Purpose: The primary outcome is to compare post-operative outcomes between opioid naïve patients and patients with a history of pre-operative opioid usage undergoing hip arthroscopy. The secondary outcome is to determine if pre-operative opioid users consumed more oral morphine milligram equivalents than opioid naïve patients following surgery.
Methods: This is a single-center, retrospective analysis comparing outcomes and postoperative opioid usage between patients with and without a history of pre-operative opioid use. Inclusion criteria included patients ≥ 18 years, Tonnis grade 0 or 1, imaging consistent with FAI or labral pathology, and a diagnosis of symptomatic FAI requiring hip arthroscopy. Patient outcomes were compared throughout a 2-year follow up using the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS) and Visual Analog Scale (VAS).
Results: 17 patients were evaluated in each cohort. The mean age of the study cohort and control cohort were 52.0 ± 9.4 years and 51.2 ± 12.2 years, respectively. Females were 58.8% (n=10) of both cohorts. Non-naïve patients had a lower pre-operative NAHS score (p= 0.05) and a higher VAS at their 6-month and 1-year (p <0.001) postoperative visits. Naïve patients reported higher mHHS scores 2 years postoperatively (p <0.001). The study cohort was prescribed higher levels of oral morphine equivalents (OME) at the postoperative 1-year visit (p=0.05). Opioid naïve patients were more likely to reach MCID and PASS of VAS at a faster rate. At the 2-year follow-up, 11.8% of opioid naïve patients continued to take opioids compared to 58.8% from the non-naïve group for persistent hip pain (p <0.001).
Conclusion: We have determined that preoperative opioid usage in patients undergoing hip arthroscopy is associated with inferior outcomes compared to opioid naïve patients. Additionally, pre-operative opioid users are likely to continue the use of opioid medications postoperatively and at higher doses than opioid naïve patients.