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Published on: July 2, 2021
Psychiatric Comorbidity Is Associated With Increased Failure Rates and Inferior Clinical Outcomes After Hip
Rushani K Cameron1, Isabella Jazrawi1, Samuel R Montgomery1
1Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA.
Background:
Psychiatric comorbidity has been linked to inferior orthopaedic outcomes, but studies evaluating its impact on survivorship after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) in the long term remain limited.
Purpose:
To evaluate the association between preoperative psychiatric comorbidity, particularly among those who are using psychotropic medications, and failure, patient-reported outcome measure (PROM) scores, and failure-free survivorship after hip arthroscopy for FAIS at a minimum 10-year follow-up.
Study Design:
Cohort study; Level of evidence, 3.
Methods:
A retrospective review was performed on 243 adult patients who underwent primary hip arthroscopy for FAIS between 2010 and 2014. A preoperative psychiatric comorbidity diagnosis and psychotropic medication use were identified through a medical record review. Failure was defined as revision hip arthroscopy or conversion to total hip arthroplasty. Kaplan-Meier analysis was used to assess failure-free survivorship. Logistic regression analyses were performed to evaluate associations between psychiatric comorbidity and failure. PROMs, including the modified Harris Hip Score (mHHS) and Non-Arthritic Hip Score (NAHS), were administered preoperatively and at 10-year follow-up. A post hoc power analysis was performed using a 2-proportion model. Significance was considered at P < .05.
Results:
Psychiatric comorbidity was present in 73 patients (30.0%), and psychotropic medication use was identified in 51 patients (21.0%). Failure occurred in 26 patients (10.7%) overall and was more common among those with psychiatric comorbidity compared with those without (23.3% vs 5.3%, respectively; P < .001). Patients with psychiatric comorbidity demonstrated inferior failure-free survivorship times (11.49 vs 13.68 years, respectively; P = .0105) and lower 2-, 5-, and 10-year survivorship rates. On adjusted multivariable analysis, anxiety, depression, combined anxiety and depression, and combined psychiatric comorbidity and psychotropic medication use were independently associated with increased odds of failure (all P≤ .002). Although both the psychiatric comorbidity and no psychiatric comorbidity groups improved significantly, patients with psychiatric comorbidity achieved smaller improvements and lower postoperative PROM scores.
Conclusion:
Psychiatric comorbidity was associated with increased failure rates, reduced long-term survivorship, and lower PROM scores after hip arthroscopy for FAIS.