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August 10, 2018

Preoperative Opioid Use Before Joint Replacement Surgery Increases Risks

New research indicates that opioid use before joint replacement surgery puts patients at substantially higher risks for excruciating injuries, hospital readmittance, and joint implant failure, necessitating additional surgeries.

The Journal of Bone and Joint Surgery published the revelatory study this past month. Researchers from the University of Chicago found that more than half the patients in the national database study had at least one opioid prescription before undergoing total hip or knee replacement surgery. Consequently, researchers are alerting orthopedic surgeons to consider this factor during the screening process for artificial joint replacement candidates.

“Opioid use should be considered yet another risk factor for surgeons and patients to consider prior to elective primary joint arthroplasty,” wrote researcher Dr. Hue H. Luu.

The study followed approximately 324,000 total patients. All the patients had at least one year of follow-up data, following joint replacement surgery between 2003 and 2014. However, approximately 160,000 patients had three years of follow-up information, as well. 233,000 of the patients underwent total knee arthroplasty (TKA), and 91,000 were total hip arthroplasty (TKA) patients.

Researchers pulled the patients from a national database including patients with private insurance, as well as those on Medicare. Based on the data, researchers determined that preoperative opioid use to be a substantial risk factor for two serious adverse outcomes – rehospitalization within 30 days of joint replacement surgery and revision surgery due to artificial joint failure within one to three years of implantation.

The one-year follow-up group consisted of 51 percent ]TKA patients and 56 percent THA patients with one or more opioid prescriptions that were filled within six months before the procedure. Patients with continual preoperative use of more than 60 days represented 16 percent of TKA patients and 19 percent of THA patients.

Chronic Opioid Use Causes Joint Replacement Surgery Risks Spike

joint replacement


Researchers discovered that long-term opioid use of more than 60 days caused a significant increase in risk of both possible adverse outcomes. In TKA patients, the hospital readmission rate was 4.82 percent among those with no preoperative opioid use. Patients with more than 60 days of opioid use exhibited a 6.17 percent readmission rate. THA patients experienced rates of 3.71 and 5.85 percent respectively.

In the one-year follow-up group, the revision rate for TKA patients doubled due to preoperative opioid use with 1.07 percent for patients with no opioid use and 2.14 percent for those with long-term chronic opioid use. In THA patients, the revision rate differences were even higher with .38 percent versus 1.1 percent.

The researchers also noticed significant risk increases in the three-year follow-up group associated with preoperative opioid use. In both groups, the risk increases directly related to opioid use remained significant after adjusting for age, sex, and the “comorbidity index” for other medical conditions. However, the researchers did concede some study limitations, including little data on the reasons for readmission or revision surgeries.

Joint Replacement Preoperative Opioid Use Implications

As the opioid crisis continues to escalate at a fever pitch, previous studies have also found preoperative opioid use to be detrimental to clinical outcomes for a diverse range of surgeries. Total knee and hip arthroplasty are two of the most common surgical procedures in the United States with more than a million procedures performed each year. Consequently, these findings add to the rapidly growing body of evidence that chronic opioid use poses a significant threat to sprawling patient populations, causing higher rates of complications, implant failure, and even death.

“Previous studies have highlighted factors associated with poor outcomes in total joint arthroplasty, such as diabetes, chronic kidney disease, obesity, and smoking,” Dr. Luu and coauthors wrote. “Our data suggest that preoperative opioid use may be another risk factor to take into consideration.”

Furthermore, researchers also found that more than half of patients engaged in opioid use prior to TKA or THA, often for extended periods of time.

“Although it may not be possible for certain conditions, diminishing or eliminating opioid use preoperatively would be beneficial when planning a total joint arthroplasty,” the researchers wrote.

“Both readmissions and additional revision surgeries add to the cost of healthcare and are often physically and emotionally challenging for our patients,” Dr. Luu noted. “As physicians, we can help our patients and the healthcare system by reducing or eliminating preoperative opioid use in hip and knee replacement patients.”

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