Pre-operative Anxiety and Depression Predict Functional Outcomes After Periacetabular Osteotomy and Hip Arthroscopy Surgery

Background: The EuroQol-5D (EQ-5D) anxiety/depression dimension has been shown to be predictive of pain and patient satisfaction after total hip replacement. We investigated whether EQ-5D anxiety/depression dimension can predict patient-reported pain and function before and after periacetabular osteotomy (PAO) and hip arthroscopy (HA) surgery.

Methods: Patients undergoing PAO or HA at a single institution between 2013 and 2021 completed EQ-5D and Hip disability and Osteoarthritis Outcome Score (HOOS) questionnaires at their pre-operative and annual post-operative clinical visits. The EQ-5D assessment asked patients to rate their anxiety/depression from none, moderate, to extreme. The HOOS assessment generated scores for symptoms, pain, daily living function, sports and recreational activities function, and quality of life (QoL). Pre-operative anxiety/depression reports were compared to pre-operative HOOS scores using multivariable regression and compared to post-operative HOOS scores using mixed-effects models.

Results: 76 patients (59 female) with PAO or HA were included. Mean age was 24.9 years (range:10.2-58.5 years). Average follow-up time from surgery was 2.1 years (range: 1.0-6.1 years). Compared to patients with no anxiety/depression pre-operatively, patients with moderate anxiety/depression had worse pre-operative HOOS sports and recreational activities scores (p=0.046) and QoL scores (p=0.006), and patients with extreme anxiety/depression pre-operatively had worse pre-operative HOOS pain scores (p=0.039) and daily living scores (p=0.018). Patients with moderate anxiety/depression pre-operatively had worse post-operative HOOS pain scores compared to patients with no anxiety/depression pre-operatively (p=0.035).

Conclusion: Compared to patients who reported no anxiety/depression before PAO or HA, patients who reported moderate or extreme levels of anxiety/depression before surgery had worse pain and functional outcomes before and after hip preservation surgery. Findings suggest that clinicians should assess anxiety/depression scores prior to PAO or HA surgery to help identify and potentially address psychosocial needs of patients who may be at risk for inferior postoperative outcomes.