Anxiety and depression linked to failure 10 years after hip arthroscopy

Design

Retrospective cohort, minimum 10-year follow-up

Population

243 adults after primary hip arthroscopy for femoroacetabular impingement

Primary outcome

Failure (revision arthroscopy or conversion to THA)

Effect

Failure 23.3% with psychiatric comorbidity vs 5.3% without

This retrospective cohort followed 243 adults for at least 10 years after primary hip arthroscopy for femoroacetabular impingement syndrome, performed between 2010 and 2014.

Thirty per cent had a psychiatric diagnosis before surgery and 21% took psychotropic medication. Failure, defined as revision arthroscopy or conversion to hip replacement, occurred in 23.3% with psychiatric comorbidity vs 5.3% without (P < .001). Anxiety, depression, both together, and psychiatric comorbidity with medication use were each independently associated with failure after adjustment. Both groups improved, but patients with psychiatric comorbidity improved less.

This does not mean patients with anxiety or depression should be refused surgery; they still improved. It does support identifying them before surgery, setting expectations honestly and treating the mental health problem alongside the hip. Being a single-centre observational study, it cannot separate the psychiatric diagnosis from factors that travel with it, such as pain sensitisation.

• Ask about anxiety, depression and psychotropic use before listing for hip arthroscopy.
• Discuss a higher chance of revision or conversion, and smaller gains, with patients who have psychiatric comorbidity.
• Coordinate with the GP or psychiatrist so mental health treatment is optimised before surgery.
• Do not use a psychiatric diagnosis alone as a reason to deny arthroscopy; these patients still improved.

Why it matters

A condition often left out of the surgical assessment tracked with a four-fold difference in failure.

Don't overread it

Observational and single-centre; the association does not prove that treating depression would prevent failure.

The statistics, in plain English

Failure in 23.3% vs 5.3% is roughly a four-fold difference, but with 26 failures in total the estimate is imprecise. The adjusted analysis supports an independent association; the abstract does not give odds ratios.

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