Effects of Depression and/or Anxiety on the Outcomes of Hip Arthroscopy for Femoroacetabular Impingement and Labral Tears: A Minimum 5-Year Follow-up Study
Authors: Quesada-Jimenez R, Walsh EG, Keane JC, Kahana-Rojkind AH, Domb ES, Domb BG
DOI: 10.2106/JBJS.24.01054
Background
Depression and anxiety have been associated with poorer outcomes in various orthopedic surgeries. This study evaluates their impact on intermediate-term outcomes following hip arthroscopy for femoroacetabular impingement (FAI) and labral tears.
Methods
A retrospective propensity score–matched analysis was conducted on patients undergoing primary hip arthroscopy between 2008 and 2018. Patients self-reporting depression and/or anxiety were matched 1:1 to controls without these diagnoses. Outcomes assessed at a minimum 5-year follow-up included:
- PROs: mHHS, NAHS, HOS-SSS, iHOT-12, VAS, SF-12 Mental, VR-12 Mental
- Patient satisfaction
- Revision surgeries and complication rates
- Achievement of Patient Acceptable Symptom State (PASS)
Key Findings
- Both groups experienced significant improvement in all PROs over 5+ years.
- The depression/anxiety group had:
- Lower baseline scores in HOS-SSS, SF-12 Mental, and VR-12 Mental scales
- Lower final scores in mHHS, NAHS, HOS-SSS, SF-12 Mental, and VR-12 Mental
- Lower rates of PASS achievement for mHHS and HOS-SSS
- No significant difference in revision surgery or complication rates between groups.
- Despite lower absolute scores, the magnitude of improvement was similar between groups.
Conclusion
Patients with depression and/or anxiety achieve meaningful functional and quality-of-life improvements following hip arthroscopy. However, their absolute PRO scores remain lower both pre- and postoperatively, and they are less likely to reach symptom states deemed acceptable by patients without these mental health conditions.
What Does This Mean for Providers?
- Mental health status should be considered an important factor in preoperative evaluation and counseling for hip arthroscopy candidates.
- Patients with depression and/or anxiety may require tailored perioperative management, including mental health support, to optimize outcomes.
- Providers should set realistic expectations regarding postoperative symptom relief and functional gains in this population.
- Despite lower absolute scores, these patients still demonstrate clinically meaningful improvements, reinforcing that depression/anxiety are not contraindications for surgery.
- Close multidisciplinary collaboration with mental health professionals may enhance recovery trajectories and patient satisfaction.