Preoperative Opioid Use is Associated with Inferior Patient Reported Outcomes and Prolonged Opioid Use after Patellofemoral Stabilization Surgery

Abstract

Objectives:

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.

Table 1.

Comparison of KOOS Subscore between Opioid Naïve and Preoperative Opioid User

	Opioid Naïve (n=48)	Preoperative Opioid Use (n=12)	P-Value
At Baseline
KOOS ADL	75.0116.49	48.6519.80	0.0001*
KOOS Pain	66.2117.52	39.1212.84	<0.0001*
KOOS Symptom	59.6715.45	37.5016.79	0.0004*
KOOS Quality of Life	32.1221.35	28.3024.04	0.6091
KOOS Sport	37.7326.09	20.0026.71	0.0105*
At 6-Month Follow-up Visit
KOOS ADL	90.5313.92	72.0623.79	0.0068*
KOOS Pain	83.1517.01	66.6623.65	0.0339*
KOOS Symptom	75.6218.15	71.4312.37	0.2492
KOOS Quality of Life	62.4522.00	51.4622.82	0.1095
KOOS Sport	67.2626.66	41.0031.69	0.0183*
At 2-Year Follow up Visit
KOOS ADL	94.5410.32	74.6023.06	<0.001*
KOOS Pain	89.4314.41	68.1723.33	0.0004*
KOOS Symptom	79.4617.32	66.9616.69	0.0249*
KOOS Quality of Life	71.8821.57	40.1025.63	0.0003*
KOOS Sport	77.5021.54	40.8325.66	<0.001*

*significant finding (P<0.05); KOOS-Knee Injury and Osteoarthritis and Outcomes Score; ADL-Activities of Daily Living

Table 2.

Comparison of Kujala Scores between Opioid Naïve and Preoperative Opioid Users

Time Point	Opioid Naïve (n=32)	Preoperative Opioid Use (n=9)	P-Value
At Baseline	41.8826.74	29.8920.08	0.1503
At 6-Month Follow up	78.6118.67	56.1023.01	0.0063*
At 2 Year Follow up	83.4917.66	63.5820.63	0.0023*

*significant findings (P<0.05)