Anxiety and depression linked to hip arthroscopy failure at ten years

Design

Retrospective single-centre 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 arthroplasty)

Effect

23.3% with psychiatric comorbidity vs 5.3% without (P<0.001)

A single-centre US series reviewed 243 adults who had primary hip arthroscopy for femoroacetabular impingement between 2010 and 2014. Failure was revision arthroscopy or conversion to total hip arthroplasty, at a minimum of ten years.

Thirty per cent had a psychiatric diagnosis before surgery. Failure occurred in 23.3% of them against 5.3% of the rest. Anxiety, depression and psychotropic medication use were each independently associated with higher odds of failure after adjustment. Both groups improved, but those with psychiatric comorbidity improved less and finished with lower hip scores.

This is retrospective and observational: a psychiatric diagnosis may mark pain sensitisation, different expectations or a lower threshold for further surgery rather than a worse hip. It does not mean these patients should be denied surgery, but it is a reason to screen and set expectations.

• Ask about anxiety, depression and psychotropic medication before offering hip arthroscopy.
• Discuss a higher chance of revision or conversion with patients who have a psychiatric diagnosis.
• Consider optimising mental health care before elective hip preservation surgery.
• Record baseline patient-reported scores so improvement can be judged fairly.

Why it matters

It puts a ten-year number on a risk factor that is usually left out of the consent discussion.

Don't overread it

This was observational — it cannot show that treating depression would improve the hip outcome.

The statistics, in plain English

The difference between 23% and 5% failure is large, but it comes from 73 patients with a psychiatric diagnosis at one centre, so the true size could be smaller. Adjustment for measured factors cannot remove unmeasured ones.

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