Pain Catastrophizing and Kinesiophobia Affect Return to Sport in Patients Undergoing Hip Arthroscopy for the Treatment of Femoroacetabular Impingement

PURPOSE: To assess whether pain catastrophizing and kinesiophobia affect return to sport (RTS) or clinically significant outcome (CSO) achievement in patients undergoing hip arthroscopy for the treatment of femoroacetabular impingement (FAI). METHODS: Patients undergoing primary hip arthroscopy at a single institution between January 2017 and March 2017 were prospectively enrolled. Patients received the Tampa Scale of Kinesiophobia-11 (TSK-11) and Pain Catastrophizing Scale (PCS) questionnaires preoperatively, 3 weeks, 6 weeks, 3 months, 6 months, and 1 year postoperatively. Patients also received the Hip Outcome Score Sport-Specific (HOS-SS) questionnaire preoperatively and 1 year and 2 years’ postoperatively. An RTS questionnaire was completed at final follow-up. Bivariate correlations were conducted between PCS and TSK-11 scores and RTS status and achievement of CSOs of HOS-SS, based on patient acceptable symptom state (PASS) and substantial clinical benefit (SCB). RESULTS: Fifty-eight patients with an average age of 31.9 ± 12.2 and body mass index of 24.0 ± 3.8 participated in sport prior to surgery and were included in the study. Forty-two (72.4%) patients returned to sport at 10.5 ± 7.1 months following surgery. There was a significant reduction in TSK-11 and PCS scores at 1-year follow-up (TSK-11, 26.1 ± 6.0 vs 18.6 ± 6.1, P < .001; PCS, 17.7 ± 10.5 vs 4.3 ± 6.8, P < .001) as well as a significant improvement in HOS-SS (P < .001). At 1 year, fair correlations were demonstrated between PCS (r = –0.446, P = .010) and TSK (r = –0.330, P = .029) scores and RTS. Patient who returned to sport had lower PCS (8.5 ± 11.7 vs 3.0 ± 3.7, P = .010) and TSK-11 (21.8 ± 8.5 vs 17.6 ± 4.8, P = .029) scores at 1 year. At 1-year follow-up, PCS (r = –0.572, P = .001) and TSK-11 (r = –0.441, P = .012) scores demonstrated fair correlations with achieving PASS for HOS-SS at 2-year follow-up. CONCLUSIONS: Patient kinesiophobia and pain catastrophizing at 1-year follow-up were negatively correlated with RTS and achievement of a CSO in sport-related activities at 2-year follow-up. LEVEL OF EVIDENCE: III, prospective cohort study.