A quarter of hip arthroscopy patients carried a psychiatric diagnosis, and coding missed most of them

Design

PRISMA systematic review and random-effects meta-analysis of prevalence; Level III

Population

38 observational studies of adults undergoing hip arthroscopy, literature to June 2025

Primary outcome

pooled prevalence of psychiatric diagnosis, anxiety, depression and prior opioid use

Effect

any psychiatric diagnosis 24.6% (95% CI 17.3-33.8, I² 99.3%); anxiety 16.6% (13.1-20.7); depression 12.9% (7.5-21.3); prior opioid use 14.8% (5.7-33.4)

A systematic review pooled 38 observational studies of adults presenting for hip arthroscopy. Pooled prevalence was 24.6% for any psychiatric diagnosis (95% CI 17.3-33.8), 16.6% for anxiety (13.1-20.7), 12.9% for depression (7.5-21.3) and 14.8% for prior opioid use (5.7-33.4).

The methodological finding is more useful than the prevalence. Studies using validated screening instruments found substantially more than studies relying on diagnostic codes, and meta-regression attributed part of the between-study variation to ascertainment method - 13.6% for any psychiatric diagnosis and 33.1% for anxiety. Heterogeneity was extreme throughout, with I² above 98% for every outcome, so the pooled numbers are best read as a range rather than as an estimate.

Why this matters to a hip surgeon rather than a psychiatrist: psychiatric comorbidity and preoperative opioid use are among the more consistent predictors of poorer patient-reported outcomes after hip arthroscopy, and the case selection that determines those outcomes happens in clinic. If the information is only ever taken from the referral letter or the coded past history, roughly a third of the anxiety in the clinic list is invisible. A two-minute validated screener at the preoperative visit is the entire intervention being proposed here.

• Add a brief validated anxiety and depression screener to the preoperative hip arthroscopy assessment
• Ask directly about current and previous opioid use, including tramadol and combination analgesics bought over the counter
• Do not rely on the coded past medical history or the referral letter for either
• Use a positive screen to inform the conversation about expected outcome, not as a reason to refuse surgery
• Have a referral route agreed in advance, so a positive screen produces something other than a note

Why it matters

It says the preoperative information most predictive of a poor result is the information routinely not collected.

Don't overread it

Heterogeneity was extreme and these are prevalence estimates only - the review does not show that screening changes outcomes.

The statistics, in plain English

An I² above 98% means almost all the variation between studies reflects genuine differences between them rather than chance, so the pooled prevalence is not really a single number describing a single population - it is an average across very different cohorts and definitions. That is why the confidence interval for prior opioid use runs from 5.7% to 33.4%: the studies simply do not agree. The reliable finding is the comparison inside the analysis - screeners find more than codes - not the pooled percentages themselves.

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