A study appearing in the Journal of Bone and Joint Surgery indicates patients who use narcotic pain relievers (opioids) prior to knee replacement surgery, exhibit greater difficulty in recovering post-surgery.

According to the study, opioid users remain in the hospital longer, experience more post-surgical pain, have a higher rate of complications, and are more likely to require additional procedures compared to patients who are not opioid-dependent. 

The results were not surprising, says Michael A. Mont, MD, principal investigator and director for the Center for Joint Preservation and Reconstruction at the Rubin Institute for Advanced Orthopaedics at Sinai Hospital, Baltimore, Md. “But the differences between the two groups of patients were even greater than we thought they would be. The chronic narcotic users did significantly worse in every category,” Mont adds.

Researchers say they matched patients according to age, ex, body-mass index, insurance type, and other medical factors. The study’s results suggested that chronic opioid users endured longer hospital stays post-surgery, were more likely to need referrals for pain management, and had a greater likelihood of unexplained pain or stiffness. Patients also exhibited lower function and less motion in the replaced knee. 

Based upon the study’s findings, Mont says opioid-dependent patients and their physicians should be aware that post-surgery results might not be optimal, but adds that it might also be possible that to work with these patients to improve surgical outcomes. To accomplish a positive outcome, Mont and the study’s co-authors suggest weaning patients off strong opioid medications prior to surgery, prescribing alternate, non-opioid pain medications, or considering non-pharmaceutical pain management strategies.

Researchers acknowledge limitations of the study, which includes the possibility that some patients who become dependent on opioids may have lower pain thresholds than those who do not. These particular patients may also be less compliant with rehabilitation plans and other post-surgical treatments. 

Mont emphasizes that the study’s findings still warrant action, “This is a topic our orthopaedic community and other care providers need to address together.”

Source: Journal of Bone and Joint Surgery