Effect of A History of Anxiety and Depression on Patient-Reported Outcomes After Hip Arthroscopy at 2-Year Follow-up

Background: Patient resilience and mental health, including anxiety and depression, are increasingly recognized as critical factors influencing outcomes in orthopaedic surgery. However, the relative effect of these psychosocial factors on postoperative outcomes after hip arthroscopy remains unclear. Purpose: To quantify the relationship between anxiety, depression, the Brief Resilience Scale (BRS), and 4 validated patient-reported outcomes (PROMs) after hip arthroscopy. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review of prospectively collected data for patients undergoing primary hip labrum repair from January 1, 2021, to January 1, 2022. Patients completed the BRS and 4 PROMs—modified Harris Hip Score (mHHS), visual analog scale for pain (VAS), Hip Outcomes Score for Activities of Daily Living (HOS-ADL), and Hip Outcomes Score for Sports-Related Activities (HOS-SP)—preoperatively, 6 months, 1 year, and 2 years postoperatively. Patients were stratified into tertiles based on baseline BRS scores: low resilience, normal resilience, and high resilience. Outcomes were analyzed using t tests, 1-way analysis of variance, principal component analysis, and Pearson correlation coefficients to assess relationships between resilience, anxiety, depression, and PROMs. Results: In total, 35 patients met the inclusion criteria with a mean follow-up of 741.4 days. Resilience showed a variable effect on PROMs, with no consistent differences observed across resilience tertiles at any follow-up interval. In contrast, patients with a history of anxiety and/or depression had significantly lower mHHS scores (68.7 vs 80.5, P = .041) and higher VAS scores (8.7 vs 3.9, P = .017) at 2 years, compared with those without such a history. Principal component analysis further highlighted the stronger association of anxiety and depression with outcomes compared with resilience at 6 months ( P = .041), 1 year ( P = .026), and the 2-year follow-up ( P = .014). Overall, 85.7% of patients achieved the minimal clinically important difference for mHHS, 85.7% for VAS, 65.7% for HOS-ADL, and 67.5% for HOS-SP. Conclusion: The present study suggests that a history of anxiety and/or depression is consistently associated with poorer outcomes after arthroscopic hip surgery, whereas resilience demonstrates a less consistent and variable association.