Poster 152. Mind over Matter: Baseline Resilience Tied to Baseline Mental Health, Not Baseline Pain or Function

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Objective: Despite increasing recognition of psychosocial factors in orthopaedic outcomes, the role of resilience in patients undergoing hip arthroscopy for femoroacetabular impingement (FAI) remains poorly understood. Prior literature suggests resilience may influence recovery and long-term outcomes, but gaps remain regarding its association with preoperative pain, function, and mental health. This study aimed to: (1) evaluate whether baseline resilience correlates with baseline pain and function, (2) assess the relationship between baseline resilience and mental health, and (3) identify additional predictors of baseline pain and function in patients undergoing hip arthroscopy. Methods: Patients undergoing hip arthroscopy for FAI were identified within a prospectively collected registry database from two surgeons at a single institution. Patients were excluded if they were missing any baseline information, undergoing revision hip arthroscopy, or indicated for surgery for diagnosis other than FAI. Patient information including age, sex, BMI, years of education, smoking status, cartilage status and history of prior surgery were captured in the database. Baseline outcome measures captured included the 10-item Connor-Davidson resilience scale (CD-RISC10), Veterans Rand 12 item Mental Component score (VR12-MCS), Hip disability and osteoarthritis outcome score pain subscale (HOOS Pain), Hip disability and osteoarthritis outcome score physical function short form (HOOS PS), UCLA activity score (UCLA) and Veterans Rand 12 item Physical component score (VR12-PCS). Continuous variables were summarized using medians and interquartile ranges (IQR). Categorical variables were summarized using counts and percentages. Multivariable linear regressions were used to model baseline HOOS Pain, or baseline HOOS PS, while assessing the relative contribution of baseline resiliency score. The predictors in the model included age, sex, smoking, education, BMI, resilience score, VR12-MCS, cartilage status, chondral separation yes/no, history of contralateral hip arthroscopy, baseline UCLA, baseline VR12-PCS. The model fit was assessed using adjusted R2. Variance Inflation Factor (VIF) was used to check multicollinearity among the predictors. Variable importance plot was obtained for the model by ranking each variable by the increase in AIC upon its removal. Results: A total of 311 patients were identified and consented for research. Eleven patients failed to complete all of the baseline assessments, leaving 300 (96.5%) for final analysis. The median age was 32 years (IQR 20-43), and 71.7% were female. The median education level was 14.5 years (IQR 12-16), and the median BMI was 24.4 (IQR 22-28.8). Of the total cohort, 75.7% had never smoked, 13.7% had quit over 6 months prior, 2.33% had quit within the last 6 months, and 8.33% identified as current smokers. Multivariable models examined the association between demographic variables and baseline pain and function scores. Baseline CD-RISC10 was not significantly associated with baseline HOOS Pain [Table 1a] or HOOS PS [Table 1b]. Baseline resilience demonstrated a moderate correlation with baseline mental health VR12-MCS scores (Pearson correlation 0.55, [0.47.62]). The final model explained 35% of the variance in baseline pain and function. Exclusion of resiliency resulted in less than a 1% change in adjusted R², indicating that resiliency contributed minimal additional predictive value beyond mental health. These findings suggest that baseline resiliency does not substantially influence pain or function when mental health is accounted for. Sex (95% CI 5.61-13.65, p<0.001), BMI (95% CI -4.7 - -0.02, p=0.049), education level (95% CI 0.43-5.42, p=0.022) and baseline VR12-PCS scores (95% CI 8.67-14.51, p<0.001) were significantly associated with baseline HOOS Pain scores. Sex (95% CI 1.03-9.65, p=0.016), education level (95% CI 1.02-6.37, p=0.007), history of prior surgery (95% CI 0.25-13.56, p=0.043) and VR12-PCS scores (95% CI 6.02-12.29, p<0.001) were also significantly associated with baseline HOOS PS. Model fit diagnostics (AIC-based ranking) identified VR12-PCS, sex, years of education and BMI as the top predictors of baseline HOOS Pain [Figure 1a], while VR12-PCS, years of education, sex and prior surgery were the top predictors of baseline HOOS PS [Figure 1b]. The models were considered moderate to strong as it relates to predicting HOOS Pain and HOOS PS (R2 = 0.35 for HOOS Pain and 0.23 for HOOS PS). Conclusions: In patients undergoing hip arthroscopy for FAI, resilience was moderately correlated with mental health. Conversely, resilience was not correlated with baseline pain or physical function. Instead, physical health, demographic, and surgical history factors were the most robust predictors of baseline pain and functional status. These findings demonstrate the relationship between resilience and mental health. However, resilience may not independently influence baseline symptom burden among patients with FAI. Longitudinal investigation is warranted to determine if resilience affects postoperative recovery trajectories.

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