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Symptoms in patients with FAI correlated more with mental health scores vs severity of tear, deformity
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Investigators found symptom severity correlated more with mental health status than with the size of labral tear or femoroacetabular deformity among patients with femoroacetabular impingement.
Researchers identified 64 patients with arthroscopically treated labral tears and cam deformities. Patient factors, surgical findings, mental health factors, magnitude of femoroacetabular impingement deformity, preoperative hip dysfunction and osteoarthritis outcome score (HOOS) subscales were assessed to determine any correlations. Patients with low and high mental health scores were compared for patient factors, surgical findings, radiographic findings and preoperative HOOS scores.
Results showed significant and potentially meaningful correlations between mental health scores and HOOS pain and activity of daily living scores. Mental health was also linked to HOOS symptom and pain scores. Investigators noted no significant associations between HOOS scores, hip pathology and patient-related factors.
Patients with a low mental health score had significantly lower preoperative scores for the five HOOS subscales. These patients had chondral lesions and comorbid depression more often than patients with a higher mental health score. – by Monica Jaramillo
Disclosures: Jacobs reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
Perspective
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Joshua D. Harris, MD
Jacobs and colleagues have published an excellent study using a prospectively collected patient-reported outcomes (PRO) database of subjects with FAI that underwent arthroscopic hip preservation surgery. The impact of mental health has been well documented in many musculoskeletal disorders including back pain, shoulder injuries and joint replacement patients, among others. The authors sought to compare mental health factors using VR-12 MCS (mental component score), depression and use of psychiatric and/or opioid medications) to patient- and hip-specific demographics, including preoperative HOOS subscores.
In [their work], not surprisingly, hip imaging and surgical findings did not correlate with pain or symptoms. However, low VR-12 MCS significantly correlated with all five HOOS subscores and the presence of more severe articular cartilage injury. The take-home message of this study is to “treat the patient, and not the X-ray.”
This study adds to the rapidly growing evidence base that strongly illustrates the role of mental wellness in influencing orthopedic outcomes. It further proves that orthopedic clinicians must be able to “identify and treat” or “identify and refer” patients with mental disorders and concomitant musculoskeletal injuries. Tunnel vision “bone broke, me fix” will not optimize outcomes if mental disorders are missed or ignored. Further research needs to better clarify how best to evaluate and manage these patients.
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