Delayed hip arthroscopy for femoroacetabular impingement syndrome does not increase revision but does increase rates of chronic opiate use

Kian Niknam; Ryan Freshman; Sergio E Flores; Drew A Lansdown; Stephanie E Wong; Alan L Zhang

doi:10.1016/j.jor.2024.02.046

Delayed hip arthroscopy for femoroacetabular impingement syndrome does not increase revision but does increase rates of chronic opiate use

J Orthop. 2024 Feb 28:53:49-54. doi: 10.1016/j.jor.2024.02.046. eCollection 2024 Jul.

Authors

Kian Niknam¹, Ryan Freshman¹, Sergio E Flores¹, Drew A Lansdown¹, Stephanie E Wong¹, Alan L Zhang¹

Affiliation

¹ Department of Orthopaedic Surgery, University of California - San Francisco, San Francisco, CA, USA.

PMID: 38456177
PMCID: PMC10915368 (available on 2025-07-01)
DOI: 10.1016/j.jor.2024.02.046

Abstract

Introduction: In recent years, the utilization of hip arthroscopy to treat femoroacetabular impingement syndrome (FAIS) has increased due to its low complication rates, positive impact on patient-reported outcomes (PROs), and association with faster rehabilitation. Despite this, there are high rates of revision and conversion to total hip arthroplasty (THA) in some of these patients. It is unclear whether time from initial FAIS diagnosis to surgery is a risk factor for poor outcomes. In this study, we examined the relationship between timing of hip arthroscopy for FAIS and rates of 2-year revision hip procedures, 2-year conversion to total hip arthroplasty (THA), post-operative medical complications, and opioid prescriptions.

Methods: This is a retrospective cohort study utilizing the PearlDiver database. Current Procedural Terminology (CPT) and International Classification of Diseases (ICD) codes were used to identify patients who had surgery for FAIS with minimum 2 years follow-up available. Patients were stratified by 3-month intervals into 5 groups based on time from diagnosis of FAIS to hip arthroscopy. Multivariate logistic regression was performed to determine factors independently associated with continued opiate use and subsequent surgeries.

Results: A total of 14,677 patients were included in the study. The 2-year rate of revision hip arthroscopy was 4.2%. As time from diagnosis to surgery increased, even in multivariate regression analysis, there was a higher risk of filling an opioid prescription 90 days after surgery (P < 0.001). Regression analysis demonstrated that timing of surgery was not associated with 2-year revision hip arthroscopy or conversion to THA. Age, sex, obesity, and tobacco use were significant predictors of revision hip arthroscopy and conversion to THA (p < 0.001).

Conclusion: There is no significant difference between timing of surgery for FAIS and odds of revision or conversion to THA. Prolonged opiate use after hip arthroscopy was significantly higher as duration from initial FAIS diagnosis to surgery increased. Age, sex, obesity, and tobacco use are significant predictors for revision, conversion to THA, and continued opiate prescriptions.

Keywords: Femoroacetabular impingement syndrome; Post-operative opioid use; Revision hip arthroscopy; Total hip arthroplasty.