Preoperative Symptoms in Femoroacetabular Impingement Patients Are More Related to Mental Health Scores Than the Severity of Labral Tear or Magnitude of Bony Deformity Cale A. Jacobs, PhD, ATC a, * , Jeremy M. Burnham, MD b , Kate N. Jochimsen, MS, ATC c , Domingo Molina IV, MD a , David A. Hamilton, MD a , Stephen T. Duncan, MD a a Department of Orthopedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky b Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania c Division of Athletic Training, Sports Medicine Research Institute, University of Kentucky, Lexington, Kentucky article info Article history: Received 7 March 2017 Received in revised form 19 June 2017 Accepted 29 June 2017 Available online xxx Keywords: femoroacetabular impingement acetabular labral tear hip arthroscopy depression mental health abstract Background: The purpose of this study was to determine the relationships between patient factors, mental health status, the condition of the local tissue, magnitude of bony deformity, and preoperative symptoms in a series of femoroacetabular impingement (FAI) patients. Methods: From our prospective outcomes registry, we identified 64 patients with arthroscopically- treated labral tears and cam deformities. We assessed the correlations between patient factors (age, sex, body mass index, level of education), surgical findings (size of labral tear, presence of chondral le- sions), mental health factors (VR-12 mental component score [MCS], depression, and preoperative use of psychotropic and/or opioid drugs), magnitude of FAI deformity (alpha and lateral center edge angles), and preoperative hip dysfunction and osteoarthritis outcome score (HOOS) subscales. Patient factors, surgical and radiographic findings, and preoperative HOOS scores were compared between patients with low and high MCS. Results: Neither hip pathology nor patient-related factors significantly correlated with HOOS scores. On the contrary, MCS significantly correlated with HOOS symptom (r ¼ 0.45, P < .001) and pain scores (r ¼ 0.52, P < .001). Low MCS patients had significantly lower preoperative scores for all 5 HOOS subscales (P  .002) and more frequent chondral lesions and comorbid depression (P  .01). Conclusion: Symptom severity was significantly more related to mental health status than either the size of labral tear or FAI deformity. Patients with low MCS had significantly worse preoperative pain and self- reported function, and a greater prevalence of concomitant chondral lesions. Future studies are necessary to determine if earlier surgical treatment or preoperative psychological and/or pain coping interventions may improve outcomes for those with low MCS. © 2017 Elsevier Inc. All rights reserved. Preoperative symptom severity has been previously reported to have a stronger connection with mental health status than actual structural pathology for both rotator cuff and knee osteoarthritis patients [1e5]. Although there is an established connection with preoperative symptoms, the relationship between mental health status and/or comorbid psychological disorders and symptoms appears to persist postoperatively as well [6e8]. However, the relationship between mental health and symptom severity has yet to be identified in femoroacetabular impingement (FAI) patients. As such, the purpose of this study was to determine the relationships between patient factors, mental health status, the condition of the local tissue, and preoperative symptoms in a series of FAI patients. We hypothesized that preoperative symptoms would have a stronger relationship with preoperative mental health status than the severity of tissue pathology. Methods From our IRB-approved, single-surgeon, prospective outcomes registry, we identified 64 FAI patients with complete preoperative One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to http://dx.doi.org/10.1016/j.arth.2017.06.053. * Reprint requests: Cale A. Jacobs, PhD, ATC, 740 S Limestone, Room K426, Lex- ington, KY 40536-0284. Contents lists available at ScienceDirect The Journal of Arthroplasty journal homepage: www.arthroplastyjournal.org http://dx.doi.org/10.1016/j.arth.2017.06.053 0883-5403/© 2017 Elsevier Inc. All rights reserved. The Journal of Arthroplasty xxx (2017) 1e4 Downloaded for Anonymous User (n/a) at University of Kentucky from ClinicalKey.com by Elsevier on August 23, 2017. For personal use only. No other uses without permission. Copyright ©2017. Elsevier Inc. All rights reserved.