Psychiatric Diagnoses and Outcomes After Hip Arthroscopy: A Systematic Review and Meta-analysis
Alan D Villegas Meza1, Michael Nocek1, Blanca Morales Lugo2
1The Steadman Philippon Research Institute, Vail, Colorado, USA.
Background:
Psychiatric comorbidity-most commonly depression and anxiety-is frequently reported among patients undergoing hip arthroscopy and may influence postoperative trajectories, but existing analyses vary in scope and methods, limiting clinical interpretation.
Purpose:
To determine whether recorded psychiatric diagnoses are associated with worse surgical, patient-reported, and health care utilization outcomes after hip arthroscopy.
Study Design:
Systematic review and meta-analysis; Level of evidence, 3.
Methods:
The authors conducted a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-compliant search (International Prospective Register of Systematic Reviews [PROSPERO] CRD420251101816) of the MEDLINE, Embase, Web of Science, and PsycINFO databases to identify studies comparing postoperative outcomes in patients undergoing hip arthroscopy with and without recorded psychiatric diagnoses. Two reviewers independently screened, extracted data, and assessed the risk of bias using the Risk of Bias in Non-randomized Studies of Interventions tool. Primary endpoints were arthroscopy failure, revision, conversion to total hip arthroplasty (THA), and readmission. Secondary endpoints included the modified Harris Hip Score (mHHS), International Hip Outcome Tool-12 (iHOT-12) score, visual analog scale (VAS) pain score, and costs. Random-effects meta-analyses with Hartung-Knapp-Sidik-Jonkman intervals, prediction intervals, leave-one-out sensitivity analyses, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) certainty assessment were performed.
Results:
Eighteen comparative studies were included. Recorded psychiatric diagnoses were associated with higher odds of revision (k = 5; OR, 2.53; 95% CI, 1.87-3.43) and arthroscopy failure (k = 5; OR, 1.76; 95% CI, 1.41-2.20). No association was observed with conversion to THA (k = 5; OR, 1.00; 95% CI, 0.72-1.38). Readmissions were modestly increased (k = 3; OR, 1.37; 95% CI, 1.02-1.84). Patients with psychiatric diagnoses reported worse outcomes (mHHS mean difference [MD], -8.85 [k = 3], VAS pain score MD, +10.67 [k = 4], and iHOT-12 MD, -9.50 [k = 2]). GRADE certainty ranged from very low (most patient-reported outcomes and complications) to moderate (revision). Heterogeneity and variable exposure definitions limited some inferences; cost data were narratively summarized.
Conclusion:
Recorded psychiatric diagnoses are associated with substantially higher odds of revision and arthroscopy failure, modestly higher readmissions, and worse postoperative pain and function, but not with conversion to THA within the available follow-up. Findings support routine preoperative psychiatric screening and perioperative co-management to identify and optimize higher-risk patients.
