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Comorbidities in the first 2 years after arthroscopic hip surgery: substantial increases in mental health disorders, chronic pain, substance abuse and cardiometabolic conditions
  1. Daniel I Rhon1,2,
  2. Tina A Greenlee1,
  3. Bryant G Marchant3,
  4. Charles Dennis Sissel4,
  5. Chad E Cook5
  1. 1 Department of Rehabilitation Medicine, Center for the Intrepid, Brooke Army Medical Center, San Antonio, Texas, USA
  2. 2 Doctoral Program in Physical Therapy, Baylor University, Fort Sam Houston, Texas, USA
  3. 3 Department of Orthopaedics and Rehabilitation, Madigan Army Medical Center, Tacoma, Washington, USA
  4. 4 Program Analysis and Evaluation Division, US Army Medical Command, Fort Sam Houston, Texas, USA
  5. 5 Division of Physical Therapy, Department of Orthopedics, Duke University, Durham, North Carolina, USA
  1. Correspondence to Dr Daniel I Rhon, Department of Rehabilitation Medicine, Brooke Army Medical Center, San Antonio, TX 78234, USA; daniel_rhon{at}


Objectives We aimed to identify the rate of seven comorbidities (mental health disorders, chronic pain, substance abuse disorders, cardiovascular disorders, metabolic syndrome, systemic arthropathy and sleep disorders) that occurred within 2 years after hip arthroscopy.

Methods Data from individuals (ages 18–50 years) undergoing arthroscopic hip surgery between 2004 and 2013 were collected from the Military Health System (MHS) Data Repository (MDR). The MDR captures all healthcare encounters in all settings and locations for individuals within the MHS. Person-level data over 36 months were pulled and aggregated. Seven comorbidities related to poor outcomes from musculoskeletal disorders (mental health disorders, chronic pain, substance abuse disorders, cardiovascular disorders, metabolic syndrome, systemic arthropathy and sleep disorders) were examined 12 months prior and 24 months after surgery. Changes in frequencies were calculated as were differences in proportions between presurgery and postsurgery.

Results 1870 subjects were identified (mean age 32.24 years; 55.5% men) and analysed. There were statistically significant increases (p<0.001) proportionally for all comorbidities after surgery. Relative to baseline, cases of mental health disorders rose 84%, chronic pain diagnoses increased 166%, substance abuse disorders rose 57%, cardiovascular disorders rose by 71%, metabolic syndrome cases rose 85.9%, systemic arthropathy rose 132% and sleep disorders rose 111%.

Conclusions Major (potentially ‘hidden’) clinical comorbidities increased substantially after elective arthroscopic hip surgery when compared with preoperative status. These comorbidities appear to have been overlooked in major studies evaluating the benefits and risks of arthroscopic hip surgery.

Level of evidence Prognostic, level III.

  • arthroscopic surgery
  • hip
  • cohort study
  • health

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  • Contributors DIR: received funding for the study; CDS: developed the extraction syntax and was responsible for data preparation for analyses; DIR, CEC and BGM: were involved in study question and design; DIR, CEC and TAG: were involved with analysing the data. All authors were involved and approved primary manuscript and revisions.

  • Funding This research was supported by an internal grant from the US Defense Health Agency (W911Qy-15-1-0016).

  • Disclaimer The view(s) expressed herein are those of the author(s) and do not reflect the official policy or position of Madigan Army Medical Center, Brooke Army Medical Center, the U.S. Army Medical Department, the U.S. Army Office of the Surgeon General, the Department of the Army, the Department of the AIr Force, or the Department of Defense, or the U.S. Government.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval US Army Regional Health Command - Central IRB.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data belong to the US Defense Health Agency and can be shared if proper Data Sharing Agreement Applications are filed and approved through the Privacy Board Data Sharing Office at DHA.