Arthroscopy - 2026-03-24 - Journal Article
Patients With Increased Anxiety and Depression Scores Are at Greater Risk of Not Achieving a Meaningful Improvement in Patient-Reported Outcomes After Hip Arthroscopy for Femoroacetabular Impingement Syndrome.
van Duren BH, Pursun Y, Andrade AJ, Bankes MJK, Khanduja V, Malviya A
Topics
Key Takeaway
Patients with the highest preoperative anxiety/depression scores achieved MCID on iHOT-12 at significantly lower rates than those without (47% vs 63%, P=.031) after hip arthroscopy for FAI syndrome.
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Summary
This study used the UK Non-Arthroplasty Hip Registry (2012–2024) to determine whether preoperative anxiety/depression, measured via EQ-5D-5L question 5, predicts iHOT-12 outcomes at 1 year in patients undergoing primary hip arthroscopy for FAI syndrome. Anxiety/depression correlated negatively with absolute iHOT-12 scores at baseline and 1 year (r=-0.309, P<.001), but did not correlate with the magnitude of change (ΔiHOT-12, r=0.028, P=.206). Despite lower MCID achievement rates in the highest-anxiety cohort (47% vs 63%), this group paradoxically showed the greatest improvement in anxiety/depression scores at 1 year.
Key Limitation
Anxiety/depression classification relies on a single EQ-5D-5L domain item rather than a validated psychiatric screening tool, precluding differentiation of anxiety from depression and preventing severity-based dose-response analysis.
Original Abstract
PURPOSE
To evaluate whether patients undergoing arthroscopic intervention for femoroacetabular impingement syndrome with preoperative anxiety or depression potentially experience reduced benefit from arthroscopic surgery.
METHODS
All patient pathways (hips) over 18 years entered into the UK Non-Arthroplasty Hip Registry between 2012 and 2024 who underwent arthroscopic intervention for femoroacetabular impingement syndrome were included. Exclusions were revision procedures, planned 1 st /2 nd of a two-stage procedure. Patient demographics, EuroQol 5-Dimension 5-Level, and International Hip Outcome Tool-12 (iHOT-12) scores preoperatively and 1-year were recorded. EuroQol 5-Dimension 5-Level question 5 was used as a surrogate for anxiety/depression. The iHOT-12 score was used to quantify outcomes of hip function.
RESULTS
We identified 5109 hips that underwent hip arthroscopy for femoroacetabular impingement syndrome; 56% were female, with an average age of 35.3 (SD: 10.1) years. Mean preoperative iHOT-12 score was 33 (SD: 18) and at 1-year 59 (SD: 28) with a mean improvement of 26 (range: -61 to 93). There was a significant negative correlation between preoperative anxiety/depression and iHOT-12 at both baseline and 1 year (r = -0.309, P < .001). There was no significant correlation between change in iHOT-12 (ΔiHOT-12) (r = 0.0282, P = .206). Among female patients, 66% improved by minimally clinically important difference, whereas only 61% of males did (P = .049). Patients achieving minimally clinically important difference was significantly lower (47% vs 63%, P = .031) in the group with the highest preop anxiety scores. At 1 year, 33% of patients reported improvement, 49% showed no change, and 18% experienced worsening in their anxiety/depression scores. Patients with higher preoperative scores showed the greatest improvement.
CONCLUSIONS
This study showed a negative correlation between increased anxiety/depression and iHOT-12 outcomes; however, this was not reflected in the relative improvement in outcomes. Those with greatest preoperative anxiety/depression were at greater risk of not achieving minimally clinically important difference yet were most likely to see an improvement in their anxiety/depression scores.
LEVEL OF EVIDENCE
Level III, retrospective comparative case series.