Pre-Knee Replacement Use of Opioids Tied to Complications

Significantly higher complication rate and greater need for pain management referral

THURSDAY, Nov. 10 (HealthDay News) -- Use of chronic opioid analgesia prior to total knee arthroplasty is associated with significantly increased prevalence of complications and poorer clinical outcomes, according to a study published in the Nov. 2 issue of The Journal of Bone & Joint Surgery.

Michael G. Zywiel, M.D., from the University of Toronto, and colleagues compared the perioperative course, complication rates, and clinical outcomes after 49 total knee arthroplasty surgeries in patients (mean age, 56 years) who regularly used opioids for pain for six or more weeks prior to surgery versus those who did not use opioids preoperatively. Both of the groups were assessed for Knee Society scores, hospitalization length, aseptic complications requiring reoperation, need for specialized pain management, and clinical outcomes. Participants were followed up for an average of three years.

The investigators found that the patients regularly using opioids at the time of final follow-up had significantly lower mean Knee Society scores than nonusers (79 versus 92 points). The opioid cohort had a significantly higher prevalence of complications, with five arthroscopic evaluations and eight revision surgeries for persistent stiffness and/or pain versus no complications in the non-opioid group. Ten patients in the opioid group, versus one in the non-opioid group, were referred for outpatient pain management.

"Patients who chronically use opioid medications prior to total knee arthroplasty may be at a substantially greater risk for complications and painful prolonged recoveries," the authors write.

Two study authors disclosed financial relationships with the biomedical industry.

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