Abstract
Objectives:
Femoroacetabular impingement (FAI) is a condition that affects young athletes who participate in high impact activities. Patients often experience gradually worsening hip and/or groin pain, and thus have months to years of symptoms before choosing to undergo hip arthroscopy to correct the bony and soft tissue pathology. Patients undergoing surgery usually report that they are pursuing surgery for pain relief and expect to be able to return to their previous level of activity. An athlete’s ability to return to their previous level of sport depends not only on their physical ability, but their psychological ability as well. Because patients often experience months to years of symptoms before surgery, this group is particularly vulnerable to kinesiophobia, pain catastrophizing, and other psychological factors that may influence recovery and overall return to physical activity. The Hip-Return to Sport after Injury (Hip-RSI) scale is a validated tool used to assess an athlete’s psychological readiness to return to sport and specifically looks at emotions, confidence, and risk appraisal in relation to a patient’s perception of hip function and is positively associated with return to sport (RTS). Recovery and RTS is not a linear process, as an athlete’s psychological readiness likely changes over time. However, this potential change in readiness throughout the recovery process has not yet been described.
This study primarily aimed to describe the change in Hip-RSI in patients who undergo hip arthroscopy for FAI. A secondary objective was to examine the relationship between Hip- RSI and patient satisfaction with hip function, patient expectations of recovery timeline, patient expectations to return to sport, and history of anxiety/depression.
Methods:
A single surgeon’s prospectively collected Hip Database was used to obtain a comprehensive patient list. This study was conducted under the IRB approval of the Hip Database. Patients were included if they underwent a hip arthroscopy and completed the Hip-Return to Sport after Injury questionnaire (Hip-RSI) at minimum one of four postoperative timepoints: 3 months, 6 months, 1 year and 2 years. One hundred and fifty patients had a completed Hip-RSI score at at least one of these timepoints. Additional variables included BMI, diagnosis codes, patient satisfaction and expectations, history or presence of anxiety/depression, and other patient reported outcomes (PROs), including iHOT-12, HOS-ADL and HOS-SSS. There were four patient satisfaction and expectations questions patients answered in their questionnaire, three of which were yes/no questions, and one was a slider scale from 0-10 that pertained to hip function satisfaction.
A chart review was performed to determine the BMI, diagnosis codes, and history/presence of history of anxiety/depression for patients who did not have this data in the Hip Database. A Mann Whitney U test and Pearson correlation tests were performed to determine averages and correlations between Hip-RSI and the history/presence of anxiety/depression and satisfaction and expectations.
Results:
The average age of this population was 30 ± 13 years, with an average BMI of 25.8 ± 5.7, and an average duration of symptoms for 24.7± 22.6 months. Hip-RSI scores were determined for each of the four timepoints, which showed that there was an increase in Hip-RSI scores from 3 months to 1 year postoperatively, and an almost a 10-point decrease at 2 years postoperatively, as shown in Table 1. There was no significant difference in Hip-RSI in patients with a history of anxiety and/or depression at any of the four timepoints. There were no significant correlations between Hip-RSI and any other variables or outcome measures at two years postoperatively.
At 3 months, 6 months, and 12 months postoperatively, Hip-RSI had a strong, positive correlation with a patient’s self-reported satisfaction level of their current hip function (p<0.001). The averages of Hip-RSI and this patient satisfaction question are shown in Table 2. Two other patient expectation questions were also positively correlated with Hip-RSI at various timepoints, as shown in Figure 1.
Hip-RSI had a strong correlation with three other PROs: iHOT-12, HOS-ADL, and HOS-SSS at all three timepoints (p<0.001). The only exceptions were two moderative, positive correlations between Hip-RSI and HOS-ADL, as well as between Hip-RSI and HOS-SSS, at 3 months postoperatively.
Conclusions:
Based on our findings, a patient’s psychological readiness for return to sport changes over time, with an increase in readiness up to 1 year postoperatively, and a decrease in readiness at two years postoperatively. While history or presence of anxiety and/or depression does not influence Hip-RSI scores, patient satisfaction and expectations after a hip arthroscopy appears to influence it, however further investigation is required.
