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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

Lookup NU author(s): Ajay MalviyaORCiD

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Abstract

© 2026 the Arthroscopy Association of North America. 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 1st/2nd 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.

Publication metadata

Author(s): van Duren BH, Pursun Y, Andrade AJ, Bankes MJK, Khanduja V, Malviya A

Publication type: Article

Publication status: Published

Journal: Arthroscopy

Year: 2026

Volume: 42

Issue: 2

Pages: 455-464

Online publication date: 24/03/2026

Acceptance date: 18/07/2025

ISSN (print): 0749-8063

ISSN (electronic): 1526-3231

Publisher: John Wiley and Sons Inc.

URL: https://doi.org/10.1002/arj.70014

DOI: 10.1002/arj.70014

PubMed id: 41877428

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