Editorial Commentary: Hip Preservation and Opioids

Abstract

Approximately 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. Mental wellness disorders (e.g., depression, anxiety, substance abuse) significantly impact both pre-and postoperative pain, function, and activity in nearly all joint and general health outcome measures. Multimodal pain management strategies have shown excellent reduction in perioperative opioid utilization. Intraoperative techniques should strive for comprehensive true hip preservation: labral repair, accurate cam/pincer morphology correction, and routine capsular management. Objective, quantitative pain threshold and pain tolerance measurements may improve treatment decision-making, with better prediction of surgical outcomes. Future personalized health care may use a single individual's mu opioid receptor (OPRM-1 gene) and a number of other genetic markers for pain management to reduce the need for traditional opioid medications. Is opioid-free hip arthroscopy possible? Absolutely. Will the opioid epidemic end? Yes, but we have a lot of work to do.

Effect of Perioperative Opioid Use on Patients Undergoing Hip Arthroscopy

“…A far higher proportion of patients who used opioids preoperatively went on to request ≥2 more refills after their index arthroscopy, signifying that preoperative opioid use is a marker for potential prolonged opioid use after surgery, allowing for appropriate counseling and cessation efforts before surgery occurs. Our results reinforced what has been shown previously: preoperative opioid use before index hip arthroscopy remains one of the single most important predictors for chronic postoperative opioid use 2 , 11 , 14 , 21 , 50 and is closely tied to patient outcomes. 52 …”

“…A far higher proportion of patients who used opioids preoperatively went on to request 2 more refills after their index arthroscopy, signifying that preoperative opioid use is a marker for potential prolonged opioid use after surgery, allowing for appropriate counseling and cessation efforts before surgery occurs. Our results reinforced what has been shown previously: preoperative opioid use before index hip arthroscopy remains one of the single most important predictors for chronic postoperative opioid use 2,11,14,21,50 and is closely tied to patient outcomes. 52 In 2020, Beck et al 3 specifically assessed the connection between refills and postoperative outcome, determining that patients requiring more refills had lower patient-reported outcomes and visual analog scale (VAS) satisfaction score averages and higher VAS pain score averages after surgery.…”

“… 5 , 49 Decreasing opioid use is particularly crucial as we navigate the ongoing opioid epidemic and define our role as surgical care providers in that setting. 21 Additionally, as is seen in our study, surgeons prescribe differing amounts of opioids to different patients, and this may represent an opportunity for standardization in practice.…”

Movement if Life-Optimizing Patient Access to Total Joint Arthroplasty: Alcohol and Substance Abuse Disparities

“…37 Preoperative use of opioids is also the number one predictor of prolonged chronic postoperative opioid use. 38,39 Patients with preoperative opioid use were also found to have a fourfold increased risk of requiring a second opioid prescription postoperatively and a 12-fold greater risk of continued opioid use after total hip arthoplasty. 40 Prescription drug use, particularly opioid use, is especially common in individuals awaiting orthopaedic procedures.…”

Editorial Commentary: Hip Arthroscopists Can Reduce Postoperative Opioid Use

“…[10][11][12][13] Of these patients awaiting arthroscopic surgery, approximately one-third are on opioids to address preoperative pain. 14,15 The most important risk factor for prolonged opioid use is preoperative use. 16 In addition, many postoperative protocols include the use of opioids to combat surgical pain.…”