2021 ISAKOS Biennial Congress Paper
Can BMAC Application Safely Diminish Perioperative Pain In Patients Undergoing Hip Arthroscopy?
Michael Peter Kucharik, BS, Boston, Massachusetts UNITED STATES
Paul F Abraham, BS, Boston, Massachusetts UNITED STATES
Mark R. Nazal, MPH, Stoneham, MA UNITED STATES
Nathan Varady, MD, MBA, Boston, MA UNITED STATES
Wendy Madeline Meek, BBA, Boston, Massachusetts UNITED STATES
Stephen M Gillinov, AB, New Haven, Connecticut UNITED STATES
Christopher T Eberlin, BS, Boston, MA UNITED STATES
Scott Martin, MD, Boston, MA UNITED STATES
Massachusetts General Hospital, Boston, MA, UNITED STATES
FDA Status Not Applicable
Patients who received BMAC during arthroscopic labral repair reported significantly less pain than those who did not receive BMAC. Patients receiving BMAC also reported with minimal complications.
The purpose of this study was to compare pain levels and medication use in the perioperative period in patients undergoing arthroscopic labral repair with and without BMAC application. The secondary purpose of this study was to report safety of the procedure by evaluating post-operative complications from the perioperative period to final follow-up.
A prospective cohort of consecutive patients undergoing arthroscopic acetabular labral repair with possible BMAC application between January 2018 and March 2020 were offered enrollment into the study. BMAC was not used in patients with widespread degenerative changes or patients without any discernable degenerative changes. Each patient was prescribed 20 tablets of 5 mg oxycodone and was instructed to take 1 tablet for breakthrough pain of moderate intensity. Patients were instructed to complete a medication and visual analog scale (VAS) pain tracker and return it at their suture removal appointment, approximately 12-14 days after surgery. Outcomes collected from this tracker were compared between the group of patients treated with BMAC and the group not treated with BMAC. In addition, retrospective chart review was conducted for 171 patients who received BMAC by the senior surgeon during arthroscopic acetabular labral repair. Progress notes from the perioperative period until final follow-up were examined for possible complications related to BMAC harvesting and application.
Seventy patients [40 (57.1%) males] completed the medication and pain tracker. 59 (84.3%) of these patients underwent BMAC application. Mean (95% CI) age was 31.71 (29.52, 33.91). On postoperative day #1 (POD#1), VAS pain scores were lower in the BMAC group, approaching statistical significance (4.76 vs. 6.18 p=0.095). The BMAC group reported significantly less pain than the No BMAC group on POD#5 (3.53 vs. 5.18; p=0.010), POD #10 (2.23 vs. 3.73; p=0.014), and the suture removal appointment (1.80 vs. 3.18; p=0.008). The mean length of opioid (4.02 vs. 2.82 days; p=0.348) and NSAID (8.59 vs. 8.00 days; p=0.677) usage did not differ significantly between groups. The total number of opioid (8.47 vs. 7.45; p=0.715) and NSAID (27.83 vs. 21.36; p=0.464) pills taken also did not differ significantly between groups. The maximum number of opioid (2.61 vs. 2.64; p=0.973) and NSAID (5.07 vs. 5.55; p=0.708) pills taken in a single day was also similar. Among the 171 patients in the retrospective cohort, 19 (11.1%) had signs of heterotopic ossification (HO) on follow-up radiograph, 2 (1.2%) progressed to total hip arthroplasty (THA) by final follow-up, and 1 (0.5%) had evidence of neuropraxia. Zero patients had evidence of wound infection, joint infection, skin necrosis, hemorrhage, avascular necrosis, or required a repeat arthroscopic procedure.
Patients treated with BMAC at the time of hip arthroscopy had significantly lower VAS pain scores than those not treated with BMAC, despite undergoing bone marrow aspiration—normally a painful procedure. Furthermore, the patients treated with BMAC used opioids and NSAID medications at similar rates as those treated without BMAC. Patients treated with BMAC suffered minimal postoperative complications, as zero patients had evidence of joint infection, wound infection, or hemorrhage secondary to BMAC harvesting and application.