Psychological impairment linked to worse outcomes in FAI after hip arthroscopy
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Clinically significant worse outcomes in patients with femoroacetabular impingement after hip arthroscopy were associated with baseline psychological impairment.
“We need to be screening these patients for anxiety and depression, even though they're presenting for an orthopedic problem,” Abby L. Cheng, MD, told Healio.com/Orthopedics. “We have the evidence to tell them that their psychological well-being may be affecting their hip pain and function, and it may be the motivation they need to start addressing their behavioral health.”
Cheng and colleagues performed a systematic review using Ovid Medline, Embase, Scopus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and ClinicalTrials.gov databases to identify studies that assessed patients with femoroacetabular impingement after hip arthroscopy. Ultimately, 12 studies met their criteria.
Investigators recorded descriptive measures of study quality and bias. Studies were analyzed with metanalyses with random effects models if they reported statistically comparable outcomes.
Eight of the 12 studies reported odds ratios and four studies reported mean postoperative patient-reported outcome measure scores (PROMS). All patient-reported outcome measures were scored between 0 and 100; higher numbers indicated favorable outcomes. After arthroscopy, patients with psychological impairment were less likely to have favorable outcomes. These patients reported worse postoperative PROM scores vs. nonimpaired patients.
Cheng said, “Now that we know depression and anxiety can affect hip-related health, we need to find ways of providing easier access to affordable, convenient behavioral health treatment for these patients. This may include integration of a psychologist into a multi-disciplinary orthopedic clinic, or it may mean we need to harness telehealth or other electronic technology. We also need to study whether depression and anxiety affect young hip patients who choose non-surgical care and who have other hip conditions such as acetabular dysplasia.”
Cheng added, “[As] health care providers, we need to advocate for better coverage of behavioral health treatment by third party payers, and we need to destigmatize depression and anxiety so that patients don't feel hesitant to seek help. – by Monica Jaramillo
Disclosure: The researchers report no relevant financial disclosures.
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