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ArthroplastyCohort

Psychiatric Comorbidity Is Associated With Increased Failure Rates and Inferior Clinical Outcomes After Hip Arthroscopy for Femoroacetabular Impingement Syndrome at a Minimum 10-Year Follow-up

The American Journal of Sports Medicine · 9 Sept 2026

Rigour21/100
Clinical50/100
Impact†48/100

† Impact is the editorial-priority score. All scores are out of 100. Clinical is a stored clinical-importance score from the earlier method; it has not been recalculated.

Why it matters

This suggests surgeons should screen for and counsel patients about psychiatric comorbidity before hip arthroscopy, since it appears to meaningfully worsen long-term implant/procedure survival and patient-reported outcomes.

The evidence

This retrospective cohort study followed 243 adults who had hip arthroscopy for femoroacetabular impingement syndrome (FAIS) for a minimum of 10 years, comparing those with a documented psychiatric diagnosis (30%) to those without. Patients with psychiatric comorbidity had a much higher failure rate (revision arthroscopy or conversion to THA) at 23.3% versus 5.3%, and this comorbidity independently predicted failure on adjusted Cox regression (HR 2.84, 95% CI 1.17-6.88). Both groups improved significantly on hip function scores after surgery, but patients with psychiatric comorbidity started lower, ended lower, and improved less than those without.

surgical failure (revision hip arthroscopy or conversion to THA): Hazard ratio 2.84 (95% CI 1.17 to 6.88; ratio). Interpret in the study's stated comparison; this alone does not establish a treatment's causal effect.

Why this rigour score?

Retrospective cohortDesign starting point: 29.6

21/ 100

Raised the score

  • 120-month follow-up+3.4
  • Aligned time zero+2.5

Lowered the score

  • Underpowered−8.5
  • No correction for multiple comparisons−3.4

Methods at a glance

Recorded assessment
  • Confounding adjustmentMultivariable regression
  • Covariate balance confirmedNot applicable
  • Outcome assessors blindedNot reported
  • Comparable start of follow-upMet
  • Adequate statistical powerUnderpowered
  • Prospective registrationNot met

Not reported does not mean not done. Checks have different weights; this is not a count of boxes ticked.

See the full score breakdown
Study design starting point
29.6
Aligned time zero
+2.5
120-month follow-up
+3.4
Underpowered
−8.5
No correction for multiple comparisons
−3.4
A single centre's own patients
−3.4
Journal prior (not an observed method)
+1.1
Final rigour score rounded
21 / 100

Study design sets the starting point and a ceiling of 72. Recorded methods then adjust the score. Points are shown to one decimal place; the final score uses unrounded values.

Checklist from the stored appraisal. “Not met” describes the recorded criterion; it does not always produce a deduction. This overview supports reading the full study.

For journal club

1.Should a positive psychiatric history change how surgeons counsel FAIS patients about expected improvement and failure risk before hip arthroscopy?

2.Would preoperative mental health optimisation (therapy, medication review) before hip arthroscopy plausibly reduce the observed failure gap, or does this study only show association rather than a modifiable pathway?

Original publication title

Psychiatric Comorbidity Is Associated With Increased Failure Rates and Inferior Clinical Outcomes After Hip Arthroscopy for Femoroacetabular Impingement Syndrome at a Minimum 10-Year Follow-up

Read original paper