A study at Washington University School of Medicine in St. Louis suggests that while considering patients' physical health, physicians evaluating young patients with hip pain also should consider screening those patients for clinical depression and anxiety, impairments that can have a negative impact on outcomes following hip surgery, such as pain, slower recoveries and inadequate return to activity.

The researchers analyzed data from more than 5,600 hip surgery patients aged 29 to 41.

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.

Patients with these hip problems also often have unexpectedly high rates of depression and anxiety.

"There are people who may have anxiety or depression, who then develop a hip problem, and that can make things worse because rather than having the mindset that the hip problem is a small, fixable issue, their extra worry actually can increase the impact of the hip problem on their lives," said first author Abby L. Cheng, an assistant professor of orthopedic surgery. "Or sometimes people who have hip problems may then develop new depressive or anxious symptoms because their hip issues are preventing them from doing things they want and need to do. That combination of things can play a role in making each of the problems worse."

In all of the studies reviewed, the patients were otherwise healthy and active before being limited by hip pain. The patients in the studies were young primarily because of the type of hip surgery studied. For younger patients, doctors often perform arthroscopic procedures to correct defects, attempting to delay or prevent the need for total joint-replacement operations that are so common in older adults.

"These young people often were involved in sports activities such as soccer or dance, but their pain prevented them from participating in these things they had enjoyed," Cheng said. "Often those activities are good outlets for stress, so the inability to participate affects quality of life."

Doctors who treat young hip patients don't routinely screen for depression or anxiety, much less refer their patients to behavioral health services as part of the treatment plan for hip pain.

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.

The findings were published online on December 12 in The American Journal of Sports Medicine.