Research Identifies Joint Replacement Patients Vulnerable To Opioid Use

According to new research, red flags have been identified that may predict when a joint replacement patient is vulnerable to prolonged use of opioid medications.

joint replacement

Opioid addiction –  a national crisis

“Arthritis can be a painful disease,” says orthopedic surgeon and arthritis subspecialist Dr. Dane Hansen. “As a physician caring for patients with arthritis, I want to manage my patients’ pain with appropriate conservative or surgical treatment that will help them maintain their health and quality of life. Medication has a role in pain management, but inappropriate medical use of narcotics for joint replacement goes hand in hand with chemical dependency risks that can be devastating.”

Prescription opioid addiction has become a national crisis, and numerous medical societies are organizing health initiatives to reduce opioid use and address patient addiction. Because opioids are commonly prescribed for acute pain management following total knee or hip replacement surgery, understanding and addressing opioid addiction is a priority for orthopedic physicians. Joint replacement surgery has been highly effective to treat severe joint pain—often caused by arthritis—but little is known about patient patterns of opioid use following such surgery.

“This is important information for us to have,” says Dr. Hansen, “especially as the number of joint replacement surgeries rises with our aging population. Patients are concerned about opioid use and misuse, and so are we.”

Study identifies risk factors for joint replacement patients

In May 2016, researchers at the University of Michigan published a study that analyzed opioid use in 574 patients who had knee or hip replacements. Researchers followed up with these patients at one-, three-, and six-month intervals following their surgeries, and were able to identify some risk factors linked to long-term opioid use.

  • Patients who took opioids prior to their surgery were 35 to 53 percent more likely to continue opioid use six months after surgery.
  • Patients taking high-dose opioids were the most vulnerable to long-term postoperative use. Among patients taking more than 60 milligrams of oral morphine per day, 80 percent were still using opioids six months after their surgery.
  • Joint replacement patients who had not previously taken opioids, but who had higher pain scores on the day of surgery—and more exaggerated worries about pain—were also more susceptible to long-term opioid use.
  • A reduction in overall postsurgery body pain did decrease the risk of long-term opioid use, but pain improvement that was limited to the replaced knee or hip alone was not enough to reduce risk of long-term use.

“Understanding the danger of presurgical opioid use can help us to strengthen our prevention measures,” observes Dr. Hansen. “Two research studies presented at the 2016 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS) confirmed this link between preoperative opioid use and increased addiction risk, and showed that decreased opioid use prior to joint replacement surgery also reduces complications, improves surgical outcomes, and increases patient satisfaction. All of this information helps us to develop strategies for safer and more effective pain management after joint replacement surgery—with an emphasis on achieving the best surgical outcomes while supporting our patients’ quality of life in the long term.”

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  • Dane Hansen, D.O.

    “Arthritis patients have high expectations for their activity level. With advanced training in minimally invasive surgical techniques and quick-recovery joint replacement, I strive to help my patients return to their fully active lifestyle as quickly as possible.”

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