Original Article
Preoperative Depression Is Negatively Associated With Function and Predicts Poorer Outcomes After Hip Arthroscopy for Femoroacetabular Impingement

https://doi.org/10.1016/j.arthro.2018.03.020Get rights and content

Purpose

(1) To determine the prevalence of depression in patients undergoing hip arthroscopy for the treatment of femoroacetabular impingement (FAI) syndrome and (2) to determine whether depression has a statistically significant and clinically relevant effect on preoperative and postoperative patient-reported outcome scores.

Methods

Consecutive subjects undergoing hip arthroscopy for FAI syndrome were retrospectively reviewed. The Beck Depression Inventory-II (BDI-II), Hip Outcome Score (HOS), and 33-item International Hip Outcome Tool (iHOT-33) were administered preoperatively and postoperatively. Clinically relevant differences were defined by the minimal clinically important difference, substantial clinical benefit, and patient acceptable symptom state. Comparisons between preoperative and postoperative scores were completed. The Spearman correlation coefficient (r) was used to determine the degree of correlation between the BDI-II score, HOS, and iHOT-33 score preoperatively and postoperatively.

Results

We analyzed 77 patients (72.7% female patients; mean age, 35.2 ± 12.5 years). Depressive symptoms were reported as minimal (75.3%), mild (11.7%), moderate (6.5%), or severe (6.5%). Patients with minimal or mild depression had a superior HOS Activities of Daily Living (Δ17.3 preoperatively [P < .001] and Δ37.8 postoperatively [P < .001]), HOS Sport-Specific Subscore (Δ12.8 preoperatively [P = .002] and Δ52.1 postoperatively [P < .0001]), and iHOT-33 score (Δ15.4 preoperatively [P < .0001] and Δ51.3 postoperatively [P < .0001]) compared with patients with moderate or severe depression. There was a weak to moderate negative correlation between the BDI-II score and iHOT-33 score (r = −0.4614, P < .0001 preoperatively; r = −0.327, P < .0001 at 1 year), HOS Activities of Daily Living (r = −0.531, P < .0001 preoperatively), and HOS Sport-Specific Subscore (r = −0.379, P < .0017 at 1 year).

Conclusions

Most patients undergoing hip arthroscopy for FAI have minimal depressive symptoms with the overall prevalence higher than the general population. Patients with minimal or mild depressive symptoms have statistically and clinically better preoperative and postoperative patient-reported outcomes, are more likely to obtain substantial clinical benefit from surgery, and are more likely to reach a patient acceptable symptom state after surgery than patients with moderate to severe depressive symptoms.

Level of Evidence

Level III, case-control study.

Section snippets

Methods

Institutional review board approval was obtained for this retrospective review of consecutive subjects who underwent hip arthroscopy by a single fellowship-trained orthopaedic surgeon (T.J.E.), with a minimum of 1-year follow-up. Subjects with FAI syndrome (defined by the Warwick Agreement as a triad of symptoms, clinical signs, and imaging findings consistent with cam and/or pincer morphology) who had completed a minimum 3-month course of nonsurgical treatment (which included rest, activity

Results

We analyzed 77 patients. There were 21 male patients (27.3%) and 56 female patients (72.7%). The mean age was 35.2 ± 12.5 years. Of the subjects, 58 (75.3%) reported minimal depressive symptoms, whereas the remaining patients reported mild (11.7%), moderate (6.5%), or severe (6.5%) depressive symptoms as measured on the BDI-II.

Discussion

Patients with minimal or mild depressive symptoms have statistically and clinically better preoperative and postoperative PROs, are more likely to obtain SCB from surgery, and are more likely to reach a PASS after surgery than patients with moderate to severe depressive symptoms. There is a mild to moderate negative correlation between depressive symptoms and PROs at preoperative and postoperative time points. These findings confirm our hypotheses that (1) fewer than 50% of patients with FAI

Conclusions

Most patients undergoing hip arthroscopy for FAI have minimal depressive symptoms with the overall prevalence higher than the general population. Patients with minimal or mild depressive symptoms have statistically and clinically better preoperative and postoperative PROs, are more likely to obtain SCB from surgery, and are more likely to reach a PASS after surgery than patients with moderate to severe depressive symptoms.

References (52)

  • C.H. Cho et al.

    The impact of depression and anxiety on self-assessed pain, disability, and quality of life in patients scheduled for rotator cuff repair

    J Shoulder Elbow Surg

    (2013)
  • C. Bufalino et al.

    The role of immune genes in the association between depression and inflammation: A review of recent clinical studies

    Brain Behav Immun

    (2013)
  • M. Jiang et al.

    Comorbidity between depression and asthma via immune-inflammatory pathways: A meta-analysis

    J Affect Disord

    (2014)
  • C.L. Raison et al.

    Cytokines sing the blues: Inflammation and the pathogenesis of depression

    Trends Immunol

    (2006)
  • O. Gureje et al.

    The role of global traditional and complementary systems of medicine in treating mental health problems

    Lancet Psychiatry

    (2015)
  • P. Banerjee et al.

    Femoroacetabular impingement: A review of diagnosis and management

    Curr Rev Musculoskelet Med

    (2011)
  • J.C. Clohisy et al.

    Clinical presentation of patients with symptomatic anterior hip impingement

    Clin Orthop Relat Res

    (2009)
  • M.J. Philippon et al.

    Clinical presentation of femoroacetabular impingement

    Knee Surg Sports Traumatol Arthrosc

    (2007)
  • B.T. Kelly et al.

    Hip arthroscopy: Current indications, treatment options, and management issues

    Am J Sports Med

    (2003)
  • J.S. Frank et al.

    Hip pathology in the adolescent athlete

    J Am Acad Orthop Surg

    (2013)
  • S. Hammoud et al.

    The recognition and evaluation of patterns of compensatory injury in patients with mechanical hip pain

    Sports Health

    (2014)
  • M. Philippon et al.

    Femoroacetabular impingement in 45 professional athletes: Associated pathologies and return to sport following arthroscopic decompression

    Knee Surg Sports Traumatol Arthrosc

    (2007)
  • M.J. Philippon et al.

    Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction: Minimum two-year follow-up

    J Bone Joint Surg Br

    (2009)
  • M.J. Philippon et al.

    Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient: A preliminary report

    J Pediatr Orthop

    (2008)
  • J.W. Byrd et al.

    Arthroscopic management of femoroacetabular impingement in athletes

    Am J Sports Med

    (2011)
  • S.J. Nho et al.

    Outcomes after the arthroscopic treatment of femoroacetabular impingement in a mixed group of high-level athletes

    Am J Sports Med

    (2011)
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      The most common measures included history of psychiatric diagnosis and mental health medication use. Depression was measured by various scales, including the SF-12 MCS,46 Beck Depression Inventory-II (BDI-II),30 PHQ-8,31 or the Hospital Anxiety and Depression Scale.47 More general measures of emotional health or quality of life included VR-12 MCS,33 the World Health Organization Quality of Life,35 and the EuroQoL-5D.47

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    The authors report the following potential conflict of interest or source of funding: J.D.H. receives support from AAOS, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America. Board or committee member. Arthroscopy, Frontiers in Surgery. Editorial or governing board. NIA Magellan. Paid consultant. Smith & Nephew. Paid consultant, paid presenter or speaker. Ossur. Paid speaker. SLACK Incorporated. Publishing royalties, financial or material support. T.J.E. receives support from Medacta. Paid consultant. Acute Innovations. IP royalties. Full ICMJE author disclosure forms are available for this article online, as supplementary material.

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