Poor preoperative mental health status linked to worse outcomes after hip arthroscopy

BOSTON — Results presented at the American Orthopaedic Society for Sports Medicine Annual Meeting showed preoperative mental health status was more predictive of 1-year patient-reported outcomes of hip pain and function compared with intraoperative findings during hip arthroscopy for femoroacetabular impingement.

Perspective from Sanjeev Bhatia, MD

James T. Rosneck , MD, from the department of orthopedic surgery at Cleveland Clinic, and colleagues collected baseline patient-reported outcome measures, including hip disability and osteoarthritis outcome score (HOOS) for pain, HOOS-physical function short form, Veterans RAND 12-Item Health Survey (VR-12) and UCLA Activity Score, for 494 patients undergoing hip arthroscopy for femoroacetabular impingement.

Overall, 377 patients completed both preoperative and 1-year patient-reported outcome measures. Multivariate analysis results showed baseline pain and function had a significant impact on postoperative outcomes at 1 year. Researchers found patients with grade 3 or 4 articular cartilage damage had worse pain and physical function scores. Results also showed patients who were smokers preoperatively had worse postoperative outcomes, and patients with worse VR-12 scores had less improvement in patient-reported outcome measurements.

“The mental health scores had a more significant impact at 1 year than any of the other [outcome measures], which is a little bit counterintuitive,” Rosneck told Healio.com/Orthopedics. “You would think their joint status would be more indicative of how they would do at 1 year, where in reality, their psychiatric or mental health status has more of an impact.” – by Casey Tingle

Reference:

Lynch TS, et al. Abstract 21. Presented at: American Orthopaedic Society for Sports Medicine Annual Meeting; July 11-14, 2019; Boston.

Disclosure: Rosneck reports no relevant financial disclosures.

Perspective

Sanjeev Bhatia, MD

As our understanding of hip biomechanics and femoroacetabular impingement syndrome evolves, the desire to optimize function and recovery of hip arthroscopy patients persists. Paramount to these efforts is appreciating the role that psychosocial factors play in the manifestation of hip pain and ability to cope with the demands of surgical recovery.

In this prospective cohort analysis, the authors assessed how baseline data, mental health scores and smoking status influenced postoperative rehabilitation, recovery and final outcome after hip arthroscopy. Using multivariate analyses, they found that baseline characteristics, mental health and smoking status are bigger predictors of the hip disability osteoarthritis and outcome score at 1 year than even intra-articular factors, such as chondral damage or extent of labral tearing.

The findings of this study underscore the need to more extensively study how mental health and other psychological factors influence a patient’s perception of joint pain. The Biopsychosocial Model of Medicine, first proposed by George L. Engel, MD, in 1977, implies that behaviors and thoughts strongly influence a disease state. Given this reality, many integrative programs in cardiology and oncology have begun to optimize mental health through counseling, education and stress reduction postoperatively. As orthopedic surgeons, we may want to consider such efforts as well.

Reference:

Engel GL. Science. 1977;196:129-136.

Sanjeev Bhatia, MD

Orthopedic surgeon, Northwestern Medicine

Co-director, Hip and Knee Joint Preservation Center

Northwestern Medicine Central DuPage Hospital

Winfield, Illinois

Disclosures: Bhatia reports no relevant financial disclosures.

American Orthopaedic Society for Sports Medicine Annual Meeting

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Poor preoperative mental health status linked to worse outcomes after hip arthroscopy

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