12 (ΔiHOT-12) and pre-operative anxiety/depression. There was significant positive correlation between ΔiHOT-12 and change in anxiety/depression. Patients achieving MCID was significantly lower (47% vs. population mean of 63%) in the group with the highest pre-op anxiety scores.
Conclusion
Although there was a negative correlation between increased pre-operative anxiety/depression and iHOT-12 outcomes this correlation was not reflected in the relative improvement in outcomes. Those with greatest pre-operative anxiety/depression were at greater risk of not achieving MCID, however, they were most likely to see an improvement in their anxiety/depression scores. This study shows that although patients with increased anxiety/depression may achieve lower absolute outcomes they still benefit from relative improvement in outcomes and greater improvements in their anxiety/depression.