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

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

Taylor Murray, Aaron Blom, Courtney Seffker, Nick Bender, Jenna Jensen, Tony Pennuto, Natalie Glass, Robert Westermann and Michael Willey
Journal of hip preservation surgery, Vol.13(Suppl 1), pp.i180-i180
10/05/2026
DOI: 10.1093/jhps/hnag043.435
PMCID: PMC13636814
url
https://doi.org/10.1093/jhps/hnag043.435View
Published (Version of record) Open Access

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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