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Preoperative opioid use is associated with inferior outcomes after patellofemoral stabilization surgery

  • Zain M. Khazi
  • Alan G. ShamrockEmail author
  • Christina Hajewski
  • Natalie Glass
  • Brian R. Wolf
  • Kyle R. Duchman
  • Robert W. Westermann
  • Matthew Bollier
KNEE
  • 19 Downloads

Abstract

Purpose

The purpose of the study was to investigate the association between preoperative opioid use and persistent postoperative use, and determine the impact of preoperative opioid use on patient-reported outcomes (PROs) in patients undergoing patellofemoral stabilization surgery.

Methods

A retrospective analysis of 60 patients after patellofemoral stabilization surgery with a minimum of 2-year follow-up was performed using a prospectively collected patellar instability registry. Patients were categorized as opioid naïve (n = 48) or preoperative opioid users (n = 12). Postoperative opioid use was assessed for all patients at 2 and 6 weeks. Knee Injury and Osteoarthritis Outcome Score (KOOS) and Kujala questionnaires were administered at baseline, and 6 months and 2 years postoperatively.

Results

Preoperative opioid use was identified as an independent risk factor for postoperative opioid use at 2- and 6-weeks following surgery (p = 0.0023 and p < 0.0001, respectively). Preoperative opioid use was associated with significantly lower KOOS and Kujala scores at baseline, 6 months and 2 years postoperatively. Both groups significantly improved from baseline KOOS and Kujala scores at 6 months and 2 years postoperatively. Regardless of preoperative opioid use, opioid use at 6 weeks after surgery was associated with worse KOOS scores at 6 months and 2 years postoperatively.

Conclusion

In patients undergoing patellofemoral stabilization surgery, preoperative opioid use was predictive of postoperative use. Additionally, preoperative opioid use was associated with worse PROs at 6 months and 2 years following surgery.

Level of evidence

III.

Keywords

Patellar instability Patient reported outcomes Opioid Patellar stabilization Fulkerson osteotomy Medial patellofemoral ligament reconstruction 

Notes

Author contribution

ZMK: provided substantial contributions to the analysis, interpretation of data, and drafting the manuscript for the submitted work. He approves of the final version of the work submitted for publication. He agrees to be accountable for all aspects of the work, ensuring that questions related to accuracy or integrity of the submitted work are properly investigated and resolved. AS: provided substantial contributions to the conception, study design, acquisition, analysis, interpretation of data, and revising the manuscript for the submitted work. He approves of the final version of the work submitted for publication. He agrees to be accountable for all aspects of the work, ensuring that questions related to accuracy or integrity of the submitted work are properly investigated and resolved. CH: provided substantial contributions to the conception, study design, acquisition, analysis, and interpretation of data. He provided revisions essential for intellectual content of the work. She approves of the final version of the work submitted for publication. He agrees to be accountable for all aspects of the work, ensuring that questions related to accuracy or integrity of the submitted work are properly investigated and resolved. NG: provided substantial contributions to the study design, acquisition, analysis, and interpretation of data. She approves of the final version of the work submitted for publication. He agrees to be accountable for all aspects of the work, ensuring that questions related to accuracy or integrity of the submitted work are properly investigated and resolved. BRW: provided substantial contributions to the conception, study design, and interpretation of data. He provided with revisions and suggestions for improvement of the study and manuscript. He approves of the final version of the work submitted for publication. He agrees to be accountable for all aspects of the work, ensuring that questions related to accuracy or integrity of the submitted work are properly investigated and resolved. KRD: provided substantial contributions to the conception, study design, and interpretation of data. He provided with revisions and suggestions for improvement of the study and manuscript. He approves of the final version of the work submitted for publication. He agrees to be accountable for all aspects of the work, ensuring that questions related to accuracy or integrity of the submitted work are properly investigated and resolved. RWW: provided substantial contributions to the conception, study design, and interpretation of data. He provided with revisions and suggestions for improvement of the study and manuscript. He approves of the final version of the work submitted for publication. He agrees to be accountable for all aspects of the work, ensuring that questions related to accuracy or integrity of the submitted work are properly investigated and resolved. MB: provided substantial contributions to the conception, study design, and interpretation of data. He provided with revisions and suggestions for improvement of the study and manuscript. He approves of the final version of the work submitted for publication. He agrees to be accountable for all aspects of the work, ensuring that questions related to accuracy or integrity of the submitted work are properly investigated and resolved.

Funding

There was no outside funding utilized for this study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The current study was approved by the local Institutional Review Board (IRB).

Informed consent

All participating patients signed an informed consent document.

References

  1. 1.
    Anthony CA, Westermann RW, Bedard N, Glass N, Bollier M, Hettrich CM et al (2017) Opioid demand before and after anterior cruciate ligament reconstruction. Am J Sports Med 45:3098–3103CrossRefGoogle Scholar
  2. 2.
    Bedard NA, DeMik DE, Dowdle SB, Callaghan JJ (2018) Trends and risk factors for prolonged opioid use after unicompartmental knee arthroplasty. Bone Jt J 100:62–67CrossRefGoogle Scholar
  3. 3.
    Bedard NA, Pugely AJ, Dowdle SB, Duchman KR, Glass NA, Callaghan JJ (2017) Opioid use following total hip arthroplasty: trends and risk factors for prolonged use. J Arthroplasty 32:3675–3679CrossRefGoogle Scholar
  4. 4.
    Bedard NA, Pugely AJ, Westermann RW, Duchman KR, Glass NA, Callaghan JJ (2017) Opioid use after total knee arthroplasty: trends and risk factors for prolonged use. J Arthroplasty 32:2390–2394CrossRefGoogle Scholar
  5. 5.
    Cancienne JM, Patel KJ, Browne JA, Werner BC (2018) Narcotic use and total knee arthroplasty. J Arthroplasty 33:113–118CrossRefGoogle Scholar
  6. 6.
    Chen Q, Larochelle MR, Weaver DT, Lietz AP, Mueller PP, Mercaldo S et al (2019) Prevention of prescription opioid misuse and projected overdose deaths in the united states. JAMA Netw Open 2:e187621CrossRefGoogle Scholar
  7. 7.
    Fithian DC, Paxton EW, Stone ML, Silva P, Davis DK, Elias DA et al (2004) Epidemiology and natural history of acute patellar dislocation. Am J Sports Med 32:1114–1121CrossRefGoogle Scholar
  8. 8.
    Kalakoti P, Hendrickson NR, Bedard NA, Pugely AJ (2018) Opioid utilization following lumbar arthrodesis: trends and factors associated with long-term use. Spine 43:1208–1216CrossRefGoogle Scholar
  9. 9.
    Kim K, Chen K, Anoushiravani AA, Roof M, Long WJ, Schwarzkopf R (2019) Preoperative chronic opioid use and its effects on total knee arthroplasty outcomes. J Knee Surg.  https://doi.org/10.1055/s-0039-1678538 CrossRefPubMedGoogle Scholar
  10. 10.
    Kujala UM, Jaakkola LH, Koskinen SK, Taimela S, Hurme M, Nelimarkka O (1993) Scoring of patellofemoral disorders. Arthroscopy 9:159–163CrossRefGoogle Scholar
  11. 11.
    Manchikanti L, Singh A (2008) Therapeutic opioids: a ten-year perspective on the complexities and complications of the escalating use, abuse, and nonmedical use of opioids. Pain Physician 11:S63–88PubMedGoogle Scholar
  12. 12.
    McCabe SE, West BT, Veliz P, McCabe VV, Stoddard SA, Boyd CJ (2017) Trends in Medical and Nonmedical Use of Prescription Opioids Among US Adolescents. Pediatrics 139:e2016–e2387CrossRefGoogle Scholar
  13. 13.
    McLaughlin DC, Cheah JW, Aleshi P, Zhang AL, Ma CB, Feeley BT (2018) Multimodal analgesia decreases opioid consumption after shoulder arthroplasty: a prospective cohort study. J Shoulder Elbow Surg 27:686–691CrossRefGoogle Scholar
  14. 14.
    Montazeri K, Kashefi P, Honarmand A (2007) Pre-emptive gabapentin significantly reduces postoperative pain and morphine demand following lower extremity orthopaedic surgery. Singap Med J 48:748–751Google Scholar
  15. 15.
    Morris BJ, Laughlin MS, Elkousy HA, Gartsman GM, Edwards TB (2015) Preoperative opioid use and outcomes after reverse shoulder arthroplasty. J Shoulder Elbow Surg 24:11–16CrossRefGoogle Scholar
  16. 16.
    Morris BJ, Sciascia AD, Jacobs CA, Edwards TB (2016) Preoperative opioid use associated with worse outcomes after anatomic shoulder arthroplasty. J Shoulder Elbow Surg 25:619–623CrossRefGoogle Scholar
  17. 17.
    Nietosvaara Y, Aalto K, Kallio PE (1994) Acute patellar dislocation in children: incidence and associated osteochondral fractures. J Pediatr Orthop 14:513–515CrossRefGoogle Scholar
  18. 18.
    Okie S (2010) A flood of opioids, a rising tide of deaths. N Engl J Med 363:1981–1985CrossRefGoogle Scholar
  19. 19.
    Pivec R, Issa K, Naziri Q, Kapadia BH, Bonutti PM, Mont MA (2014) Opioid use prior to total hip arthroplasty leads to worse clinical outcomes. Int Orthop 38:1159–1165CrossRefGoogle Scholar
  20. 20.
    Pugely AJ, Bedard NA, Kalakoti P, Hendrickson NR, Shillingford JN, Laratta JL et al (2018) Opioid use following cervical spine surgery: trends and factors associated with long-term use. Spine J 18:1974–1981CrossRefGoogle Scholar
  21. 21.
    Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD (1998) Knee Injury and Osteoarthritis Outcome Score (KOOS)–development of a self-administered outcome measure. J Orthop Sports Phys Ther 28:88–96CrossRefGoogle Scholar
  22. 22.
    Seth P, Scholl L, Rudd RA, Bacon S (2018) Overdose Deaths Involving Opioids, Cocaine, and psychostimulants United States, 2015–2016. MMWR Morb Mortal Wkly Rep 67:349–358CrossRefGoogle Scholar
  23. 23.
    Smith SR, Bido J, Collins JE, Yang H, Katz JN, Losina E (2017) Impact of preoperative opioid use on total knee arthroplasty outcomes. J Bone Jt Surg Am 99:803–808CrossRefGoogle Scholar
  24. 24.
    Tepolt FA, Bido J, Burgess S, Micheli LJ, Kocher MS (2018) Opioid overprescription after knee arthroscopy and related surgery in adolescents and young adults. Arthroscopy 34:3236–3243CrossRefGoogle Scholar
  25. 25.
    van Amsterdam J, van den Brink W (2015) The misuse of prescription opioids: a threat for Europe? Curr Drug Abuse Rev 8:3–14CrossRefGoogle Scholar
  26. 26.
    Westermann RW, Anthony CA, Bedard N, Glass N, Bollier M, Hettrich CM et al (2017) Opioid consumption after rotator cuff repair. Arthroscopy 33:1467–1472CrossRefGoogle Scholar
  27. 27.
    Westermann RW, Hu J, Hagen MS, Willey M, Lynch TS, Rosneck J (2018) Epidemiology and detrimental impact of opioid use in patients undergoing arthroscopic treatment of femoroacetabular impingement syndrome. Arthroscopy 34:2832–2836CrossRefGoogle Scholar
  28. 28.
    Westermann RW, Mather RC, Bedard NA, Anthony CA, Glass NA, Lynch TS et al (2019) Prescription opioid use before and after hip arthroscopy: a caution to prescribers. Arthroscopy 35:453–460CrossRefGoogle Scholar
  29. 29.
    Zin CS, Chen LC, Knaggs RD (2014) Changes in trends and pattern of strong opioid prescribing in primary care. Eur J Pain 18:1343–1351CrossRefGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  1. 1.Department of Orthopaedics and RehabilitationUniversity of Iowa Hospitals and ClinicsIowa CityUSA

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