Skip to main content

Preoperative morbidity and joint awareness while awaiting hip arthroscopy for femoroacetabular impingement



The Forgotten Joint Score (FJS-12) is a valid tool in the evaluation of patients undergoing hip arthroscopy, assessing the unique concept of joint awareness in the setting of a patient’s hip pathology. The preoperative burden on patients’ mental wellbeing of impaired joint function or symptoms is well established. The purpose of this study was to determine patients’ awareness of their hip joint whilst awaiting hip arthroscopy for femoroacetabular impingement, to explore any association between joint awareness and mental health status, and to determine whether this relates to time spent waiting for arthroscopy preoperatively.


A prospective database of patients undergoing hip arthroscopy between January 2018 and November 2020 was analysed. All patients with a diagnosis of femoroacetabular impingement (FAI) undergoing arthroscopic treatment were included. Questionnaires included the FJS-12, twelve item international hip outcome tool (iHOT-12), EuroQol 5D-5L (EQ-5D-5L) and the Tegner activity score. Pearson’s correlation coefficient was used to assess relationships between continuous variables.


Preoperative functional outcomes were completed by 81 patients (97.5%) prior to undergoing hip arthroscopy. Median preoperative FJS-12 score was 16.67 (IQR 8.33 – 29.68). Forty-four patients reported any level of anxiety/depression preoperatively (54.3%). Preoperative FJS-12 showed a significant negative correlation with worsening mental health status (r = − 0.359, p <  0.001), and a significant positive correlation with EQ-5D-5L (r = 0.445, p <  0.001). The duration of symptoms or time on the waiting list did not correlate with increased joint awareness or worsened mental health.


Joint awareness is high when awaiting hip arthroscopy for FAI. Increasing levels of joint awareness correlate with poorer mental health status and poorer quality of life measures, however these parameters do not seem to be associated with increased duration of symptoms prior to surgery or time on the waiting list for surgery.


Hip arthroscopy has been shown to provide superior outcomes for femoroacetabular impingement (FAI) compared to physiotherapy alone [14, 27]. Many patient reported outcome measures (PROMs) have been designed to detect symptoms related to non-arthritic hip problems [9, 15, 23, 26, 37]. Behrend et al introduced the concept of joint awareness to hip and knee arthroplasty with good effect with the Forgotten Joint Score (FJS-12) [2] which has been reported to achieve distinction between high performing older patients, which previous PROMs may have struggled to do [16]. Joint awareness is distinct from joint function or symptomatic state, and reflects a host of interplaying factors that impact on the ability of a patient to ‘forget’ their joint pathology or replacement, and has its own distinct biological basis [17, 22]. This concept is well suited for capturing reliable and valid outcomes for young, active patients undergoing hip arthroscopy [3, 28].

Impaired joint function and increased symptom burden preoperatively have been shown to be associated with increasing levels of anxiety and depression in patients with FAI [18], and the presence and severity of depression have been shown to be predictive of poor functional outcomes following hip arthroscopy [31, 33]. Furthermore, Stone et al. reported that those with minimal depressive symptoms were more likely to achieve the substantial clinical benefit and the patient acceptable symptomatic score compared to those with moderate to severe symptoms at 1 year follow up [31]. Whilst the association between joint function or symptomatology and worse mental health status is established, it has not yet been determined whether the same is true for a patient’s awareness of their hip joint. Waiting times for elective orthopaedic surgery in the United Kingdom are now at a record high [6]. With a growing number of patients waiting for surgery, it is important that hip arthroscopists are conscious of the preoperative morbidity of femoroacetabular impingement and the effect this has on patients’ mental health.

The purpose of this study was to assess the preoperative burden of joint awareness on patients undergoing hip arthroscopy for FAI, to establish whether there is a relationship between joint awareness and mental health status for these patients, and to determine whether this relates to time spent waiting for arthroscopy preoperatively.

Patients and methods

Patients for this study were identified from a prospective database of patients placed on the waiting list for hip arthroscopy by a single surgeon within the date range January 2018 to November 2020. All patients diagnosed with FAI and labral tears during this time frame were included. Exclusion criteria were patients undergoing revision arthroscopy, or those with a Tönnis grade of > 1 (Fig. 1). The treating surgeon had diagnosed all patients in this study with FAI. Diagnoses were made as per the Warwick Agreement consensus using a combination of clinical history, examination, plain radiographs, and magnetic resonance arthrogram if appropriate [13]. Patients had failed a trial of non-operative treatment including analgesia and physiotherapy. In cases of doubt, intra-articular injections were used to confirm the origin of symptoms. Patients completed preoperative functional questionnaires 2 weeks prior to surgery at the pre-assessment clinic.

Fig. 1
figure 1

Flowchart of patient inclusion and exclusion in this study

Outcome measures

Demographic data included age, sex, body mass index (BMI), smoking status and Scottish Index of Multiple Deprivation (SIMD) vigintile (a relative measure of deprivation) [36]. Preoperative patient reported outcomes measures collected included: the 12 item international hip outcome tool (iHOT-12) [15], FJS-12 [2], EuroQol-five Dimensions-5 L (EQ-5D-5L) [32] and Tegner activity grading scale [35]. The FJS-12 contains 12 questions which are scored using a Likert scale ranging from 0 to 4. The total sum score is converted into a scale ranging from 0 to 100, with lower scores reflecting more joint awareness during activities of daily living [2]. Mental health was assessed using the anxiety/depression subdomain of the EQ-5D-5L score. This has previously been shown to be a valid and reliable tool for assessing overall mental health [4, 5, 11]. Patients completed a five point Likert scale with options including “I am not anxious or depressed”, “I am slightly anxious or depressed”, “I am moderately anxious or depressed”, “I am severely anxious or depressed”, “I am extremely anxious or depressed” [32]. Pain was scored on a visual analogue scale between 0 to 10 where a rating of 10 was the worst pain patients had experienced.

Self-reported duration of symptoms and time on the waiting list were recorded in months. For duration of symptoms patients were asked “How long have you been experiencing the symptoms in your hip that caused you to seek medical advice?”. Data pertaining to previous contralateral FAI surgery and revision surgery was collected. Morphological hip data included the presence of cam or pincer lesions, centre-edge angle (CEA) and Tönnis grading. Cam deformity was classified as an alpha-angle of greater than 60o [1].

Statistical analysis

Statistical analysis was undertaken using Statistical Package for Social Sciences (SPSS) software (IBM, Inc., Armonk, New York, United States) v24. Normality was assessed using Shapiro-Wilk testing. Non-parametric data was reported as median with interquartile range and compared using Mann Whitney U-tests, Wilcoxon signed ranks tests and Kruskal-Wallis tests. Cross-tabulated data for dichotomous variables were analysed using chi squared tests. Correlation of continuous variables was assessed using Pearson correlation coefficient and ordinal variables were assessed using Spearman rank test. A correlation coefficient for each test greater than 0.6 was considered strong, 0.4 to 0.59 was considered moderate, 0.2 to 0.39 was considered weak and <  0.2 was considered very weak [34]. A p-value of < 0.05 was considered statistically significant.


There were 83 patients who were eligible, and 81 completed preoperative PROMs scores during the study period. Median age at the time of assessment was 31 years (IQR 23 – 36) and the median BMI was 24.2 (IQR 22.1 – 28.1). Preoperative functional scores, and demographic and radiographic variables are presented (Table 1). Tegner scores decreased from 6 (IQR 5 – 7) prior to injury to 5 (IQR 3 - 6) prior to surgery (p <  0.001) (Fig. 2). Median self-reported duration of symptoms was 29 months (IQR 18.25 - 48) and time on the waiting list was 4.2 months (IQR 3.3 – 5.6; range 0.5 – 12.5). Nine patients (10.8%) had previously undergone arthroscopy on their contralateral hip.

Table 1 Demographic data, radiographic data and preoperative functional scores
Fig. 2
figure 2

Pre-injury and preoperative Tegner activity scores

Forgotten joint score

Median preoperative FJS-12 score was 16.7 (IQR 8.3 – 29.7) (Table 1). FJS-12 score showed a significant positive correlation with EQ-5D-5L index (p <  0.001) and a significant negative correlation with anxiety/depression scores (p <  0.001) (Table 2). Previous surgery on the contralateral hip was not associated with significant variation in FJS-12 score (p = 0.408). FJS-12 scores were not statistically different according to smoking status (p = 0.355).

Table 2 Univariate correlation analysis for variables associated with the FJS-12

Mental health status

Sub-domain analysis of the EQ-5D-5L can be seen in Table 3. Six patients had a formal diagnosis of anxiety and/or depression from their general practitioner at the time of the study. Forty-four patients (54.3%) reported at least slight anxiety/depression at the time of assessment (Fig. 3). There was a strong, negative correlation between increasing degrees of anxiety/depression and the overall EQ-5D-5L index (r = − 0.691, p <  0.001) and moderate negative correlations with EQ-5D-5L VAS (r = − 0.449, p <  0.001) and iHOT-12 scores (r = − 0.458, p <  0.001). There was a weak, negative correlation between increasing degrees of anxiety/depression and preoperative Tegner activity scores (r = − 0.307, p = 0.011). A weak correlation was seen between increasing anxiety/depression scores and both BMI (r = 0.328, p = 0.003) and smoking status (r = 0.331, p = 0.006). There was no significant correlation between increased degrees of anxiety/depression and age (r = − 0.011, p = 0.923), SIMD vigintile (r = − 0.151, p = 0.181), pain score (r = 0.125, p = 0.309), duration of symptoms (r = 0.137, p = 0.267) or time on the waiting list (r = 0.010, p = 0.932). Preoperative Tegner scores were also correlated to EQ-5D-5L index(r = 0.288, p = 0.017) and EQ-5D-5L VAS (r = 0.434, p <  0.001).

Table 3 EQ-5D-5L results by each domain
Fig. 3
figure 3

Degrees of anxiety/depression compared to population norms


The most notable findings from this study were 1) the high level of joint awareness in patients awaiting arthroscopic hip surgery for FAI (median FJS-12 score 16.7), 2) the high proportion of mental anxiety/depression reporting in patients awaiting hip arthroscopy, with 54.3% of patients reporting at least slight anxiety/depression, and 3) that there was a relationship between these variables.

Data relating to the concept of joint awareness has only been reported twice in the hip arthroscopy literature - when it was validated for this patient population [3, 28]. It has already been shown in the arthroplasty literature that joint awareness and other common functional outcome scores, such as the Oxford Hip Score are not perfectly correlated with one another, as they measure different, but related, constructs [21]. In this study, although there was strong correlation between the FJS-12 and the iHOT-12, this was not absolute, similarly suggesting that the FJS-12 captures additional data on patient perspectives. The FJS-12 will indirectly assess function to some degree, which may account for its correlation with other PROMs, as pain, stiffness, or limitation in function due to joint pathology will inherently make the patient ‘aware’ of the joint in those instances. However, joint awareness is a biologically distinct concept, triggered by multiple interplaying factors at a cortical level [17, 22]. Joint awareness is not just limited to symptomatology and functionality, but also reflects other less tangible influences on patients’ joint-related quality of life, such as psychosocial influences and patients’ expectations [2]. Therefore, it is imperative that we better understand joint awareness and its implications in FAI patients.

Preoperative joint awareness in this study was considerable, with a median FJS-12 score of 16.7, in comparison to population normative values of 87.5 reported in the literature [12]. This study establishes a relationship between the impact of joint awareness and mental health, something that has, to the best of our understanding, not previously been reported. Increasing levels of preoperative joint awareness correlated with greater severity of anxiety/depression and poorer health related quality of life, suggesting that awareness of a pathological hip is associated with worse self-reported mental health status and health related quality of life. This may be due to the FJS-12 capturing a more holistic approach to joint evaluation, assessing not just the symptomatic burden of pain, stiffness and function in activities of daily living, but also allowing for the psychosocial factors that affect patients’ wellbeing [2]. Additionally, general chronic disease states seen in wider clinical practice have well-established links with anxiety and depression [8, 39], and the functional limitations often resulting from such conditions can result in negative affective responses from the patient [38]. High levels of joint awareness as assessed by the FJS-12 reflect frequent awareness of the hip in a variety of activities, and so in the preoperative setting for FAI this may further highlight to the patient the chronicity of their symptoms and disability, in a similar vein to the day-to-day impact of chronic disease states on patients’ mental health status. Furthermore, the FJS-12 also captures patients’ awareness of their functional limitations, and restrictions in these may also correspond to poorer mental health [38].

There were high levels of self-reported anxiety/depression reported in this study and a previous study has reported inferior functional outcomes following hip arthroscopy in patients with significant depressive symptoms [31]. Age-matched population norms in the United Kingdom (UK) for the anxiety/depression domain of the EQ-5D-5L highlight the symptom burden in our patient cohort. Typically, 83% report no mental health symptoms and 17% of the population have at least slight anxiety/depression, whilst in our cohort 54.3% of patients had at least slight anxiety/depression [10]. Whilst there is little literature assessing the psychological burden of hip arthroscopy patients, high levels of anxiety/depression have been observed in other patient cohorts with femoroacetabular impingement, although comparisons between studies assessing mental health burden are limited by the heterogeneity of outcomes measures used [29, 31].

Scott et al reported the poor quality of life (QoL) status of patients while on the waiting list for joint replacement. The authors reported a median EQ-5D-5L index lower than that reported in this study (0.364 vs 0.584) and found 19% of patients [30] to be in a state ‘worse than death’ represented by a negative EQ-5D-5L index score [19, 30]. We found there to be 3.6% of patients with an EQ-5D-5L index score less than zero – or ‘worse than death’, and the median EQ-5D-5L index score in this study was well below the population norm for this age group (0.620 vs 0.939) [20]. This is especially pertinent given lengthy nature of elective surgical waiting lists [7], as the high levels of anxiety/depression and the poorer quality of life preoperatively are perhaps an overlooked burden on patients’ preoperative wellbeing whilst awaiting orthopaedic surgery, and one that surgeons should be aware of. Interestingly, neither prolonged symptom duration nor time spent on the elective surgical waiting list were correlated with patients’ anxiety/depression scores, suggesting that whilst patients’ preoperative mental health burden is considerable, it may not significantly deteriorate with increasing wait time preoperatively. However, further research assessing mental health status at multiple preoperative time-points would be required to definitively establish this.

This study is not without limitations. Retrospective self-reporting of symptom duration may lead to reporting bias and inaccuracies however recent studies have used this method reliably [25] and patients’ reporting of symptoms has been recommended over clinicians’ ratings [24]. The nature of presentation to our system precluded the ability to collect a prospective symptom diary. The definition of what constitutes a FAI-related symptom can be debated, however we took a pragmatic approach to this, asking patients how long the symptoms which caused referral to an orthopaedic surgeon, had been present. Though strongly correlated, one must resist the temptation to conclude that the symptoms associated with FAI were causative of anxiety or depression symptoms.


Joint awareness is high when awaiting hip arthroscopy for FAI. Increasing levels of joint awareness correlate with poorer mental health status and poorer quality of life measures, however these parameters do not seem to be associated with increased duration of symptoms prior to surgery or time on the waiting list for surgery.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.


  1. 1.

    Agricola R, Waarsing JH, Thomas GE, Carr AJ, Reijman M, Bierma-Zeinstra SM et al (2014) Cam impingement: defining the presence of a cam deformity by the alpha angle: data from the CHECK cohort and Chingford cohort. Osteoarthr Cartil 22:218–225

    CAS  Article  Google Scholar 

  2. 2.

    Behrend H, Giesinger K, Giesinger JM, Kuster MS (2012) The "forgotten joint" as the ultimate goal in joint arthroplasty: validation of a new patient-reported outcome measure. J Arthroplast 27:430–436.e431

    Article  Google Scholar 

  3. 3.

    Bramming IB, Kierkegaard S, Lund B, Jakobsen SS, Mechlenburg I (2019) High relative reliability and responsiveness of the forgotten joint score-12 in patients with femoroacetabular impingement undergoing hip arthroscopic treatment. A prospective survey-based study. J Hip Preserv Surg 6:149–156

    Article  Google Scholar 

  4. 4.

    Brazier J (2010) Is the EQ-5D fit for purpose in mental health? Br J Psychiatry 197:348–349

    Article  Google Scholar 

  5. 5.

    Brettschneider C, König H-H, Herzog W, Kaufmann C, Schaefert R, Konnopka A (2013) Validity and responsiveness of the EQ-5D in assessing and valuing health status in patients with somatoform disorders. Health Qual Life Outcomes 11:3

    Article  Google Scholar 

  6. 6.

    British Orthopaedic Association (2020). BOA statement about proposed suspensions of elective operations in some regions. Available from: Accessed 1/7/21

  7. 7.

    British Orthopaedic Association (2020). Progress on restarting elective orthopaedic surgery. Available from: Accessed 1/7/21

  8. 8.

    Capobianco L, Faija C, Husain Z, Wells A (2020) Metacognitive beliefs and their relationship with anxiety and depression in physical illnesses: a systematic review. PLoS One 15:e0238457–e0238457

    CAS  Article  Google Scholar 

  9. 9.

    Christensen CP, Althausen PL, Mittleman MA, Lee JA, McCarthy JC (2003) The nonarthritic hip score: reliable and validated. Clin Orthop Relat Res.

  10. 10.

    Feng Y, Devlin N, Herdman M (2015) Assessing the health of the general population in England: how do the three- and five-level versions of EQ-5D compare? Health Qual Life Outcomes 13:171

    Article  Google Scholar 

  11. 11.

    Gamst-Klaussen T, Lamu AN, Chen G, Olsen JA (2018) Assessment of outcome measures for cost-utility analysis in depression: mapping depression scales onto the EQ-5D-5L. BJPsych open 4:160–166

    Article  Google Scholar 

  12. 12.

    Giesinger JM, Behrend H, Hamilton DF, Kuster MS, Giesinger K (2019) Normative values for the forgotten joint Score-12 for the US general population. J Arthroplast 34:650–655

    Article  Google Scholar 

  13. 13.

    Griffin DR, Dickenson EJ, O'Donnell J, Agricola R, Awan T, Beck M et al (2016) The Warwick agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. Br J Sports Med 50:1169–1176

    CAS  Article  Google Scholar 

  14. 14.

    Griffin DR, Dickenson EJ, Wall PDH, Achana F, Donovan JL, Griffin J et al (2018) Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome (UK FASHIoN): a multicentre randomised controlled trial. Lancet 391:2225–2235

    Article  Google Scholar 

  15. 15.

    Griffin DR, Parsons N, Mohtadi NG, Safran MR, Multicenter Arthroscopy of the Hip Outcomes Research N (2012) A short version of the international hip outcome tool (iHOT-12) for use in routine clinical practice. Arthroscopy 28:611–616 quiz 616-618

    Article  Google Scholar 

  16. 16.

    Hamilton DF, Giesinger JM, MacDonald DJ, Simpson AH, Howie CR, Giesinger K (2016) Responsiveness and ceiling effects of the forgotten joint Score-12 following total hip arthroplasty. Bone Joint Res 5:87–91

    CAS  Article  Google Scholar 

  17. 17.

    Hamilton DF, Loth FL, Giesinger JM, Giesinger K, MacDonald DJ, Patton JT et al (2017) Validation of the English language forgotten joint score-12 as an outcome measure for total hip and knee arthroplasty in a British population. Bone Joint J 99-b:218–224

    CAS  Article  Google Scholar 

  18. 18.

    Jacobs CA, Burnham JM, Jochimsen KN, Molina D, Hamilton DA, Duncan ST (2017) Preoperative symptoms in Femoroacetabular impingement patients are more related to mental health scores than the severity of Labral tear or magnitude of bony deformity. J Arthroplast 32:3603–3606

    Article  Google Scholar 

  19. 19.

    Janssen BS, Szende A (2014) Population Norms for the EQ-5D. In: Self-Reported Population Health: An International Perspective based on EQ-5D. Springer, Dordrecht, pp 19–30

    Chapter  Google Scholar 

  20. 20.

    Kind P, Hardman G, Macran S (1999) UK population norms for EQ-5D. The University of York

    Google Scholar 

  21. 21.

    Larsson A, Rolfson O, Kärrholm J (2019) Evaluation of forgotten joint score in total hip arthroplasty with Oxford hip score as reference standard. Acta Orthop 90:253–257

    Article  Google Scholar 

  22. 22.

    Lewis S, Price M, Dwyer KA, O'Brien S, Heekin RD, Yates PJ et al (2014) Development of a scale to assess performance following primary total knee arthroplasty. Value Health 17:350–359

    Article  Google Scholar 

  23. 23.

    Martin RL, Kelly BT, Philippon MJ (2006) Evidence of validity for the hip outcome score. Arthroscopy 22:1304–1311

    Article  Google Scholar 

  24. 24.

    McColl E (2004) Best practice in symptom assessment: a review. Gut 53 Suppl 4:iv49–iv54

    CAS  PubMed  Google Scholar 

  25. 25.

    Menni C, Valdes AM, Freidin MB, Sudre CH, Nguyen LH, Drew DA et al (2020) Real-time tracking of self-reported symptoms to predict potential COVID-19. Nat Med 26:1037–1040

    CAS  Article  Google Scholar 

  26. 26.

    Mohtadi NG, Griffin DR, Pedersen ME, Chan D, Safran MR, Parsons N et al (2012) The development and validation of a self-administered quality-of-life outcome measure for young, active patients with symptomatic hip disease: the international hip outcome tool (iHOT-33). Arthroscopy 28:595–605 quiz 606-510 e591

    Article  Google Scholar 

  27. 27.

    Palmer AJR, Ayyar Gupta V, Fernquest S, Rombach I, Dutton SJ, Mansour R et al (2019) Arthroscopic hip surgery compared with physiotherapy and activity modification for the treatment of symptomatic femoroacetabular impingement: multicentre randomised controlled trial. BMJ 364:l185

    Article  Google Scholar 

  28. 28.

    Robinson PG, Rankin CS, Murray IR, Maempel JF, Gaston P, Hamilton DF (2020) The forgotten joint score-12 is a valid and responsive outcome tool for measuring success following hip arthroscopy for femoroacetabular impingement syndrome. Knee Surg Sports Traumatol Arthrosc.

  29. 29.

    Sacolick DA, Faucett SC (2021) Editorial commentary: hip Femoroacetabular impingement emotional impact and mental health: an Arthroscope Can't fix everything. Arthroscopy 37:577–578

    Article  Google Scholar 

  30. 30.

    Scott CEH, MacDonald DJ, Howie CR (2019) 'Worse than death' and waiting for a joint arthroplasty. Bone Joint J 101-B:941–950

    CAS  Article  Google Scholar 

  31. 31.

    Sochacki KR, Brown L, Cenkus K, Di Stasi S, Harris JD, Ellis TJ (2018) Preoperative depression is negatively associated with function and predicts poorer outcomes after hip arthroscopy for Femoroacetabular impingement. Arthroscopy 34:2368–2374

    Article  Google Scholar 

  32. 32.

    Stolk E, Ludwig K, Rand K, van Hout B, Ramos-Goni JM (2019) Overview, update, and lessons learned from the international EQ-5D-5L valuation work: version 2 of the EQ-5D-5L valuation protocol. Value Health 22:23–30

    Article  Google Scholar 

  33. 33.

    Stone AV, Beck EC, Malloy P, Chahla J, Nwachukwu BU, Neal WH et al (2019) Preoperative predictors of achieving clinically significant athletic functional status after hip arthroscopy for Femoroacetabular impingement at minimum 2-year follow-up. Arthroscopy 35:3049–3056.e3041

    Article  Google Scholar 

  34. 34.

    Swinscow T (2020). Correlation and regression. Available from: Accessed 1/7/21

  35. 35.

    Tegner Y, Lysholm J, Odensten M, Gillquist J (1988) Evaluation of cruciate ligament injuries. A review. Acta Orthop Scand 59:336–341

    CAS  Article  Google Scholar 

  36. 36.

    The Scottish Government (2020). Scottish Index of Multiple Deprivation Available from: Accessed 1/7/21

  37. 37.

    Thorborg K, Holmich P, Christensen R, Petersen J, Roos EM (2011) The Copenhagen hip and groin outcome score (HAGOS): development and validation according to the COSMIN checklist. Br J Sports Med 45:478–491

    CAS  Article  Google Scholar 

  38. 38.

    Turner J, Kelly B (2000) Emotional dimensions of chronic disease. Western J Med 172:124–128

    CAS  Article  Google Scholar 

  39. 39.

    Vitaloni M, Botto-van Bemden A, Sciortino Contreras RM, Scotton D, Bibas M, Quintero M et al (2019) Global management of patients with knee osteoarthritis begins with quality of life assessment: a systematic review. BMC Musculoskelet Disord 20:493–493

    Article  Google Scholar 

Download references



Take home message

Joint awareness is high when awaiting hip arthroscopy for FAI, and increased joint awareness correlates with both increasing severity of anxiety/depression and worse quality of life.


This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Author information




PGR: Research idea, data collection, data analysis, and writing manuscript; read and approved the final manuscript. TRW: Data collection, data analysis, and writing manuscript; read and approved the final manuscript. IRM: Writing manuscript; read and approved the final manuscript. JFM: Writing manuscript; read and approved the final manuscript. DJM: Data collection and writing manuscript; read and approved the final manuscript. DFH: Research idea and writing manuscript; read and approved the final manuscript. PG: Operating surgeon for study patients; read and approved the final manuscript.

Corresponding author

Correspondence to T. R. Williamson.

Ethics declarations

Ethics approval and consent to participate

Ethical approval was obtained from the regional ethics committee (Research Ethics Committee, South East Scotland Research Ethics Service, Scotland [16/SS/0026]) for analysis and publication of the presented data. The data collection was carried out in accordance with the GMC guidelines for good clinical practice and the Declaration of Helsinki.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Robinson, P.G., Williamson, T.R., Murray, I.R. et al. Preoperative morbidity and joint awareness while awaiting hip arthroscopy for femoroacetabular impingement. J EXP ORTOP 8, 113 (2021).

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI:


  • Femoroacetabular
  • Impingement
  • Hip
  • Awareness
  • FJS-12