EP8.55 Psychological distress and specifically anxiety is associated with failure to improve after hip surgery in adolescents and young adults

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ID: 331070
2026
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Abstract
Abstract Introduction Psychological distress in young adults with hip conditions is increasingly recognized as a risk-factor persistent dysfunction despite surgical treatment. This study evaluated the relationship between persistent psychological distress and patient-reported hip dysfunction after hip preservation surgery. Methods Adolescents and young adults (ages 10-24 years old) presenting with hip conditions completed patient reported outcomes pre-operatively and minimum 1-year post-operatively. Outcomes included the 17-item Optimal Screening for Prediction of Referral and Outcome-Yellow Flag (OSPRO-YF) survey that assesses multiple domains of psychological distress related to musculoskeletal pain and the International Hip Outcome Tool-12 (iHOT) to measure patient-reported hip pain and function. The primary outcome was failure to improve after surgery, defined as failure to achieve a minimal clinically important difference (MCID ≥26) for the iHOT-12 from preoperative to one-year postoperative. Logistic regression was used to evaluate associations between individual psychosocial distress domains and delayed recovery. Subjects were categorized none/mild psychological distress (≤4 yellow flags), moderate (5-8), or severe ( ≥9) and between group differences in iHOT score were assessed using Wilcoxon Rank Sum tests. Results Fifty-five patients underwent surgical treatment with hip arthroscopy (26), periacetabular osteotomy (PAO) (21), femoral osteotomy (6), PAO with surgical hip dislocation (1), and total hip arthroplasty (1). At minimum 1-year after surgery 34 (61.8%) had none/mild, 16 (29.1%) had moderate, and 5 (9.1%) had severe persistent psychological distress. Postoperative iHOT scores were significantly lower in those with persistent severe psychological distress (median(IQR): 32.0(20-34) compared with none/mild (90.0(63-99),p<0.001) and moderate (74.5(59.5-84.5),p=0.003). Those with none/mild or moderate psychological distress demonstrated significant improvement in iHOT-12 (median change 44.2(21.9-65.3) and 45.2(29.5-59.8), respectively, both p<0.001), whereas those with severe psychological distress showed no meaningful improvement (−2.9(-8.4 to 22.4), p=0.813). Of the multiple psychological domains of the OSPRO-YF, logistic regression identified only Anxiety Flag as associated with failure to improve (OR=5.3(95%CI=1.2-22.3),p=0.025). Conclusions Persistent severe psychological distress was strongly associated with greater patient-reported pain/dysfunction and reduced odds of improvement at 1 year after hip surgery in adolescents and young adults. The anxiety domain of the OSPRO-YF was associated with persist dysfunction, indicating a high-risk group that could benefit from intervention.
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Authors Taylor Murray, Aaron Blom, Courtney Seffker, Nick Bender, Jenna L. Jensen, Tony Pennuto, Natalie Glass, Robert W. Westermann, Michael Willey
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Journal Journal of hip preservation surgery
Year 2026
DOI
10.1093/jhps/hnag043.435
URL
https://doi.org/10.1093/jhps/hnag043.435
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