Preoperative opioid use negatively impacts pain and met expectations 2 years after hip arthroscopy

Orthopaedic surgery patients have among the highest rates of preoperative opioid use. Prior literature links preoperative opioid use with worse patient-reported outcomes (PROs) in other orthopedic procedures, but studies examining this relationship 2 years after hip arthroscopy are limited. This study aimed to investigate the impact of preoperative opioid use on 2-year PROs after hip arthroscopy. We hypothesized that preoperative opioid use would be associated with worse pain, function, and mental health at 2-year follow-up.

Patients undergoing hip arthroscopy from October 2015 to February 2022 were retrospectively identified. Patients completed surveys containing multiple PROs, including six Patient-Reported Outcomes Measurement Information System (PROMIS) domains at baseline and 2 years postoperatively. A statewide Prescription Drug Monitoring Program (PDMP) identified opioid prescriptions filled within 3 months preoperatively, standardized as morphine milligram equivalents (MMEs).

Of 117 eligible patients, 84 (71.8 %) completed 2-year surveys, and 11 (13 %) filled an opioid prescription within 3 months of surgery. At baseline, preoperative opioid use was associated with worse PROMIS Fatigue (p < .001), Numeric Pain Scale (NPS) operative hip (p = .043), Tegner Activity Scale (TAS) (p = .039), and Marx Activity Rating Scale lower extremity (MARS LE) (p = .036). At 2 years, preoperative opioid use was associated with worse PROMIS Fatigue (54.3 vs 45.7, p = .007), TAS (2.9 vs 4.9, p = .025), and MARS LE (21.1 vs 41.8, p = .047). On regression, preoperative MMEs predicted worse 2-year Musculoskeletal Outcomes Data Evaluation and Management System (MODEMS) met expectations (Est. = -0.001, p = .005) and less improvement in 2-year NPS operative hip (Est. = 8.78e-5, p = .032).

Preoperative opioid use was associated with worse 2-year PROMIS Fatigue, TAS, and MARS LE. Preoperative MMEs independently predicted worse MODEMS met expectations and less improvement in NPS operative hip at 2 years. These findings suggest preoperative opioid use negatively affects pain, activity, and expectations after hip arthroscopy.