Postoperative Doxycycline Did Not Improve Early Postoperative Outcomes in Hip Arthroscopy Patients: A Retrospective Cohort Study

Abstract Doxycycline has been shown to reduce fibroblast activity in the treatment of multiple pathologies, and was utilized as part of the postoperative medication protocol to help prevent adhesions from developing after hip arthroscopy. The purpose of this study was to compare early postoperative pain outcomes between consecutive case series of femoroacetabular impingement syndrome (FAIS) patients treated with or without a 7-day postoperative course of doxycycline following hip arthroscopy. We hypothesized that the doxycycline-treated group would have superior patient-reported outcomes at 6 weeks, and the effect would be more pronounced for patients with low preoperative mental health scores. Our institutional review board–approved prospective outcomes registry was queried for patients who had undergone arthroscopic femoral osteochondroplasty and/or labral repair or reconstruction secondary to FAIS performed by a single, fellowship-trained surgeon. A 7-day postoperative course of doxycycline was initiated in 2018. Six-week postoperative Hip Disability and Osteoarthritis Outcome Score (HOOS) global (HOOSglobal) and International Hip Outcome Tool (iHOT) scores were compared between the consecutive series treated with versus without doxycycline. Additional subgroup analysis was performed on patients with low preoperative Veterans RAND 12-Item Health Survey (VR-12) mental component scores to determine possible additional benefit of postoperative doxycycline in this group. A total of 134 patients (98 female, 36 male, age = 36.2 ± 13.4 years, body mass index [BMI] = 27.2 ± 5 kg/m2) were identified between 2013 and 2020. There were no differences between the control (n = 84) and doxycycline group (n = 50) in age, sex, or BMI. Postoperative HOOSglobal scores (control = 58.5 ± 13.1, doxycycline = 58.7 ± 14.7, p = 0.96) and iHOT scores (control = 54.4 ± 22.2, doxycycline = 52.3 ± 24.8, p = 0.61) did not differ between groups. The subset of 83 patients with low preoperative mental scores showed no differences in HOOSglobal (control = 51.6 ± 13.3, doxycycline = 57.3 ± 7.4, p = 0.12) or iHOT scores (control = 45.5 ± 20.3, doxycycline = 53.6 ± 23.1, p = 0.250). Our results do not support the hypothesis that postoperative doxycycline leads to significant improvement in early postoperative pain scores or functional outcomes in patients undergoing hip arthroscopy for FAIS.

[1]  G. Ungvari,et al.  Minocycline for Depressive Symptoms: a Meta-Analysis of Randomized, Double-Blinded, Placebo-Controlled Trials , 2020, Psychiatric Quarterly.

[2]  J. Carrino,et al.  Pathological mechanisms and therapeutic outlooks for arthrofibrosis , 2019, Bone Research.

[3]  E. Brähler,et al.  Obesity, depression and hip pain , 2019, Musculoskeletal care.

[4]  S. Nho,et al.  Predictors of Persistent Postoperative Pain at Minimum 2 Years After Arthroscopic Treatment of Femoroacetabular Impingement , 2019, The American journal of sports medicine.

[5]  A. Rosenblum,et al.  The Presence of a Psychiatric Condition is Associated With Undergoing Hip Arthroscopy for Femoroacetabular Impingement: A Matched Case-Controlled Study. , 2019, The Journal of arthroplasty.

[6]  R. Westermann,et al.  Systematic Review and Meta-analysis of Outcomes After Hip Arthroscopy in Femoroacetabular Impingement , 2019, The American journal of sports medicine.

[7]  D. Vyas,et al.  Pain Management After Hip Arthroscopy: Systematic Review of Randomized Controlled Trials and Cohort Studies , 2018, The American journal of sports medicine.

[8]  P. Beaulé,et al.  Development of the HOOSglobal to Assess Patient-Reported Outcomes in Patients Undergoing Hip Preservation Procedures , 2018, The American journal of sports medicine.

[9]  Sophie E. Holmes,et al.  Elevated Translocator Protein in Anterior Cingulate in Major Depression and a Role for Inflammation in Suicidal Thinking: A Positron Emission Tomography Study , 2018, Biological Psychiatry.

[10]  R. Marx,et al.  Defining the Learning Curve for Hip Arthroscopy: A Threshold Analysis of the Volume-Outcomes Relationship , 2018, The American journal of sports medicine.

[11]  D. Hamilton,et al.  Preoperative Symptoms in Femoroacetabular Impingement Patients Are More Related to Mental Health Scores Than the Severity of Labral Tear or Magnitude of Bony Deformity. , 2017, The Journal of arthroplasty.

[12]  Y. Zhong,et al.  Minocycline targets multiple secondary injury mechanisms in traumatic spinal cord injury , 2017, Neural regeneration research.

[13]  A. Mittal,et al.  Defining the lateral edge of the femoroacetabular articulation: correlation analysis between radiographs and computed tomography , 2016, Journal of children's orthopaedics.

[14]  Mohamed M. Ghoneim,et al.  Depression and postoperative complications: an overview , 2016, BMC Surgery.

[15]  M. Barekatain,et al.  The effect of adjunctive low-dose doxycycline and licorice therapy on gingival crevicular fluid matrix metalloproteinase-8 levels in chronic periodontitis , 2013, Dental research journal.

[16]  M. Maes,et al.  So depression is an inflammatory disease, but where does the inflammation come from? , 2013, BMC Medicine.

[17]  M. Berk,et al.  Minocycline: therapeutic potential in psychiatry. , 2012, CNS drugs.

[18]  L. Watkins,et al.  Tetracyclines and pain , 2012, Naunyn-Schmiedeberg's Archives of Pharmacology.

[19]  J. Tanus-Santos,et al.  Matrix metalloproteinases: targets for doxycycline to prevent the vascular alterations of hypertension. , 2011, Pharmacological research.

[20]  M. Meurisse,et al.  Pathophysiology and prevention of postoperative peritoneal adhesions. , 2011, World journal of gastroenterology.

[21]  S. Arthurs,et al.  Comparative systematic review of the open dislocation, mini-open, and arthroscopic surgeries for femoroacetabular impingement. , 2011, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[22]  J. Burston,et al.  The contribution of spinal glial cells to chronic pain behaviour in the monosodium iodoacetate model of osteoarthritic pain , 2011, Molecular pain.

[23]  William Rogers,et al.  Updated U.S. population standard for the Veterans RAND 12-item Health Survey (VR-12) , 2009, Quality of Life Research.

[24]  M. Leunig,et al.  A systematic approach to the plain radiographic evaluation of the young adult hip. , 2008, The Journal of bone and joint surgery. American volume.

[25]  Marc J Philippon,et al.  Revision Hip Arthroscopy , 2007, The American journal of sports medicine.

[26]  L. Sharma,et al.  Effects of doxycycline on progression of osteoarthritis: results of a randomized, placebo-controlled, double-blind trial. , 2005, Arthritis and rheumatism.

[27]  M. Stone,et al.  Should tetracycline treatment be used more extensively for rheumatoid arthritis? Metaanalysis demonstrates clinical benefit with reduction in disease activity. , 2003, The Journal of rheumatology.

[28]  J. O'dell,et al.  Treatment of early seropositive rheumatoid arthritis: a two-year, double-blind comparison of minocycline and hydroxychloroquine. , 2001, Arthritis and rheumatism.

[29]  J. O'dell,et al.  Treatment of early seropositive rheumatoid arthritis with minocycline: four-year followup of a double-blind, placebo-controlled trial. , 1999, Arthritis and rheumatism.

[30]  J. O'dell,et al.  Treatment of early rheumatoid arthritis with minocycline or placebo: results of a randomized, double-blind, placebo-controlled trial. , 1997, Arthritis and rheumatism.

[31]  S. Pillemer,et al.  Minocycline in Rheumatoid Arthritis: A 48-Week, Double-Blind, Placebo-Controlled Trial , 1995, Annals of Internal Medicine.

[32]  R Core Team,et al.  R: A language and environment for statistical computing. , 2014 .

[33]  B. Morrey Comparative Systematic Review of the Open Dislocation, Mini-Open, and Arthroscopic Surgeries for Femoroacetabular Impingement , 2011 .

[34]  J. Parvizi,et al.  Femoroacetabular Impingement , 2007, Seminars in musculoskeletal radiology.