Perioperative Interdisciplinary Intervention Contributes to Improved Outcomes of Adolescents Treated With Hip Preservation Surgery.
BACKGROUND
Adolescent hip preservation surgery (HPS) candidates typically present with chronic pain, which can negatively affect psychological function and surgical outcomes. A previous study demonstrated high rates of psychological symptoms and maladaptive behaviors in this population. This study quantified psychological and functional improvements in these patients from preoperative presentation to postoperative follow-up. An integrated interdisciplinary approach is also described.


METHODS
A total of 67 patients undergoing HPS were evaluated preoperatively and postoperatively at 1 year by staff psychologists. Perioperative psychological intervention consisted of education, counseling, and administration of self-report measures. Self-report measure scores were compared preoperatively and postoperatively, grouped by orthopaedic diagnoses. Frequency analysis, correlational analysis, and analysis of variance were conducted.


RESULTS
Psychological function improved significantly at follow-up: decreased emotional symptomatology (46.1 to 43.6, P=0.013), anxiety (49.6 to 45.8, P<0.001), school problems (46.6 to 44.7, P=0.035), internalizing problems (46.3 to 44.1, P=0.015), social stress (44.5 to 42.3, P=0.024), sense of inadequacy (49.0 to 46.0, P=0.004), and increased self-concept (51.1 to 54.1, P=0.003). Resiliency factors also significantly improved: increased mastery (50.3 to 52.9, P=0.001) and resourcefulness (49.7 to 52.0, P=0.046), decreased emotional reactivity (46.3 to 42.9, P=0.001), and vulnerability (47.7 to 44.7, P=0.011). Physical function and return to activity also significantly improved (University of California-Los Angeles: 7.1 to 8.7, P=0.017; modified Harris Hip Score: 67.3 to 83.8, P<0.001). Return to activity positively correlated with optimism and self-efficacy (P=0.041). Femoroacetabular impingement and hip dysplasia patients consistently reported feeling less depressed (P=0.036), having fewer somatic complaints (P=0.023), fewer internalized problems (P=0.037), and exhibiting fewer atypical behaviors (P=0.036) at follow-up. Slipped capital femoral epiphysis patients did not demonstrate improvements in psychological functioning postoperatively.


CONCLUSIONS
Perioperative psychological education and counseling, in combination with HPS, improved postoperative psychological and physical function. Patients reported reduced anxiety, school problems, and social stress, with marked increase in resilience. Increased mobility and return to activity significantly correlated with improved optimism and self-efficacy.


METHODS
Level II-therapeutic studies-investigating the results of treatment.
Texas Scottish Rite Hospital for Children, Dallas, TX.
Heather M
HM
Richard
Dylan C
DC
Nguyen
David A
DA
Podeszwa
Adriana
A
De La Rocha
Daniel J
DJ
Sucato
D000293:Adolescent; D001848:Bone Diseases, Developmental / Q000523:psychology / Q000601:surgery; D059350:Chronic Pain / Q000523:psychology; D005260:Female; D006618:Hip Dislocation, Congenital / Q000523:psychology / Q000601:surgery; D006621:Hip Joint / Q000601:surgery; D006801:Humans; D008297:Male; D010348:Patient Care Team / Q000458:organization & administration*; D019990:Perioperative Care / Q000379:methods / Q000523:psychology; D059035:Perioperative Period / Q000523:psychology*; D011580:Psychological Techniques; D058996:Quality Improvement; D012649:Self Concept; D016896:Treatment Outcome; D055815:Young Adult