Abstract
PurposeThe Forgotten Joint Score (FJS-12) is a valid tool in the evaluation of patients undergoing hip arthroscopy, assessing the unique concept of joint awareness in the setting of a patient’s hip pathology. The preoperative burden on patients’ mental wellbeing of impaired joint function or symptoms is well established. The purpose of this study was to determine patients’ awareness of their hip joint whilst awaiting hip arthroscopy for femoroacetabular impingement, to explore any association between joint awareness and mental health status, and to determine whether this relates to time spent waiting for arthroscopy preoperatively.MethodsA prospective database of patients undergoing hip arthroscopy between January 2018 and November 2020 was analysed. All patients with a diagnosis of femoroacetabular impingement (FAI) undergoing arthroscopic treatment were included. Questionnaires included the FJS-12, twelve item international hip outcome tool (iHOT-12), EuroQol 5D-5L (EQ-5D-5L) and the Tegner activity score. Pearson’s correlation coefficient was used to assess relationships between continuous variables.ResultsPreoperative functional outcomes were completed by 81 patients (97.5%) prior to undergoing hip arthroscopy. Median preoperative FJS-12 score was 16.67 (IQR 8.33 – 29.68). Forty-four patients reported any level of anxiety/depression preoperatively (54.3%). Preoperative FJS-12 showed a significant negative correlation with worsening mental health status (r = − 0.359, p < 0.001), and a significant positive correlation with EQ-5D-5L (r = 0.445, p < 0.001). The duration of symptoms or time on the waiting list did not correlate with increased joint awareness or worsened mental health.ConclusionJoint awareness is high when awaiting hip arthroscopy for FAI. Increasing levels of joint awareness correlate with poorer mental health status and poorer quality of life measures, however these parameters do not seem to be associated with increased duration of symptoms prior to surgery or time on the waiting list for surgery.
Highlights
Hip arthroscopy has been shown to provide superior outcomes for femoroacetabular impingement (FAI) compared to physiotherapy alone [14, 27]
Impaired joint function and increased symptom burden preoperatively have been shown to be associated with increasing levels of anxiety and depression in patients with FAI [18], and the presence and severity of depression have been shown to be predictive of poor functional outcomes following hip arthroscopy [31, 33]
With a growing number of patients waiting for surgery, it is important that hip arthroscopists are conscious of the preoperative morbidity of femoroacetabular impingement and the effect this has on patients’ mental health
Summary
Hip arthroscopy has been shown to provide superior outcomes for femoroacetabular impingement (FAI) compared to physiotherapy alone [14, 27]. Joint awareness is distinct from joint function or symptomatic state, and reflects a host of interplaying factors that impact on the ability of a patient to ‘forget’ their joint pathology or replacement, and has its own distinct biological basis [17, 22]. This concept is well suited for capturing reliable and valid outcomes for young, active patients undergoing hip arthroscopy [3, 28]. With a growing number of patients waiting for surgery, it is important that hip arthroscopists are conscious of the preoperative morbidity of femoroacetabular impingement and the effect this has on patients’ mental health
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