Patients with Preoperative Psychological Distress Obtain Meaningful Clinical Benefit After Hip Arthroscopy: A Propensity-Matched Analysis of Midterm Outcomes.

PURPOSE To evaluate the influence of baseline psychological distress on patient-reported outcomes (PROs) following arthroscopic hip surgery for femoroacetabular impingement (FAI) at a minimum of five years. METHODS Demographic and intraoperative data were prospectively collected on patients who underwent primary arthroscopic hip surgery for FAI and labral tear after failing conservative management between June 2012 and December 2014. Included patients had preoperative and minimum 5-year postoperative PROs and Visual Analog Scale (VAS) scores for pain and satisfaction. The SF-12 Mental Component Summary (SF-12 MCS) was utilized to stratify patients into two cohorts. Patients with an average or above average score (SF-12 MCS ≥ 50) were considered psychologically non-distressed, while those who scored below average (SF-12 MCS < 50) were considered to have psychological distress. Distressed patients were propensity matched by age, gender, and body mass index (BMI) to an equal number of non-distressed patients. RESULTS Of the 153 hips which met inclusion criteria, 117 hips had minimum 5-year follow-up (76.5%). Eighty-two hips were included in the final analysis after propensity matching, with 41 in both the distressed and non-distressed cohorts. Preoperatively, patients in the distressed cohort reported inferior scores for all PROs. There was a significant difference in SF-12 MCS between groups at 2-years, but similar scores for all other PROs. At minimum 5-year follow-up, there were no differences between groups for any PRO. There were no differences in the rates of achieving the minimal clinically important difference (MCID) for all PROs nor in achieving the patient acceptable symptomatic state (PASS) for the Modified Harris Hip Score (mHHS). CONCLUSIONS Patients with baseline psychological distress may have lower functional status at the time of presentation but still gain meaningful clinical benefit and pain improvement from arthroscopic hip surgery, with midterm outcomes comparable to those obtained by patients without preoperative psychological distress.