<i>Editorial Commentary</i> : Anxiety and Depression May Be More Important Than the Alpha Angle or Suction Seal in Hip Preservation Surgery Outcomes

Disorders of mental health and wellness are frequently encountered in patients with femoroacetabular impingement syndrome (FAIS) undergoing arthroscopic hip preservation surgery. Anxiety and depression are the two most common mental health diagnoses that coexist with intra-articular hip diagnoses. There is significant overlap with symptoms of anxiety and depression (sleep disturbance, energy loss, and concentration difficulties), and roughly three quarters of patients with either anxiety or depression actually have both. Patients with anxiety and/or depression may have a lower threshold for pain perception and symptom intolerance with FAIS. Patients with longstanding FAIS may develop anxiety (future-based arousal and worry) and depression (past-based hopelessness and loss of interest). Patients with anxiety or depression that undergo hip arthroscopy for FAIS start lower and end lower on subjective patient-reported outcome scores, but they do get better after surgery; it's just not as much as patients without anxiety or depression. Although arthroscopic and related surgeons are not trained mental health specialists, we can ensure high-quality patient care by screening with validated, reliable, and responsive mental wellness questionnaires and referral to trained experienced professionals when appropriate. Current hip preservation surgery literature still exhibits an inability to have high rate of achievement of minimal clinically important difference, substantial clinical benefit, and patient acceptable symptom state in multiple large surgical databases, despite appropriate patient selection and skillful surgical execution. Unaddressed disorders of mental wellness may account for this persistent deficiency. Treatment of mental health diagnoses likely would fulfill this unmet need and ultimately improve both subjective patient-reported and objective clinician-measured outcomes following hip preservation surgery.