- Design
- Single-centre retrospective cohort, minimum 10-year follow-up
- Population
- 243 adults with primary hip arthroscopy for femoroacetabular impingement, 2010–2014
- Primary outcome
- Failure: revision arthroscopy or conversion to total hip arthroplasty
- Effect
- 23.3% with psychiatric comorbidity vs 5.3% without (P<0.001)
A single-centre US review of 243 adults who had primary hip arthroscopy for femoroacetabular impingement between 2010 and 2014 looked at outcomes at ten years or more. Thirty per cent had a recorded psychiatric diagnosis before surgery.
Failure, defined as revision arthroscopy or conversion to hip replacement, occurred in 23.3% of those with psychiatric comorbidity and 5.3% of those without. Anxiety, depression and their combination were each independently associated with failure after adjustment. Both groups improved on patient-reported scores, but the gains were smaller with psychiatric comorbidity.
This is an association in a retrospective series. Psychiatric illness may be a marker for pain sensitisation, different expectations, or other factors not captured, rather than a direct cause of failure.
The practical response is to identify anxiety and depression before surgery, set realistic expectations, and involve mental health care where it helps, not to deny patients an operation that still improved them.
- Screen for anxiety and depression before hip arthroscopy for femoroacetabular impingement
- Discuss a higher chance of revision or conversion with patients who have psychiatric comorbidity
- Patients with psychiatric comorbidity still improved; this is not a reason to refuse surgery
- Consider referral for psychological support alongside surgical planning
Why it matters
It puts psychological health into the preoperative risk conversation for young adults with hip pain.
Don't overread it
The design shows association, not that treating anxiety or depression would prevent failure.
The statistics, in plain English
23.3% versus 5.3% is a large difference, but it comes from 26 failures in 243 patients in one centre. Retrospective record review can misclassify psychiatric status, and unmeasured factors may explain part of the gap.
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