Psychiatric comorbidity was linked to higher failure ten years after hip arthroscopy

Design

Retrospective cohort with minimum 10-year follow-up (Level 3)

Population

243 adults after primary hip arthroscopy for femoroacetabular impingement syndrome, 2010 to 2014

Primary outcome

Failure: revision hip arthroscopy or conversion to hip replacement

Effect

23.3% vs 5.3% (P < .001); failure-free survival 11.49 vs 13.68 years

This retrospective cohort followed 243 adults for at least ten years after primary hip arthroscopy for femoroacetabular impingement syndrome (2010 to 2014). Psychiatric comorbidity was recorded in 73 (30.0%) and psychotropic medication use in 51 (21.0%). Failure, meaning revision arthroscopy or conversion to hip replacement, occurred in 26 (10.7%).

Failure was more common with psychiatric comorbidity: 23.3% against 5.3% (P < .001). Failure-free survival was 11.49 years against 13.68 years. In adjusted analyses, anxiety, depression and combined anxiety and depression were each independently associated with failure (all P at or below .002). Both groups improved, but the comorbidity group improved less and ended with lower scores.

This is not a reason to withhold surgery. It supports identifying mental health comorbidity before operating, setting expectations accordingly and coordinating care. The medical-record definition of comorbidity and the retrospective design limit the conclusions.

• Ask about anxiety, depression and psychotropic medication in the pre-operative assessment.
• Counsel patients with these conditions that outcomes may be less favourable and revision more likely.
• Consider arranging mental health support alongside surgery and rehabilitation.
• Do not decline surgery on this basis alone; both groups improved.
• Record the comorbidity so long-term outcomes can be interpreted.

Why it matters

Mental health is a modifiable and often unmeasured predictor of surgical outcome.

Don't overread it

Retrospective and single-centre; it shows an association with failure and does not show that treating the psychiatric condition improves surgical outcomes.

The statistics, in plain English

A failure rate of 23.3% against 5.3% is a large absolute gap. Comorbidity was taken from medical records, so milder or undiagnosed problems could be missed, and a retrospective design cannot separate mental illness from other factors such as pain behaviour or follow-up patterns.

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