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Mental Health Medication Use Correlates with Poor Outcome After Femoroacetabular Impingement Surgery in a Military Population

Ernat, J.J. MD1; Song, D.J. MD2; Brugman, S.C. MD1; Shaha, S.H. PhD, DBA3; Tokish, J.M. MD4; Lee, G.Y. MD5

doi: 10.2106/JBJS.O.00043
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Background: Femoroacetabular impingement is a common cause of hip pain in young adults. Several preoperative risk factors for poor outcomes with surgery have been identified; however, to our knowledge, no study has attempted to determine the effect of psychiatric comorbidity on outcomes with femoroacetabular impingement surgery.

Methods: A retrospective review was performed on active-duty patients at one institution undergoing surgery for femoroacetabular impingement over five years. Medical records were reviewed for demographic characteristics, radiographic data, and history of mental health medication use. Return-to-duty status was considered the primary outcome measure. Outcome scores obtained included modified Harris hip scores, Single Assessment Numeric Evaluation scores, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, patient satisfaction, and Veterans RAND-12 scores. Patients taking mental health medication were compared with those who were not with regard to return to duty and validated patient-reported outcome measures.

Results: Ninety-three patients (mean age, 32.2 years) were available for follow-up at a mean duration of 3.6 years. Of the seventeen patients discharged from service postoperatively, twelve (71%) were taking mental health medications. One-third (twenty-five) of seventy-six patients who returned to duty were taking mental health medication and this difference was significant (p < 0.006). Patients taking mental health medication had significantly poorer modified Harris hip scores (p < 0.02), WOMAC scores (p < 0.0008), and Veterans RAND-12 mental scores (p < 0.001). Antidepressant, antipsychotic, and multiple mental health medication use were all predictive of medical discharge due to hip pain.

Conclusions: Psychiatric comorbidities are an important risk factor in active-duty military personnel undergoing surgery for femoroacetabular impingement. Mental health medication use is associated with poorer outcome scores and can significantly lower the possibility of returning to active-duty status.

Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

1Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI 96859

2Landstuhl Regional Medical Center, Geb. 3765, 66849 Landstuhl, Germany

3Allscripts, 222 Merchandise Mart Plaza, Suite 2024, Chicago, IL 60694

4Steadman Hawkins Clinic of the Carolinas, Greenville Health System, 200 Patewood Drive, Suite C100, Greenville, SC 29615. E-mail address: jtokish@ghs.org

5Kaiser Permenante Hospital, 680 Iwilei Road, #600, Honolulu, HI 96817

Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated
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