The impact of mental health disorders on outcomes following hip arthroscopy for femoroacetabular impingement syndrome: a systematic review

Abstract

Hip arthroscopy for femoroacetabular impingement syndrome (FAI) has been shown to be beneficial in the short- to medium-term though outcomes vary between individuals. Multiple factors have been suggested to affect outcomes including pre-operative mental health disorders. We undertook a systematic review to assess the evidence relating to the effect of pre-existing mental health disorders on the outcomes following hip arthroscopy for FAI. Following PRISMA guidelines, a multi-database search was undertaken using three key concepts: ‘mental health’, ‘FAI’ and ‘hip arthroscopy’. Results were screened and data extracted from relevant studies. A total of six studies met the inclusion criteria including 2248 hips, all published between 2017 and 2019. All studies were of evidence level III or IV with reasonable methodological quality. One study demonstrated pre-operative depression to be related to altered pain reduction in the short-term following surgery. Three studies reported inferior outcomes in the medium-term (1–2 years) in those with worse mental health. One study demonstrated an increased risk of persistent pain 2 years following surgery and one a reduced chance of returning to active military service following surgery in those with worse mental health. Despite inferior outcomes individuals with mental health disorders did still benefit from surgery in general. In conclusion, the presence of pre-existing poor mental health is associated with inferior outcomes in the medium-term following arthroscopic surgery for FAI. Surgeons should consider screening patients for mental health disorders before surgery and counselling them appropriately as to the potential for less satisfactory surgical outcomes.

Association Between Comorbid Depression and Rates of Postoperative Complications, Readmissions, and Revision Arthroscopic Procedures After Elective Hip Arthroscopy

“…While a connection between mental health and PROs after hip arthroscopy for FAIS has been demonstrated, 8 , 21 , 23 , 24 our study is the first to our knowledge to show how mental health may affect postoperative complication and readmission rates in a large population of patients undergoing hip arthroscopy. Although this concept is novel to the field of hip arthroscopy, it has been demonstrated in patients with depression undergoing hip, knee, and shoulder arthroplasty, 27 , 31 who have been shown to be at increased risk of postoperative anemia, renal failure, and prosthetic joint infection.…”

“…10,11 A significant proportion of patients with FAIS have psychiatric disorders, with up to 35% of patients reported to have a diagnosis of depression or anxiety before elective hip arthroscopy. 16 These conditions are associated with inferior PROs after hip arthroscopy, 8,21,23,24 as well as an increased risk of chronic opioid use and higher health care costs. 15 Although several studies have demonstrated that patients with depression and anxiety experience less improvement in PROs after arthroscopic management of FAIS, 23,34 data are lacking on the effect of mental health conditions on postoperative complication rates, revision hip arthroscopy rates, and conversion to total hip arthroplasty (THA).…”

The predictive value of self-reported allergies for reoperation after index hip arthroscopy

“…This association may explain the results of the present study and similar investigations because psychological factors can influence the postoperative course and compromised mental wellness increases the likelihood of inferior patient-reported outcomes [ 14 , 18 , 31 , 32 ]. Further, preoperative mental health conditions associated with reduced postoperative hip function and poor surgical outcomes [ 15 , 17 , 33 ]. However, mental health well-being and its relationship with allergy status were not analyzed in the present study as it was outside of its original scope.…”

Low Back Pain, Psychiatric Disorders, and a Combination of Both Negatively Affect Hip Arthroscopy Outcomes in Servicemembers

“…The prevalence of PSYs among adults undergoing hip arthroscopy has been estimated as high as 50%, 15 and multiple studies have demonstrated the negative effect of PSYs on hip arthroscopy outcomes in the civilian population. 12,16,17,20,34,35 Conversely, in the military population, there is disagreement about the effect of PSYs on hip arthroscopy outcomes. In a retrospective review of 93 servicemembers who underwent arthroscopically assisted, mini-open hip surgery for FAI, Ernat et al 14 reported that 40% of servicemembers were taking mental health medication and this was associated with worse outcome scores and lower RTD rates.…”