Opioid Use Before Knee Replacement Surgery Leads to Worse Pain Outcomes

VBCR - August 2017, Vol 6, No 3 - Osteoarthritis
Anne Rowe

Knee osteoarthritis (OA) affects millions of American adults and is characterized by substantial pain, joint stiffness, and functional limitations. Many patients with knee OA eventually undergo total knee arthroplasty (TKA), which can significantly increase mobility and decrease pain. However, the results of a new clinical trial suggest that preoperative opioid use may lead to worse pain outcomes following this procedure (Smith SR, et al. J Bone Joint Surg Am. 2017;99:803-808).

Savannah R. Smith, Clinical Research Coordinator, Orthopaedics and Arthritis Center for Outcomes Research, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, and colleagues gathered data from 156 patients who underwent TKAs at their institution between 2011 and 2013, and compared pain relief between those who used opioids before their surgery and those who had not. The average age of the patients was 66 years, and more than half (62.2%) of them were women.

The investigators collected patient-reported outcomes and demographic data from 6 weeks before and 6 months after surgery and obtained data regarding opioid use from the patients’ medical records. During the 2 years before surgery, 23% of patients had received ≥1 prescriptions for opioids, and 9% had used multiple opioids. After surgery, 96.2% of patients received ≥1 opioid prescriptions, and 93.6% received prescriptions for multiple opioids. The 2 most frequently prescribed opioids were oxycodone (96.2%) and hydrocodone (33.3%).

Using standard pain scales (eg, Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] and Pain Catastrophizing Scale), Ms Smith and colleagues analyzed the pain experiences of patients undergoing total knee replacement surgery by comparing the changes in pain scores 6 months after surgery between patients who had used opioids before TKA and those who had not. The analysis included a propensity score to account for other factors associated with an increased likelihood of patients using opioids.

Ms. Smith and colleagues found that opioid use before surgery resulted in decreased pain reduction after surgery. In particular, patients who had not taken opioids before their knee replacement surgery had a mean 6-month WOMAC pain score of 10.5 points (95% confidence interval [CI], 8.3-12.8) compared with 17.1 points (95% CI, 12.8-21.4) for those who had taken these medications.

“Preoperatively, there was a small but not significant difference in the WOMAC pain scores between the groups, whereas the pain scores at 6 months were significantly worse for those who had used opioids preoperatively (p = 0.008). This difference indicates that preoperative opioid use may have affected the pain reduction achieved with the TKA,” Ms. Smith and colleagues asserted.

In addition, patients who used opioids before surgery had a mean Pain Catastrophizing Scale score of 15.5 points, whereas those who had not used opioids had a score of 10.7 points.

“As individuals with osteoarthritis spend an average of 13 years between trials of nonoperative therapies and elective TKA, our results should be viewed as a warning that opioid use may be problematic during this period due to their negative effects on subsequent TKA outcomes,” the investigators concluded.

Related Items
Noises In and Around Joint Signal Future Knee Osteoarthritis
Anne Rowe
VBCR - April 2018, Vol 7, No 1 published on April 17, 2018 in Osteoarthritis
Medical Groups Applaud Congressional Leaders for Agreement to Repeal Medicare Therapy Caps
Anne Rowe
VBCR - December 2017, Vol 6, No 5 published on December 19, 2017 in Health Policy
ACR Responds to 2019 Benefit and Payment Parameters Proposed Rule
Anne Rowe
VBCR - December 2017, Vol 6, No 5 published on December 19, 2017 in Health Policy
Retired UK Professional Football Players at Higher Risk for Knee OA Than Men in the General Population
Anne Rowe
VBCR - December 2017, Vol 6, No 5 published on December 19, 2017 in Osteoarthritis
Smartphone Application May Help Patients with Lupus Report Their Symptoms in Real Time
Anne Rowe
VBCR - October 2017, Vol 6, No 4 published on October 20, 2017 in Technology Update
Sustained Disease Remission Increased by Adding Tocilizumab to Glucocorticoid Therapy in Patients with Giant-Cell Arteritis
Anne Rowe
VBCR - October 2017, Vol 6, No 4 published on October 20, 2017 in Giant Cell Arteritis
New Algorithm Shows Promise in Predicting Progression of Knee Osteoarthritis
Rebecca Bailey
VBCR - October 2017, Vol 6, No 4 published on October 20, 2017 in Osteoarthritis
Motivational Counseling and Text Reminders Improve Outcomes in Patients with RA
Anne Rowe
VBCR - August 2017, Vol 6, No 3 published on August 23, 2017 in Rheumatoid Arthritis
Higher Fish Consumption Associated with Lower RA Disease Activity
Anne Rowe
VBCR - August 2017, Vol 6, No 3 published on August 23, 2017 in Rheumatoid Arthritis
High-Fiber Diet Associated with Reduced Risk for Painful Knee Osteoarthritis
Anne Rowe
VBCR - August 2017, Vol 6, No 3 published on August 23, 2017 in Osteoarthritis
Last modified: September 11, 2017
  • Rheumatology Practice Management
  • American Health & Drug Benefits
  • Value-Based Cancer Care
  • Value-Based Care in Myeloma
  • Value-Based Care in Neurology