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Consensus on Reducing Risk in Total Joint Arthroplasty

Narcotic Use

Sodhi, Nipun MD; Mont, Michael A. MD

doi: 10.1097/BTO.0000000000000391

Because of the potential adverse events associated with opioid use, the purpose of this consensus was to provide guidelines to help reduce the risks when performing lower extremity joint arthroplasty. Specifically, the authors addressed: (1) the use of nonopioid pain management; (2) national and state guidelines; (3) the role of pain management specialists; and (4) multimodal pain management options for total hip and knee arthroplasty. A literature search was performed utilizing the PubMed database focused on total hip and knee arthroplasty pain managed with opioids. The authors recommend that patients be started with nonopioid-based pharmacological treatments, such as acetaminophen and nonsteroidal anti-inflammatories. If opioids are necessary, the lowest dose for the shortest duration should initially be prescribed. Appropriate preoperative optimization, intraoperative local analgesic injections, and perioperative multimodal agents, such as long-acting injections, physical therapies, and co-management with pain specialists should all be performed. By following these guidelines, the authors believe that it will help reduce the use of opioids after hip and knee arthroplasty, all while still meeting our patient’s pain control expectations.

Northwell Health Physician Partners, Orthopaedic Institute at Lenox-Hill, New York, NY

This project was supported by an unrestricted grant from KCI, an Acelity company. Project management support was provided by MedicusWorks.

M.A.M.: AAOS, Cymedica, DJ Orthopaedics, Johnson & Johnson, Journal of Arthroplasty, Journal of Knee Surgery, Microport, National Institutes of Health (NIAMS and NICHD), Ongoing Care Solutions, Orthopedics, Orthosensor, Pacira, Peerwell, Performance Dynamics Inc., Sage, Stryker: IP royalties, Surgical Technologies International, Kolon Tissue Gene. N.S. declares that there is nothing to disclose.

For reprint requests, or additional information and guidance on the techniques described in the article, please contact Michael A. Mont, MD, at or by mail at Northwell Health Physician Partners, Orthopaedic Institute at Lenox-Hill, 130 East 77th Street, 7th Floor, New York, NY 10075. You may inquire whether the author(s) will agree to phone conferences and/or visits regarding these techniques.

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