TJA and Preoperative Opioid Use
Preoperative opioid use is associated with inferior patient reported outcomes, increased opioid consumption after surgery, an increased risk for chronic opioid use, and an increased risk of complications after TJA.
Anesthesia and Analgesia in Total Joint Arthroplasty
Developed by: American Association of Hip and Knee Surgeons, American Society of Regional Anesthesia and Pain Medicine, American Academy of Orthopaedic Surgeons, The Hip Society, and The Knee Society

Rationale

We reviewed fourteen studies that evaluated the influence of preoperative opioid use on outcomes after TJA.[2–15] All studies were assessed as low quality and thus a limited amount of meta-analyses were performed due to inconsistency in outcomes reported and the timepoints at which these outcomes were reported. 

Nine studies evaluated the effects of preoperative opioid use on patient reported outcomes.[2,5–11,15] Seven studies found that when compared to opioid naïve patients, patients taking preoperative opioids had inferior patient reported outcome scores in all outcomes measured.[2,5–8,11,15] Three of these studies were included in a direct meta-analysis with limited heterogeneity, which found that preoperative opioid use is associated with inferior pain scores postoperatively compared to opioid naïve patients (0.52 standard mean difference; 95% confidence interval 0.28 to 0.76).[5,9,15] Two studies found mixed effects of preoperative opioid use on patient reported outcome scores. Hansen et al. found that preoperative opioid users had no difference in patient reported outcome scores, but had significantly decreased range of motion following total knee arthroplasty (TKA) compared to opioid naïve patients.[9] Manalo et al. found no difference in range of motion after TKA or the University of California Los Angeles (UCLA) activity scores, but inferior visual analogue scores (VAS) among patients taking preoperative opioids compared to opioid naïve patients.[10]

            Opioid consumption after TJA among patients taking opioids preoperatively was evaluated by seven studies.[2,4–7,9,14] All seven studies found that patients taking opioids preoperatively consume significantly more opioids after TJA compared to opioid naïve patients. Seven studies evaluated chronic opioid use and found that preoperative opioid use is a major risk factor for chronic opioid use after TJA.[4,6–8,12–14] Due to heterogeneity of the timepoints at which opioid consumption were reported, a direct meta-analysis was not able to be completed.     

Five studies compared complication rates after TJA between patients taking opioids preoperatively and opioid naïve patients.[5–9] Three studies found that complications were more frequent among patients who took opioids preoperatively, while two studies found no difference between opioid naïve patients and patients that took opioids preoperatively. Three studies found no difference in reoperation rates while one study found increased reoperation rates among patients taking opioids preoperatively.[5–8] It is the opinion of the workgroup that it is likely these studies were underpowered to detect differences in reoperation and revision rates between the two groups. The current literature suggests that complications are more common among patients taking opioids preoperatively, but is inconclusive regarding reoperation and revision rates.


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