Marijuana use has become more accessible since its recent legalization in several states. However, its use in a total joint arthroplasty population to our knowledge has not been reported, and the implications of its use in this setting remain unclear.
We report (1) the self-reported use of marijuana in patients undergoing total joint arthroplasty both before and after its legalization; and (2) clinical and demographic factors associated with marijuana use in patients undergoing total joint arthroplasty.
One thousand records of patients undergoing primary total joint arthroplasty (500 consecutive before and 500 consecutive after the legalization of the commercial sale of marijuana in Colorado) were included for analysis. Preoperative medical history and physicals were retrospectively reviewed for self-reported and reasons (medicinal versus recreational) for use. Additionally, patient records were used to determine insurance type, age, gender, smoking status, history of substance abuse, preoperative narcotic use, alcohol intake, and the type of arthroplasty performed.
Self-reported use after legalization dramatically increased from 1% (four of 500) to 11% (55 of 500) (odds ratio [OR], 15.3 [95% confidence interval, 5.5–42.6]; p < 0.001) after legalization. For those reporting use after legalization, 46% (25 of 55) of patients reported recreational use, 26% (14 of 55) medicinal use, 27% (15 of 55) did not report a reason for use, and 2% (one of 55) reported both recreational and medicinal use. Factors associated with use included younger age (with a 10-year mean difference between the groups [p < 0.001]), male gender (36 of 59 users [61%] versus 411 of 941 nonusers [44%]; OR, 2.02; p < 0.01), current smokers (22 of 59 users [37%] versus 54 of 941 [6%] nonusers; OR, 0.09; p < 0.01), a history of substance abuse (eight of 59 users [14%] versus 18 of 941 nonusers [2%]; OR, 8.04; p < 0.001), insurance type (Medicaid only, 28 of 59 [48%] users versus 56 of 941 [6%] nonusers; OR, 20.45; p < 0.01), and preoperative narcotic use (eight of 59 users [14%] versus 17 of 941 nonusers [2%]; OR, 2.4; p < 0.001). We did not find differences with regard to alcohol use, amount of alcohol consumption, or insurance types other than Medicaid.
These results suggest the legalization of marijuana has led to either more users or more patients who are willing to report its use given the lack of legal ramifications. Despite these findings, the evidence to date precludes the use of marijuana postoperatively in patients undergoing total joint arthroplasty. Further investigation, ideally in a prospective randomized manner, should focus on opioid consumption, nausea, sleep patterns, and outcomes in patients using marijuana who are undergoing total joint arthroplasty before recommendations can be made for its use.
Level III, therapeutic study.
J. M. Jennings, D. L. Levy, R. M. Johnson, C. L. Eschen, D. A. Dennis, Colorado Joint Replacement, Denver, CO, USA
M. A. Williams, Porter Adventist Hospital, Denver, CO, USA
D. A. Dennis, Department of Orthopaedics, University of Colorado School of Medicine, Denver, CO, USA; Department of Biomedical Engineering, University of Tennessee, Knoxville, TN, USA
J. M. Jennings, D. A. Dennis, Department of Mechanical and Materials Engineering, University of Denver, Denver, CO, USA
D. A. Dennis, Colorado Joint Replacement, 2535 S Downing Street, Suite 100, Denver, CO 80210, USA, email: firstname.lastname@example.org
One of the authors (DAD) has or may receive payments or benefits from DePuy (Warsaw, IN, USA), Innomed (Savannah, GA, USA), Joint Vue (Columbus, OH, USA), and Wolters Kluwer Health (Philadelphia, PA, USA) not related to this work. One of the authors (JMJ) has or may receive payments or benefits from DePuy, Total Joint Orthopedics (Salt Lake City, UT, USA), and Xenex (San Antonio, TX, USA) not related to this work.
All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request.
Each author certifies that his or her institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.
This work was performed at Colorado Joint Replacement, Denver, CO, USA.
Received January 30, 2018
Accepted April 13, 2018