Examining Chronic Opioid Use in TKA

Consensus statements on the management of knee osteoarthritis have not thoroughly addressed the use of opioid medications in patients undergoing total knee arthroplasty (TKA). In order to reduce postoperative pain, most reports recommend that mild analgesics (eg, acetaminophen) be used initially after TKA, followed by NSAIDs and opioids. More recently, concerns have been raised about using opioids because of tolerance issues with these drugs as well as increased responses to pain. Other studies have suggested that opioids can worsen treatment outcomes. Opioid Dependence Worsens Outcomes In the November 2, 2011 Journal of Bone & Joint Surgery, my colleagues and I had a study published in which we compared the perioperative course, complication rates, and clinical outcomes of patients who underwent TKA and if they were treated with chronic preoperative oral opioid analgesics. We looked at 49 knees in patients who had regularly used opioids for pain control prior to TKA and compared them with patients who didn’t use these medications. According to our results, chronic opioid use prior to TKA made it much more difficult for patients to recover after their surgery. Patients who used opioids before their surgery had longer hospital stays, more postoperative pain, and higher complication rates than those who weren’t opioid dependent. They were also more likely to need additional procedures, require referrals for pain management, suffer from unexplained pain or stiffness, and have lower function and less motion in the replaced knee. The differences between patient groups in our study were even greater than we expected, and chronic opioid use was linked to poorer outcomes across the board. Seize Opportunities to Educate Patients About...