Does Periacetabular Osteotomy Improve Patient-Reported Psychological Outcomes in Patients Suffering from Acetabular Dysplasia?

Abstract

The changes in psychologic measures and symptoms of depression, anxiety, and pain catastrophizing following periacetabular osteotomy (PAO) are not well studied. This study aims to fill this knowledge gap by addressing the question: Do patients with acetabular dysplasia have significant improvement in psychological outcome scores after PAO? We reviewed 52 hips (48 patients) treated with PAO for acetabular dysplasia from February 2017 to July 2020 using Depression, Anxiety, and Stress Scale – 21 (DASS21), Hospital Anxiety and Depression Scale (HADS), Pain Catastrophizing Scale (PCS), radiographic analysis, and pain location/severity questionnaires. Descriptive statistics and a mixed effects model were used to test the difference in patient-reported outcome measures from before and after surgery with adjustment for age, body mass index, follow-up duration, previous hip surgery, and concurrent surgery while also accounting for clustered data. There was a statistically significant difference between preoperative and postoperative outcome scores for all three measures used in this study (DASS21 p = 3.22E-09; HADS p = 2.82E-10, PCS p = 2.12E-09). These results indicate that patients with acetabular dysplasia might expect significant improvement in symptoms of depression, anxiety, and pain catastrophizing following PAO.

Keywords

periacetabular osteotomy - psychologic outcomes - hip dysplasia

Publication History

Received: 30 March 2022

Accepted: 12 August 2022

Article published online:
16 March 2023

• References

• 1 Hampton SN, Nakonezny PA, Richard HM, Wells JE. Pain catastrophizing, anxiety, and depression in hip pathology. Bone Joint J 2019; 101-B [phone]
• 2 Nisar A, Augustine A, Horrey L, Craig D, Meek R, Patil S. Psychosocial aspects of hip disease in the young adult. Hip Int 2013; 23 (04) 417-423
• 3 Clohisy JC, Schutz AL, St John L, Schoenecker PL, Wright RW. Periacetabular osteotomy: a systematic literature review. Clin Orthop Relat Res 2009; 467 (08) 2041-2052
• 4 Swarup I, Zaltz I, Robustelli S, Sink E. Outcomes of periacetabular osteotomy for borderline hip dysplasia in adolescent patients. J Hip Preserv Surg 2020; 7 (02) 249-255
• 5 Wells J, Millis M, Kim YJ, Bulat E, Miller P, Matheney T. Survivorship of the Bernese periacetabular osteotomy: what factors are associated with long-term failure?. Clin Orthop Relat Res 2017; 475 (02) 396-405
• 6 Wells J, Schoenecker P, Duncan S, Goss CW, Thomason K, Clohisy JC. Intermediate-term hip survivorship and patient-reported outcomes of periacetabular osteotomy: the Washington University experience. J Bone Joint Surg Am 2018; 100 (03) 218-225
• 7 Nunley RM, Prather H, Hunt D, Schoenecker PL, Clohisy JC. Clinical presentation of symptomatic acetabular dysplasia in skeletally mature patients. J Bone Joint Surg Am 2011; 93 (Suppl. 02) 17-21
• 8 Matheney T, Kim YJ, Zurakowski D, Matero C, Millis M. Intermediate to long-term results following the Bernese periacetabular osteotomy and predictors of clinical outcome. J Bone Joint Surg Am 2009; 91 (09) 2113-2123
• 9 Ganz R, Klaue K, Vinh TS, Mast JW. A new periacetabular osteotomy for the treatment of hip dysplasias: technique and preliminary results. 1988. Clin Orthop Relat Res 2004; (418) 3-8
• 10 Murphy SB, Millis MB. Periacetabular osteotomy without abductor dissection using direct anterior exposure. Clin Orthop Relat Res 1999; (364) 92-98
• 11 Henry JD, Crawford JR. The short-form version of the Depression Anxiety Stress Scales (DASS-21): construct validity and normative data in a large non-clinical sample. Br J Clin Psychol 2005; 44 (Pt 2): 227-239
• 12 Snaith RP. The Hospital Anxiety and Depression Scale. Health Qual Life Outcomes 2003; 1: 29
• 13 Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand 1983; 67 (06) 361-370
• 14 Sullivan M, Bishop S, Pivik J. The Pain Catastrophizing Scale: development and validation. Psychol Assess 1995; 7 (04) 524-532
• 15 Carlisle JC, Zebala LP, Shia DS. et al. Reliability of various observers in determining common radiographic parameters of adult hip structural anatomy. Iowa Orthop J 2011; 31: 52-58
• 16 Barton C, Salineros MJ, Rakhra KS, Beaulé PE. Validity of the alpha angle measurement on plain radiographs in the evaluation of cam-type femoroacetabular impingement. Clin Orthop Relat Res 2011; 469 (02) 464-469
• 17 Tarakji BA, Wynkoop AT, Srivastava AK, O'Connor EG, Atkinson TS. Improvement in depression and physical health following total joint arthroplasty. J Arthroplasty 2018; 33 (08) 2423-2427
• 18 Duivenvoorden T, Vissers MM, Verhaar JA. et al. Anxiety and depressive symptoms before and after total hip and knee arthroplasty: a prospective multicentre study. Osteoarthritis Cartilage 2013; 21 (12) 1834-1840
• 19 McMurray A, Grant S, Griffiths S, Lefford A, Wilson D. Mapping recovery after total hip replacement surgery: health-related quality of life after three years. Aust J Adv Nurs 2005; 22 (04) 20-25
• 20 Phillips DL. Social participation and happiness. Am J Sociol 1967; 72 (05) 479-488
• 21 Takagi D, Kondo K, Kawachi I. Social participation and mental health: moderating effects of gender, social role and rurality. BMC Public Health 2013; 13: 701
• 22 Novais EN, Heyworth B, Murray K, Johnson VM, Kim YJ, Millis MB. Physical activity level improves after periacetabular osteotomy for the treatment of symptomatic hip dysplasia. Clin Orthop Relat Res 2013; 471 (03) 981-988
• 23 Paluska SA, Schwenk TL. Physical activity and mental health: current concepts. Sports Med 2000; 29 (03) 167-180