Functional Outcomes After Hip Arthroscopy Based on Self-Reported Cannabis Use: A Matched-Controlled Study

Abstract

Background:

There is a paucity of literature investigating the impact of cannabis usage on functional outcomes after primary hip arthroscopy surgery to treat symptomatic labral tears.

Purpose:

To compare patient-reported outcome measures (PROM) for hip arthroscopy patients who did and did not self-report cannabis use, understand how frequency of cannabis use correlates to PROMs, and compare rates of achieving clinically meaningful outcomes for both cohorts.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

This was a matched-control cohort study of patients who underwent primary hip arthroscopy for symptomatic labral tears. Included patients were ≥18 years old and completed baseline and 2-year postoperative outcomes surveys. Excluded patients had missing follow-up data, previous ipsilateral hip surgery or revision surgery, and/or hip dysplasia (lateral center-edge angle ≤20°). Patients were retrospectively divided into 2 groups based on whether they were cannabis naive (CN) or cannabis users by reviewing their social history. The 2 groups were then propensity-matched 1:1 by age, sex, body mass index, and Tönnis grade. PROMs were collected prospectively at baseline and 2 years postoperatively. These included the modified Harris Hip Score, Nonarthritic Hip Score, Hip Outcome Score–Activities of Daily Living, Hip Outcome Score–Sports Specific Subscale, 33-item International Hip Outcome Tool, Lower Extremity Functional Score, and RAND-36 pain subscale (Pain).

Results:

In total, 68 patients were included (aged 31.4 ± 9.67 years). Of these, 34 patients had self-reported cannabis use, and 34 did not report use. All PROM scales were similar at baseline (P > .05). Cannabis use was not a predictor of functional outcomes at any time point, including the 2-year follow-up for all PROM scales (P > .05); however, the improvement in Pain scores was significantly better in the CN cohort from baseline to the 2-year follow-up (27.3 ± 28.8 vs 11.6 ± 19.0, P = .012). A linear regression model adjusting for cannabis use frequency found pain scores worsened with increased usage (adjusted mean difference, –2.68; 95% CI, –5.12 to −0.25; P = .031). Further analysis showed no differences in achieving minimal clinically important difference, patient acceptable symptom state, or substantial clinical benefit (P > .05).

Conclusion:

Self-reported cannabis usage has no impact on raw functional outcomes after hip arthroscopy, but increased usage correlates with worse pain symptoms.

Keywords

hip arthroscopy femoroacetabular impingement

Cannabis has become one of the most popular recreational drugs globally, with an estimated 244 million users or 4.6% of the global adult population.⁴⁰ In comparison, only alcohol and nicotine outpace its usage at 2.5 billion and 1.25 billion global users, respectively.¹⁰ Global cannabis use has increased by 28% over the past 10 years, and within the United States, usage has increased from 19% in 2021 to 22.3% in 2024 as a result of increased legalization and its shifting public perception.^6,17,40 This increased use of cannabis has sparked interest in understanding its impact on postoperative outcomes and pain management after common procedures.¹⁷

There is a strong demand to reduce opioid prescriptions following surgical procedures due to their established risk for opioid dependence.³⁰ Cannabis-based alternatives present a possible avenue for managing perioperative and postoperative pain due to their analgesic, sedative, and anti-inflammatory properties.^12,15 As modern hip arthroscopy techniques continue to improve outcomes, there is an opportunity to focus on opioid-sparing options.^8,19,26 Furthermore, patients have displayed interest in using cannabis-based products to manage orthopaedic-related pain, and multiple studies have found strong evidence that cannabis use does not increase opioid consumption after surgery.^5,14,15,31 Given that patients may choose to use cannabis recreationally of their own volition, it is critical to determine whether such use adversely affects outcomes.

However, the orthopaedic literature has found contradictory evidence on the role cannabis use has on surgical outcomes. It has been associated with higher complication rates in knee and hip arthroplasty, as well as hand surgery, including deep vein thrombosis and readmission.^13,16 In contrast, another study found that cannabis use does not affect outcomes after total hip arthroplasty.¹² With the increased recreational use of cannabis, it is vital to further the understanding of its impact in an orthopaedic setting.

The current literature is limited by the lack of studies that investigate the relationship cannabis use has on hip arthroscopy outcomes while also considering the frequency of use. Therefore, the purpose of this study is to (1) compare patient-reported outcome measures (PROMs) in patients who underwent hip arthroscopy and self-reported cannabis use versus those who did not report cannabis use, (2) understand how frequency of cannabis use contributes to PROMs, and (3) compare rates of achieving clinically meaningful outcomes (CMOs) for both cohorts. It was hypothesized that patients who used cannabis would have worse outcomes, and a higher frequency of use would correlate with worse outcomes.

Methods

Study Population and Design

Institutional review board approval (2019P002191 and 2013P001442) was obtained for this study. PROM data were prospectively collected for patients who underwent primary hip arthroscopy for symptomatic labral tears at baseline and 2 years postoperatively. Self-reported cannabis use was collected retrospectively through a chart review of the patients’ social history on the electronic medical record, and the study authors did not directly ask patients about cannabis use. Use of any cannabis-based product was defined as cannabis use. This was used to stratify patients into 2 groups: cannabis naive (CN) or current cannabis users (CUs) before surgery.

If patients reported their frequency of use or method of administration, these variables were recorded as well. Cannabis use frequency was documented as a continuous, self-reported number of uses per week. Patients who reported their frequency of cannabis use were included in this subanalysis. Those who reported former cannabis use longer than 6 months before surgery were excluded from the present study. This temporal threshold was chosen based on the range of self-reported current users. Additionally, patients previously diagnosed with cannabis use disorders were excluded. Furthermore, no patients had a documented reason for cannabis use; therefore, the assumption was made that any cannabis use was recreational.

All patients were treated by a single, high-volume, fellowship-trained surgeon (S.D.M.) at a large academic medical center in New England between April 2014 and June 2023. The exclusion criteria were as follows: age <18 years, Tönnis grade >2, lateral center-edge angle <20°, prior ipsilateral hip arthroscopy, use of any other narcotics/illicit drugs, former cannabis use >6 months before surgery, diagnosed cannabis use disorder, and incomplete PROMs at baseline and 2-year follow-up (24-30 months).^3,4

Propensity matching was then performed to minimize the influence of potential confounding variables. Patients were matched in a 1:1 ratio based on age, sex, body mass index (BMI), and Tönnis grade. Propensity scores were estimated using a logistic regression, and matching was performed with a nearest neighbor algorithm until no further matches could be made. The quality of the matching was evaluated using a standardized mean difference threshold of 0.1.

Before surgery, all patients with hip pain received hip and pelvis radiographs along with a physical examination. Patients with positive tests upon physical examination (ie, pain and/or limited range of motion with flexion, adduction, internal rotation or flexion, abduction, and external rotation) underwent magnetic resonance imaging and a minimum of 3 months of nonoperative formal physical therapy. Patients whose symptoms did not resolve with conservative treatment were indicated for hip arthroscopy.^11,24,25,32

Demographic data, including age, sex, BMI, race, and existing psychological diagnoses (major depressive disorder, anxiety, or both), were collected from the electronic medical record. All PROM data were collected via electronic mail surveys sent at the corresponding time points. Femoroacetabular impingement (FAI) type was determined on preoperative anterior-posterior radiographs and categorized as none, only cam lesion, only pincer lesion, or both. Cam lesions were defined as an α angle >55°, and pincer lesions were defined as a lateral center-edge angle >39°. Acetabular cartilage degeneration was classified arthroscopically using the International Cartilage Research Society criteria. PROMs included the modified Harris Hip Score, Nonarthritic Hip Score, Hip Outcome Score–Activities of Daily Living, Hip Outcome Score–Sports Specific Subscale, 33-item International Hip Outcome Tool, Lower Extremity Functional Score, and RAND-36 pain subscale (Pain). Rates of achieving CMOs, such as the minimal clinically important difference (MCID), patient acceptable symptom state (PASS), and substantial clinical benefit (SCB), were calculated using previously established thresholds.^28,33 Lastly, all patients were given a prescription of oxycodone 5 to 10 mg up to 4 times daily for pain. The exact number of tablets prescribed was recorded for all patients.

Abbreviated Surgical Technique and Postoperative Rehabilitation

Once general anesthesia was administered, the patient was positioned supine on a hip distraction table (Advanced Supine Hip Positioning System; Smith & Nephew) with a silicone-padded perineal post. Intra-articular access was facilitated via the puncture capsulotomy technique with anterolateral, anterior, midanterior, and Dienst portals, as previously described in an effort to preserve the iliofemoral ligament and zona orbicularis.^1,9 To minimize neurovascular complications and maintain ambient intra-articular temperatures for chondrolabral junction preservation, sparing use of intermittent traction and pulsed intra-articular lavage was applied, respectively.^{23,27,29,36,38} Acetabular and femoral osteoplasty were performed as indicated without violation of the chondrolabral junction.³⁸ Repair was performed for small, discrete, linear tears that had adequate healthy tissue amenable to suture anchor fixation. However, if the labrum was irreparable due to the indication of complex tears, tears involving the chondrolabral junction, or degenerative labral tissue, labral augmentation via capsular autograft was performed.^20,27,29 After labral repair or augmentation, traction was fully released to ensure restoration of the hip suction seal and formation of an anatomic “in-round” repair.³⁶

All patients followed a standardized 6-month 5-phase self-directed rehabilitation program that did not contain formal physical therapy or bracing.²⁵ Patients were immediately allowed to bear weight using crutches with a flat-foot gait following surgery. At 6 weeks postoperatively, they could begin using a stationary bike with no resistance and begin weaning off of crutches. At 10 weeks, swimming and light-resistance elliptical training were allowed as tolerated. After approximately 4 months, patients were permitted to start low-weight high-repetition exercises, including leg presses and hamstring curls. At 6 months, patients could resume impact-loading activities as tolerated.

Notably, for treating full-thickness chondral flaps, focal Outerbridge grade ≥2 lesions, and/or chondrolabral junction breakdown, the senior surgeon (S.D.M.) used a standardized method of bone marrow aspirate concentrate augmentation, which was aspirated from the body of the ilium, during the entire study period.^18,20,21,37 To ensure equitable patient access, all costs associated with bone marrow aspirate concentrate were covered by the Conine Family Fund for Joint Preservation (a philanthropic organization without affiliations to industry).

Statistical Analysis

Univariate analysis was performed using a 2-tailed independent t test or Fisher exact test when appropriate. Linear regression models were performed for all PROM scales, adjusting for cannabis use frequency, labral treatment, and time point. Statistical analysis was performed using R version 4.4.2 R Project for Statistical Computing), and P < .05 was considered statistically significant.

To determine the number of patients required to detect differences in the 33-item International Hip Outcome Tool scores between cohorts at 2 years, an a priori power analysis was performed using G*Power 3.1. Based on previous literature and historical data from our prospective registry, the following assumptions were made: a standard deviation of 10.0 points, α = 0.05, an allocation ratio of 1:1, and an MCID of 9.7 points between groups at 2 years.²⁸ Given these assumptions, 18 hips per cohort (36 total hips) were required to achieve 80% power.

Results

Patient Characteristics

In total, this study evaluated 311 hips that met the inclusion criteria (Figure 1). Of the eligible patients, 34 CU hips were identified (aged 30.9 ± 9.58 years) and matched to 34 CN hips (aged 31.8 ± 9.76 years) from the senior author's prospective registry (Figure 1). The method of administration in the CU cohort was 20.6% (7/34) smoking, 20.6% (7/34) edibles, 2.9% (1/34) topical cannabis-based oil, and 55.9% (19/34) not reported. From the self-reported data, it was not possible to extrapolate whether the cannabis-based product contained tetrahydrocannabinol. Baseline comparisons between cohorts displayed no significant differences in patient demographics, including age, sex, laterality, BMI, labral management, race, and existing psychological diagnoses (Table 1). Additionally, radiographic findings and chondral treatment were similar at baseline, including Tönnis grade, FAI type, and augmentation using bone marrow aspirate concentrate (Table 2). The osteoplasties performed correspond with the type of FAI present. Furthermore, there were no differences in opioid prescription size between cohorts (mean, CU 35.0 ± 17.4 pills vs CU 35.8 ± 17.0 pills, P = .850).

Figure 1.

CONSORT (Consolidated Standards of Reporting Trials) diagram. CN, cannabis naive; CU, cannabis user; LCEA, lateral center-edge angle; PROM, patient-reported outcome measure.

Table 1

Patient Demographics and Radiographic Findings ^a

Characteristic	CN (n = 34)	CU (n = 34)	P Value
Age, y	31.8 ± 9.76	30.9 ± 9.58	.689
BMI, kg/m²	25.7 ± 3.26	24.8 ± 3.37	.301
Sex			>.99
Female	11 (32.4)	11 (32.4)
Male	23 (67.6)	23 (67.6)
Laterality			>.99
Right	22 (64.7)	23 (67.6)
Left	12 (35.3)	11 (32.4)
Race			>.99
Asian	1 (2.9)	1 (2.9)
White	33 (97.1)	32 (94.2)
Other or not reported	0 (0.0)	1 (2.9)
Tönnis grade			>.99
Grade 0	19 (55.9)	19 (55.9)
Grade 1	15 (44.1)	14 (41.2)
Grade 2	0 (0.0)	1 (2.9)
Mental health diagnoses			.079
MDD only	1 (2.9)	3 (8.9)
Anxiety only	4 (11.8)	6 (17.6)
MDD and anxiety	1 (2.9)	6 (17.6)
None	28 (82.4)	19 (55.9)

Data are reported as mean ± standard deviation or No. (%) of patients. BMI, body mass index; CN, cannabis naive; CU, cannabis user; MDD, major depressive disorder.

Table 2

Radiographic and Arthroscopic Findings ^a

Characteristic	CN (n = 34)	CU (n = 34)	P Value
Labral treatment			.024
Repair	0 (0.0)	6 (17.6)
Reconstruction	34 (100)	28 (82.4)
Additional chondral treatment			>.99
None	6 (17.6)	9 (26.5)
BMAC	28 (82.4)	25 (73.5)
FAI			.441
None	4 (11.8)	5 (14.7)
Cam	4 (11.8)	5 (14.7)
Pincer	11 (32.3)	5 (14.7)
Both	15 (44.1)	19 (55.9)
Acetabulum cartilage grades ^b			.914
0	13 (38.2)	15 (44.1)
1	10 (29.4)	10 (29.4)
2	4 (11.8)	5 (14.7)
3	6 (17.7)	4 (11.8)
4	1 (2.9)	0 (0.0)

Data are reported as No. (%) of patients. Boldface denotes statistical significance (P < .05). BMAC, bone marrow aspirate concentrate; BMI, body mass index; CN, cannabis naive; CU, cannabis user; FAI, femoroacetabular impingement.

Cartilage grades were evaluated using the International Cartilage Research Society criteria.

Patient-Reported Outcome Measures

There were no significant differences for all PROMs at baseline and the 2-year follow-up (P > .05 for all) (Table 3). However, the improvement in Pain scores was significantly better in the CN cohort (27.3 ± 28.8 vs 11.6 ± 19.0, P = .012). Furthermore, there were no differences in rates of revision hip arthroscopy (CN 3 vs CU 0; P = .238) and no cases of conversion to total hip arthroplasty across both cohorts at the 2-year follow-up.

Table 3

Patient-Reported Outcomes ^a

Time Point	PROM Scale	CN	CU	P Value
Enrollment	mHHS	64.4 ± 16.6	69.0 ± 13.8	.228
	NAHS	68.8 ± 18.2	70.4 ± 17.5	.706
	HOS-ADL	74.3 ± 19.8	76.7 ± 16.3	.574
	HOS-SSS	49.7 ± 24.3	51.8 ± 21.6	.694
	iHOT-33	43.5 ± 19.1	48.2 ± 17.6	.287
	LEFS	49.5 ± 18.8	53.4 ± 14.6	.380
	Pain	50.8 ± 24.4	60.7 ± 23.7	.094
Change in PROMs	mHHS	21.8 ± 18.4	15.0 ± 13.5	.090
	NAHS	19.9 ± 18.6	18.5 ± 14.5	.738
	HOS-ADL	17.4 ± 19.0	14.3 ± 15.7	.466
	HOS-SSS	29.3 ± 27.6	25.8 ± 23.9	.578
	iHOT-33	35.5 ± 23.0	27.0 ± 17.7	.092
	LEFS	12.9 ± 25.9	16.1 ± 13.1	.550
	Pain	27.3 ± 28.8	11.6 ± 19.0	.012
24 months	mHHS	85.9 ± 15.4	83.9 ± 11.6	.550
	NAHS	88.1 ± 12.7	88.6 ± 10.3	.706
	HOS-ADL	90.6 ± 11.2	90.9 ± 8.80	.574
	HOS-SSS	77.9 ± 22.8	79.0 ± 15.7	.694
	iHOT-33	78.2 ± 20.7	74.5 ± 16.9	.412
	LEFS	62.2 ± 19.5	69.3 ± 9.86	.076
	Pain	77.3 ± 18.3	71.2 ± 22.1	.210

Data are reported as mean ± standard deviation. Boldface denotes statistical significance (P < .05). CN, cannabis naive; CU, cannabis user; HOS-ADL, Hip Outcome Score–Activities of Daily Living; HOS-SSS, Hip Outcome Score–Sports Specific Subscale; iHOT-33, 33-item International Hip Outcome Tool; LEFS, Lower Extremity Functional Score; mHHS, modified Harris Hip Score; NAHS, Nonarthritic Hip Score; Pain, RAND-36 pain subscale.

Multivariate Linear Regression Models

Within the study sample, a total of 63 patients reported the frequency of cannabis use. The mean (SD) weekly use was 1.54 (1.73) occurrences, ranging from 0.0 to 7.0. All CN patients were assumed to have 0 weekly uses. Linear regression analysis was then performed to adjust for current cannabis use frequency, labral treatment, and time point. Increased usage was correlated with worse pain scores (adjusted mean difference, –2.68; 95% CI, –5.12 to −0.25; P = .031), regardless of perioperative time point. All other PROM scales were unaffected by the frequency of cannabis use (Table 4). Labral reconstruction did not significantly affect outcomes in all PROM scales (P > .05 for all).

Table 4

Linear Regression Adjusting for Cannabis Use Frequency and Labral Treatment ^a

PROM Scale	Variable	Adjusted Mean Difference	95% CI	P Value
mHHS	Additional cannabis use	–0.77	–2.14 to 0.59	.267
mHHS	Labral reconstruction ^b	–2.28	–8.85 to −0.66	.506
HOS-ADL	Additional cannabis use	–0.13	–1.37 to 1.11	.832
HOS-ADL	Labral reconstruction ^b	–4.84	–10.83 to 1.14	.112
HOS-SSS	Additional cannabis use	1.50	–0.90 to 3.91	.221
HOS-SSS	Labral reconstruction ^b	–8.03	–19.63 to 3.56	.174
NAHS	Additional cannabis use	–0.63	–1.94 to 0.68	.347
NAHS	Labral reconstruction ^b	–5.55	–11.89 to 0.78	.086
iHOT-33	Additional cannabis use	0.26	–1.62 to 2.15	.783
iHOT-33	Labral reconstruction ^b	–6.15	–15.26 to 2.95	.184
LEFS	Additional cannabis use	0.31	–1.07 to 1.69	.661
LEFS	Labral reconstruction ^b	–6.82	–13.91 to 0.26	.059
Pain	Additional cannabis use	–2.68	–5.12 to −0.25	.031
Pain	Labral reconstruction ^b	–7.35	–18.4 to 3.71	.191

Boldface denotes statistical significance (P < .05). HOS-ADL, Hip Outcome Score–Activities of Daily Living; HOS-SSS, Hip Outcome Score–Sports Specific Subscale; iHOT-33, 33-item International Hip Outcome Tool; LEFS, Lower Extremity Functional Score; mHHS, modified Harris Hip Score; NAHS, Nonarthritic Hip Score; Pain, RAND-36 pain subscale. A higher Pain score represents less pain.

Labral repair was used as the reference.

Clinically Meaningful Outcomes

MCID, PASS, and SCB were used as secondary outcomes based on previously published thresholds.^28,33 There were no differences in rates of achieving MCID, PASS, or SCB at 2 years between cohorts (Table 5).

Table 5

Clinically Meaningful Outcomes at 2 Years ^a

Variable	Threshold	CN, %	CU, %	P Value
MCID
mHHS	Δ >9.2	79.4	67.6	.410
NAHS	Δ >8.3	64.7	73.5	.600
HOS-ADL	Δ >9.7	58.8	58.8	>.99
HOS-SSS	Δ >14.3	73.5	67.6	.790
iHOT-33	Δ >13.9	88.2	82.4	.733
PASS
mHHS	>83.3	70.6	58.8	.447
NAHS	>85.6	70.6	67.6	>.99
HOS-ADL	>88.2	70.6	70.6	>.99
HOS-SSS	>76.4	67.6	52.9	.322
iHOT-33	>72.2	70.6	52.9	.212
SCB
mHHS	>85.8	61.8	35.3	.052
NAHS	>94.4	44.1	41.2	>.99
HOS-ADL	>91.9	55.9	55.9	>.99
HOS-SSS	>77.9	67.6	52.9	.322
iHOT-33	>76.8	64.7	44.1	.144

CN, cannabis naive; CU, cannabis user; HOS-ADL, Hip Outcome Score–Activities of Daily Living; HOS-SSS, Hip Outcome Score–Sports Specific Subscale; iHOT-33, 33-item International Hip Outcome Tool; MCID, minimal clinically important difference; mHHS, modified Harris Hip Score; NAHS, Nonarthritic Hip Score; PASS, patient acceptable symptom state; SCB, substantial clinical benefit.

Discussion

The first major finding of the present study was that following hip arthroscopy, CU patients did not have significantly different functional outcome scores from CN patients at the 2-year follow-up; however, CN patients reported better postoperative pain score improvement than CU patients. Second, increased frequency of cannabis use was correlated with significantly worse pain scores. Finally, both cohorts achieved similar rates of CMOs. Together, these findings suggest that minimal cannabis use did not negatively affect outcomes, but additional weekly uses were correlated with worse pain scores.

This study evaluated functional outcome scores after hip arthroscopy and determined that cannabis use did not affect raw outcome scores. This finding is consistent with a recent study that cannabis use did not affect outcomes after total hip arthroplasty.¹² Although there have been multiple studies correlating cannabis use disorder with an increased risk of complications and psychiatric comorbidities, these conclusions do not consider minimal or recreational use.^13,16 Studies examining recreational use find it poses no elevated risks and serves as an effective analgesic when compared to controls.^2,35 Collectively, the current literature suggests there may be a dose-dependent effect of cannabis-based products.

When adjusting PROM scores by the frequency of cannabis use, pain scores significantly worsened for every additional use per week. This contradicts evidence suggesting pain can be effectively managed using cannabis-based products.³⁴ However, 1 explanation for this finding is that patients reporting increased use of cannabis may be experiencing hyperalgesia, in which the threshold for nociceptive pain decreases following the administration of analgesics.^22,39 In conjunction with a developed tolerance for the analgesic method, patients may experience simultaneously increased pain, which limits the effectiveness of postoperative pain management.²² This is also supported by the significantly greater improvement in pain scores seen in CN patients, as cannabis use may be influencing subjective pain through hyperalgesia. This further highlights a potential dose-dependent effect of cannabis-based products and may be most beneficial for CN patients or CU patients with low usage. Future studies can explore cannabis potency, frequency, and route of administration to develop treatment protocols that maximize pain relief without inducing hyperalgesia.

The third key finding is that there were no differences in achieving clinically meaningful outcomes between cohorts. In other words, patients were not restricted by their cannabis use status in the improvement of PROM scores or their ability to achieve high outcome thresholds. This finding demonstrates the noninferiority of recreational cannabis use; however, further studies are needed to determine if it could be an alternative to opioids.⁴¹ The present study expands on this understanding by displaying that it does not affect functional outcomes; however, its benefits may be stunted by hyperalgesia. This provides additional information for preoperative planning and managing patient expectations, as preoperative cannabis use does not preclude a patient from achieving clinically significant improvement.

In light of the growing popularity of cannabis-based products and the interest in using them as a possible tool for pain management, it is imperative to thoroughly understand their influence on surgical outcomes.^6,40 Although the literature has investigated the impact of cannabis use disorders and dependency on outcomes, evidence exploring recreational use is scarce.^2,6,16 The present study's findings suggest that preoperative cannabis use does not pose significant concerns in hip arthroscopy, and increased usage was shown to negate potential pain management efficacy. While these findings may be subject to retrospective bias, they highlight an important topic that warrants further investigation. Given that most orthopaedic patients are aware of cannabis-based products and expressed openness to their use for pain management, this study offers support for them as an applicable postoperative pain management tool in the context of its limited use.¹⁴ However, for patients who use cannabis more frequently, it may not be the most effective pain management strategy. Ultimately, distinguishing between therapeutic and potentially harmful patterns of cannabis consumption will be key to optimizing patient outcomes in the orthopaedic population.

Limitations

This study has several limitations that should be acknowledged. First, cannabis use status and frequency were measured using self-reported data. Therefore, the results were considered within this context. Second, the dosage of cannabis or the proximity of its usage before surgery was not reported and could not be extrapolated from the data, and the majority of the cannabis route of administration was not reported. Third, the evaluation of revision and total hip arthroplasty rates was limited due to the relatively short follow-up period. A longer follow-up is needed to further investigate this outcome. Fourth, this study did not have data on prescription opioid use, but recent studies have found that cannabis use does not affect opioid consumption.^5,31 Lastly, all surgeries were performed by a single experienced senior surgeon (S.D.M.) who had performed >1000 hip arthroscopy procedures before April 2014. As a result, these outcomes may not be generalizable to other surgeons, especially regarding capsular management, methods of labral reconstruction, and treatment of chondrolabral/chondral injury.^7,9,20,27,29

Conclusion

Self-reported cannabis usage is not associated with functional outcomes after hip arthroscopy, but increased usage correlates with worse pain symptoms.

Footnotes

Acknowledgements

The authors would like to thank The Conine Family Fund for Joint Preservation for its continued research support.

Final revision submitted March 23, 2026; accepted April 11, 2026.

One or more of the authors has declared the following potential conflict of interest or source of funding: Research support was provided through The Conine Family Fund for Joint Preservation.

Ethical approval for this study was obtained from Partners Healthcare (2019P002191 and 2013P001442).

ORCID iDs

Brandon J. Allen

Srish S. Chenna

Jackson G. Woodrow

Rishi P. Earla

Stephen M. Gillinov

Bilal S. Siddiq

Chris T. Eberlin

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