Preoperative mental health status is a significant predictor of postoperative outcomes in adolescents treated with hip preservation surgery

Heather M. Richard, Shelby P. Cerza, Adriana De La Rocha, David A. Podeszwa

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Purpose This study was designed to evaluate predictive factors that influence pain, mental health symptoms and postoperative outcomes at six-months post-hip preservation surgery (HPS) in adolescent surgical candidates. Methods In total, 58 HPS candidates (39 female, 19 male; mean age 15.53 years (10 to 19)) were evaluated. Diagno-ses included: acetabular dysplasia (34); idiopathic femoroac-etabular impingement (15); Perthes disease (six); avascular necrosis (six); and slipped capital femoral epiphysis (six). All patients underwent periacetabular osteotomy (36), surgical hip dislocation (17) or arthroscopy (five). Patients com-pleted the following: Numerical Pain Rating Scale (NPRS); Child Health Questionnaire-87 (CHQ-87); Pediatric Symptom Checklist-Youth (PSC-Y), preoperatively and six months post-operatively. A single psychologist assessed patients in clinics and one to two additional appointments. Results In all, 78% of patients reported one to three years of pain prior to HPS (modified Harris hip score). All pain scores (NPRS) significantly decreased at six months postop-eratively. Preoperative mental health scores (CHQ-87) significantly predicted postoperative pain scores (F(1, 57) = 4.07; p < 0.048; R2 = 0.068). Mental health symptoms (PSC-Y) decreased significantly (p < 0.001). Patients who were seen by a psychologist two or more times reported better six-month postoperative outcomes than those seen once: usual pain (NPRS; p = 0.012); patient-reported physical function (CHQ-87; p = 0.029); and mental health (PSC-Y; p = 0.019). HPS patients seen ≥ 60 days prior to surgery showed marked improvements at six months compared with patients seen < 60 days prior to surgery. Conclusion HPS candidates evaluated preoperatively by psychology, as part of an integrated treatment approach, demonstrated statistically significant improvements in pain, health-related quality of life and mental health symptoms. Two+ visits, more than 60 days prior to surgery appears to be impactful. Preoperative pain and mental health symptoms were predictive of postoperative pain.

Original languageEnglish (US)
Pages (from-to)259-265
Number of pages7
JournalJournal of Children's Orthopaedics
Volume14
Issue number4
DOIs
StatePublished - 2020
Externally publishedYes

Keywords

  • Adolescent
  • Hip preservation surgery
  • Mental health
  • Paediatric orthopaedics
  • Surgical outcomes

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Orthopedics and Sports Medicine

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