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Chronic Opioid Use Prior to Total Knee Arthroplasty

Zywiel, Michael G. MD; Stroh, D. Alex BS; Lee, Seung Yong MD; Bonutti, Peter M. MD; Mont, Michael A. MD

Journal of Bone & Joint Surgery - American Volume: 2 November 2011 - Volume 93 - Issue 21 - p 1988–1993
doi: 10.2106/JBJS.J.01473
Scientific Articles

Background: Chronic use of opioid medications may lead to dependence or hyperalgesia, both of which might adversely affect perioperative and postoperative pain management, rehabilitation, and clinical outcomes after total knee arthroplasty. The purpose of this study was to evaluate patients who underwent total knee arthroplasty following six or more weeks of chronic opioid use for pain control and to compare them with a matched group who did not use opioids preoperatively.

Methods: Forty-nine knees in patients who had a mean age of fifty-six years (range, thirty-seven to seventy-eight years) and who had regularly used opioid medications for pain control prior to total knee arthroplasty were compared with a group of patients who had not used them. Length of hospitalization, aseptic complications requiring reoperation, requirement for specialized pain management, and clinical outcomes were assessed for both groups.

Results: Knee Society scores were significantly lower in the patients who regularly used opioid medications at the time of final follow-up (mean, three years; range, two to seven years); the opioid group had a mean of 79 points (range, 45 to 100 points) as compared with a mean of 92 points (range, 59 to 100 points) in the non-opioid group. A significantly higher prevalence of complications was seen in the opioid group, with five arthroscopic evaluations and eight revisions for persistent stiffness and/or pain, compared with none in the matched group. Ten patients in the opioid group were referred for outpatient pain management, compared with one patient in the non-opioid group.

Conclusions: Patients who chronically use opioid medications prior to total knee arthroplasty may be at a substantially greater risk for complications and painful prolonged recoveries. Alternative non-opioid pain medications and/or earlier referral to an orthopaedic surgeon prior to habitual opioid use should be considered for patients with painful degenerative disease of the knee.

Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

1Division of Orthopaedic Surgery, University of Toronto, 100 College Street, Room 302, Toronto, ON M5G 1L5, Canada

2Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215. E-mail address for M.A. Mont:

3Hallym University Medical Center, 445 Kildong, Kangdonggu, Seoul, South Korea

4Bonutti Clinic, 1303 West Evergreen Avenue, Effingham, IL 62401

Copyright 2011 by The Journal of Bone and Joint Surgery, Incorporated
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