School of Medicine

Depression, anxiety may hinder healing in young patients with hip pain

Physiatrist Abby Cheng, MD, examines a young patient with hip pain. Cheng has found that when patients with hip pain have depression or anxiety, they also may have worse outcomes following arthroscopic surgery to correct their hip problems. (Photo: Matt Miller)

New research suggests that physicians evaluating young patients with hip pain should consider more than such patients’ physical health. They also should consider screening those patients for clinical depression and anxiety — impairments that researchers at Washington University School of Medicine in St. Louis have found can have a negative impact on outcomes following hip surgery, such as pain, slower recoveries and inadequate return to activity.

The findings are published online Dec. 12 in The American Journal of Sports Medicine.

In one of the first large studies to focus on mental health effects associated with hip pain, the researchers analyzed data gathered in 12 smaller studies conducted since 2014. The results suggest it may be advisable to start screening young patients with hip pain for depression and anxiety, especially before they undergo arthroscopic hip procedures.

“In a perfect world, we would screen patients for anxiety and depression before surgery and offer treatment, if needed,” said first author Abby L. Cheng, MD, an assistant professor of orthopedic surgery. “But that’s not usually what happens with these patients right now. Plus, many patients think that if their pain goes away, their anxiety or depression will go away, too. But that doesn’t seem to be the case.”

All of the studies in the analysis included evaluations of the effects of depression or anxiety on postsurgical clinical outcomes, such as use of pain-killing drugs after an operation, return to pre-surgery activities, and overall patient satisfaction following surgery. In every study, patients with anxiety and depression prior to surgery were statistically less likely to have good outcomes after their operations.

All of the patients had undergone arthroscopic surgery to correct hip problems, the most common of which was femoroacetabular impingement, a condition in which the hip socket is too deep, causing the thigh bone to rub against the socket. The condition can be painful and can significantly increase arthritis risk and the need for eventual hip-replacement surgery. Cheng said patients with these hip problems also often have unexpectedly high rates of depression and anxiety.

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