Psychiatric comorbidity quadrupled failure after hip arthroscopy at ten years

Design

Retrospective cohort study with Kaplan-Meier survivorship and multivariable logistic regression; level of evidence 3

Population

243 adults after primary hip arthroscopy for femoroacetabular impingement syndrome, 2010-2014, minimum 10-year follow-up

Primary outcome

Failure, defined as revision hip arthroscopy or conversion to total hip arthroplasty

Effect

Failure 23.3% with psychiatric comorbidity versus 5.3% without (P<.001); mean failure-free survivorship 11.49 versus 13.68 years (P=.0105)

Short-term studies have linked anxiety and depression to worse orthopaedic outcomes. This retrospective cohort followed 243 adults who had primary hip arthroscopy for femoroacetabular impingement syndrome between 2010 and 2014, to a minimum of ten years. Failure was defined concretely: revision hip arthroscopy or conversion to total hip arthroplasty.

Psychiatric comorbidity was present in 73 patients (30.0%), and 51 (21.0%) were on psychotropic medication. Failure occurred in 26 patients (10.7%) overall — but in 23.3% of those with psychiatric comorbidity against 5.3% of those without (P<.001). Mean failure-free survivorship was 11.49 years against 13.68 (P=.0105), with lower survivorship at two, five and ten years. On adjusted multivariable analysis, anxiety, depression, both together, and comorbidity combined with psychotropic use were each independently associated with increased odds of failure (all P≤.002).

Both groups improved on modified Harris Hip Score and Non-Arthritic Hip Score. The comorbid group improved less and finished lower. That matters for how this is used: the finding is not that these patients should not be offered surgery. It is that the consent conversation and the expected trajectory are different, and that a fifth of them will come back needing something more.

• Ask about anxiety and depression as part of the preoperative assessment, not as an aside
• Adjust the expectation you set — smaller improvement, not no improvement
• A 23% ten-year failure rate is a number to say out loud during consent
• Consider whether psychological support alongside rehabilitation changes the trajectory; this study cannot say
• Psychotropic use was a marker here, not a target — do not tell patients to stop medication

Why it matters

It changes what a realistic outcome looks like for nearly a third of the patients on a hip arthroscopy list.

Don't overread it

This is observational; treating the psychiatric comorbidity has not been shown to improve the surgical outcome.

The statistics, in plain English

This is a level 3 cohort study, so psychiatric comorbidity is associated with failure — it is not shown to cause it. Comorbidity was identified from record review, which will under-count it, and undercounting pushes the two groups together rather than apart, so the real gap may be wider. With 26 failures in total, the adjusted model is fitting several predictors to a small number of events, which makes the individual odds ratios less stable than the overall difference.

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