Purpose
To determine whether requiring postoperative opioid refills has an effect on both
baseline and postoperative functional scores, as well as rates of achieving clinical
success 2 years after hip arthroscopy for femoroacetabular impingement syndrome (FAIS).
Methods
Data from consecutive patients undergoing hip arthroscopy for FAIS from January 2012
to December 2016 were analyzed. Patients with at least 1 postoperative opioid refill
were matched 1:2 by age and body mass index to patients not requiring refills. Preoperative
and postoperative patient-reported outcomes including the Hip Outcome Score–Activities
of Daily Living Subscale, HOS–Sports Subscale, and modified Hip Harris Score, as well
as visual analog scale (VAS) pain and satisfaction surveys, were compared between
the 2 groups, as well as between patients who requested 1 refill versus those requiring
2 or more refills. The minimal clinically important difference and patient acceptable
symptomatic state (PASS) were calculated for the study group and compared between
patient groups.
Results
A total of 128 patients (14.5%) requesting at least 1 postoperative opioid refill
and 256 with no refills were included in the study. Analysis showed that the refill
group had lower patient-reported outcomes (P < .05 for all), a lower VAS satisfaction score average (73.2 ± 30.7 vs 80.1 ± 25.9,
P = .029), and a higher VAS pain score average (27.2 ± 26.1 vs 19.9 ± 22.7, P = .007). Similar trends were seen when patients with 1 refill were compared with
those with 2 or more refills. Analysis of meaningful clinical outcomes showed that
patients in the refill group had lower rates of achieving the PASS (68.3% vs 77.2%,
P = .006). However, there were no statistically significant differences in achieving
the minimal clinically important difference between the 2 groups (P > .05 for all).
Conclusions
Patients undergoing hip arthroscopy for FAIS who require 1 or more opioid refills
postoperatively are likely to have lower baseline and postoperative functional scores,
as well as to achieve the PASS at lower rates, compared with patients who do not require
an additional opioid prescription to what is routinely given after surgery.
Level of Evidence
Level III, retrospective case-control study.
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Article info
Publication history
Published online: February 13, 2020
Accepted:
February 3,
2020
Received:
August 19,
2019
Footnotes
See commentary on page 1608
The authors report the following potential conflicts of interest or sources of funding: S.J.N. receives research support from Allosource, Arthrex, Athletico, DJ Orthopaedics, Linvatec, Miomed, Smith & Nephew, and Stryker; is on the editorial or governing board of the American Journal of Orthopedics; is a board or committee member of the American Orthopaedic Society for Sports Medicine and Arthroscopy Association of North America; receives intellectual property royalties from Ossur; is a paid consultant for Ossur; receives publishing royalties from Springer; and receives financial material support from Springer, outside the submitted work. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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Copyright
© 2020 by the Arthroscopy Association of North America
ScienceDirect
Access this article on ScienceDirectLinked Article
- Editorial Commentary: Hip Preservation and OpioidsArthroscopyVol. 36Issue 6
- PreviewApproximately one-third of patients undergoing arthroscopic hip preservation surgery for femoroacetabular impingement syndrome and labral tears are on preoperative opioid medications. The single most important predictor for prolonged chronic postoperative opioid use is preoperative use. Despite the well-documented high success rates in nonarthritic, nondysplastic individuals undergoing hip arthroscopy, up to half of those individuals on preoperative opioids may still be on opioids at 1 to 2 years of follow-up.
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