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Impact of pre-operative recreational marijuana use on outcomes two years after orthopaedic surgery

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Abstract

Purpose

The purpose of this study was to investigate the relationship between recreational marijuana use and patient-reported outcomes two years after orthopaedic surgery. We hypothesized that pre-operative recreational marijuana use would be associated with less pain, better function, and better mental health measures two years after orthopaedic surgery.

Methods

Patients were retrospectively analyzed from a prospective orthopaedic registry at a single urban institution. A total of 1710 patients completed the pre-operative assessment and 1103 patients (64.5%) completed the two-year follow-up questionnaires. The cohort was then divided into two groups based on reported preoperative recreational marijuana usage, and statistical analysis was performed to determine if marijuana use was associated with two-year outcomes. Multivariable analysis was used to control for confounding variables.

Results

Marijuana use was reported by 47 (4.3%) patients. Significantly worse scores for two-year PROMIS Anxiety (53.2 vs. 49.2, p = 0.005), PROMIS Depression (51.1 vs. 46.5, p = 0.001), Met Expectations (63.1 vs. 74.4, p = 0.024), Surgical Satisfaction Questionnaire-8 (71.7 vs. 80.4, p = 0.005), and Numeric Satisfaction Scale (75.6 vs. 83.1, p = 0.041) were associated with marijuana use. Marijuana users also had less improvement of Numeric Pain Scores at the operative site (− 1.8 vs. − 2.7, p = 0.037) and greater decrease in Marx activity scores for lower extremities (− 12.3 vs. − 3.9, p = 0.024). Marijuana use was not an independent predictor of any outcome measure in the multivariable analysis.

Conclusion

Marijuana use was associated with worse mental health scores, lower activity level, less pain relief, and worse satisfaction two years after orthopaedic surgery. However, after controlling for confounding variables, marijuana use was not predictive of any two-year outcome measure.

Study Design

Cross-sectional study.

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Data availability

Data is available by request.

Code availability

JMP Pro Version 13 Software.

References

  1. Substance abuse Mental Health Services Administration (SAMHSA) (2019) Results from the 2018 National Survey on Drug Use and Health: National Findings (2018). SAMHSA, Rockville

  2. State Medical Marijuana Laws (2020) National Conference of State Legislatures. https://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx. Accessed 21 May 2021

  3. van de Donk T, Niesters M, Kowal MA et al (2019) An experimental randomized study on the analgesic effects of pharmaceutical-grade cannabis in chronic pain patients with fibromyalgia. Pain 160:860–869. https://doi.org/10.1097/j.pain.0000000000001464

    Article  CAS  PubMed  Google Scholar 

  4. Abrams DI, Jay CA, Shade SB et al (2007) Cannabis in painful HIV-associated sensory neuropathy: a randomized placebo-controlled trial. Neurology 68:515–521. https://doi.org/10.1212/01.wnl.0000253187.66183.9c

    Article  CAS  PubMed  Google Scholar 

  5. Lynch ME, Campbell F (2011) Cannabinoids for treatment of chronic non-cancer pain; a systematic review of randomized trials. Br J Pharmacol 72:735–744. https://doi.org/10.1111/j.1365-2125.2011.03970.x

    Article  CAS  Google Scholar 

  6. Russo EB (2008) Cannabinoids in the management of difficult to treat pain. Ther Clin Risk Manag 4:245–259. https://doi.org/10.2147/tcrm.s1928

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Machado Rocha FC, Stéfano SC, De Cássia HR et al (2008) Therapeutic use of Cannabis sativa on chemotherapy-induced nausea and vomiting among cancer patients: systematic review and meta-analysis. Eur J Cancer Care 17:431–443. https://doi.org/10.1111/j.1365-2354.2008.00917.x

    Article  CAS  Google Scholar 

  8. Whiting PF, Wolff RF, Deshpande S et al (2015) Cannabinoids for medical use: a systematic review and meta-analysis. JAMA 313:2456–2473. https://doi.org/10.1001/jama.2015.6358

    Article  CAS  PubMed  Google Scholar 

  9. EPIDIOLEX (Cannabidiol) Oral Solution (2018) FDA. https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/210365lbl.pdf. Accessed 21 May 2021

  10. MARINOL (Dronabinol) Capsules, for Oral Use (2017) FDA. https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/018651s029lbl.pdf. Accessed 21 May 2021

  11. SYNDROS (Dronabinol) Oral Solution, CII (2017) FDA. https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/205525s003lbl.pdf. Accessed 21 May 2021

  12. Cesamet (Nabilone) Capsules For Oral Administration (2006) FDA. https://www.accessdata.fda.gov/drugsatfda_docs/label/2006/018677s011lbl.pdf. Accessed 21 May 2021

  13. Fisher B, Ghuran A, Vadamalai V, Antonios T (2005) Cardiovascular complications induced by cannabis smoking: a case report and review of the literature. Emerg Med J 22:679–680. https://doi.org/10.1136/emj.2004.014969

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Pacher P, Steffens S, Haskó G et al (2018) Cardiovascular effects of marijuana and synthetic cannabinoids: the good, the bad, and the ugly. Nat Rev Cardiol 15:151–166. https://doi.org/10.1038/nrcardio.2017.130

    Article  CAS  PubMed  Google Scholar 

  15. Moore BA, Augustson EM, Moser RP, Budney AJ (2005) Respiratory effects of marijuana and tobacco use in a U.S. sample. J Gen Intern Med 20:33–37. https://doi.org/10.1111/j.1525-1497.2004.40081.x

    Article  PubMed  PubMed Central  Google Scholar 

  16. Callaghan RC, Allebeck P, Sidorchuk A (2013) Marijuana use and risk of lung cancer: a 40-year cohort study. Cancer Causes Control 24:1811–1820. https://doi.org/10.1007/s10552-013-0259-0

    Article  PubMed  Google Scholar 

  17. Roth MD, Arora A, Barsky SH et al (1998) Airway inflammation in young marijuana and tobacco smokers. Am J Respir Crit Care Med 157:928–937. https://doi.org/10.1164/ajrccm.157.3.9701026

    Article  CAS  PubMed  Google Scholar 

  18. Huson HB, Granados TM, Rasko Y (2018) Surgical considerations of marijuana use in elective procedures. Heliyon 4:e00779. https://doi.org/10.1016/j.heliyon.2018.e00779

    Article  PubMed  PubMed Central  Google Scholar 

  19. Vakharia RM, Sodhi N, Anis HK et al (2020) Patients who have cannabis use disorder have higher rates of venous thromboemboli, readmission rates, and costs following primary total knee arthroplasty. J Arthroplasty 35:997–1002. https://doi.org/10.1016/j.arth.2019.11.035

    Article  PubMed  Google Scholar 

  20. Beaulieu P (2006) Effects of nabilone, a synthetic cannabinoid, on postoperative pain. Can J Anesth 53:769–775. https://doi.org/10.1007/BF03022793

    Article  PubMed  Google Scholar 

  21. Buggy DJ, Toogood L, Maric S et al (2003) Lack of analgesic efficacy of oral δ-9-tetrahydrocannabinol in postoperative pain. Pain 106:169–172. https://doi.org/10.1016/S0304-3959(03)00331-2

    Article  CAS  PubMed  Google Scholar 

  22. Jain AK, Ryan JR, McMahon FG, Smith G (1981) Evaluation of intramuscular levonantradol and placebo in acute postoperative pain. J Clin Pharmacol 21:320S-326S. https://doi.org/10.1002/j.1552-4604.1981.tb02610.x

    Article  CAS  PubMed  Google Scholar 

  23. Medina SH, Nadarajah V, Jauregui JJ et al (2019) Orthopaedic surgery patients who use recreational marijuana have less pre-operative pain. Int Orthop 43:283–292. https://doi.org/10.1007/s00264-018-4101-x

    Article  PubMed  Google Scholar 

  24. Runner RP, Luu AN, Nassif NA et al (2020) Use of tetrahydrocannabinol and cannabidiol products in the perioperative period around primary unilateral total hip and knee arthroplasty. J Arthroplasty 35:S138–S143. https://doi.org/10.1016/j.arth.2020.01.077

    Article  PubMed  Google Scholar 

  25. Jennings JM, Angerame MR, Eschen CL et al (2019) Cannabis use does not affect outcomes after total knee arthroplasty. J Arthroplasty 34:1667–1669. https://doi.org/10.1016/j.arth.2019.04.015

    Article  PubMed  Google Scholar 

  26. Henn RF, Dubina AG, Jauregui JJ et al (2017) The Maryland Orthopaedic Registry (MOR): design and baseline characteristics of a prospective registry. J Clin Orthop Trauma 8:301–307. https://doi.org/10.1016/j.jcot.2017.04.003

    Article  PubMed  PubMed Central  Google Scholar 

  27. Crippa JA, Zuardi AW, Martín-Santos R et al (2009) Cannabis and anxiety: a critical review of the evidence. Hum Psychopharmacol 24:515–523. https://doi.org/10.1002/hup.1048

    Article  CAS  PubMed  Google Scholar 

  28. Vidot DC, Bispo JB, Hlaing WM et al (2017) Moderate and vigorous physical activity patterns among marijuana users: results from the 2007–2014 National Health and Nutrition Examination Surveys. Drug Alcohol Depend 178:43–48. https://doi.org/10.1016/j.drugalcdep.2017.05.004

    Article  PubMed  Google Scholar 

  29. Zhang H, Xie M, Archibald SD et al (2018) Association of marijuana use with psychosocial and quality of life outcomes among patients with head and neck cancer. JAMA Otolaryngol Head Neck Surg 144:1017–1022. https://doi.org/10.1001/jamaoto.2018.0486

    Article  PubMed  PubMed Central  Google Scholar 

  30. Shirley ED, Sanders JO (2013) Patient satisfaction: implications and predictors of success. J Bone Joint Surg Am 95:e69. https://doi.org/10.2106/JBJS.L.01048

    Article  PubMed  Google Scholar 

  31. Graham B, Green A, James M et al (2015) Measuring patient satisfaction in orthopaedic surgery. J Bone Joint Surg Am 97:80–84. https://doi.org/10.2106/JBJS.N.00811

    Article  PubMed  Google Scholar 

  32. Stein SM, Day M, Karia R et al (2015) Patients’ perceptions of care are associated with quality of hospital care: a survey of 4605 hospitals. Am J Med Qual 30:382–388. https://doi.org/10.1177/1062860614530773

    Article  PubMed  Google Scholar 

  33. Mukamal KJ, Maclure M, Muller JE, Mittleman MA (2008) An exploratory prospective study of marijuana use and mortality following acute myocardial infarction. Am Heart J 155:465–470. https://doi.org/10.1016/j.ahj.2007.10.049

    Article  PubMed  PubMed Central  Google Scholar 

  34. Tashkin DP, Coulson AH, Clark VA et al (1987) Respiratory symptoms and lung function in habitual heavy smokers of marijuana alone, smokers of marijuana and tobacco, smokers of tobacco alone, and nonsmokers. Am Rev Respir Dis 135:209–216. https://doi.org/10.1164/arrd.1987.135.1.209

    Article  CAS  PubMed  Google Scholar 

  35. Agrawal A, Lynskey MT (2009) Tobacco and cannabis co-occurrence: does route of administration matter? Drug Alcohol Depend 99:240–247. https://doi.org/10.1016/j.drugalcdep.2008.08.007

    Article  CAS  PubMed  Google Scholar 

  36. Schauer GL, Berg CJ, Kegler MC et al (2015) Assessing the overlap between tobacco and marijuana: trends in patterns of co-use of tobacco and marijuana in adults from 2003–2012. Addict Behav 49:26–32. https://doi.org/10.1016/j.addbeh.2015.05.012

    Article  PubMed  Google Scholar 

  37. Ramo DE, Liu H, Prochaska JJ (2012) Tobacco and marijuana use among adolescents and young adults: a systematic review of their co-use. Clin Psychol Rev 32:105–121. https://doi.org/10.1016/j.cpr.2011.12.002

    Article  PubMed  Google Scholar 

  38. Goodwin RD, Sheffer CE, Chartrand H et al (2014) Drug use, abuse, and dependence and the persistence of nicotine dependence. Nicotine Tob Res 16:1606–1612. https://doi.org/10.1093/ntr/ntu115

    Article  CAS  PubMed  Google Scholar 

  39. García-Rodríguez O, Secades-Villa R, Flórez-Salamanca L et al (2013) Probability and predictors of relapse to smoking: results of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Drug Alcohol Depend 132:479–485. https://doi.org/10.1016/j.drugalcdep.2013.03.008

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

J. Kathleen Tracy, Ph.D.; Ali Aneizi, MD; Andrew G. Dubina, MD; Patrick M.J. Sajak: Joshua M. Abzug, MD; Ngozi M. Akabudike, MD; Farshad Adib, MD, Craig H. Bennett, MD; W. Andrew Eglseder, MD; Mohit N. Gilotra, MD; S. Ashfaq Hasan, MD; Christopher G. Langhammer, MD; Vincent Ng, MD; Ebrahim Paryavi, MD; Raymond A. Pensy, MD; Cameran I. Burt; Shaun H. Medina; Keyan Shasti; Dominic J. Ventimiglia; Alexander J. Wahl; and Michael P. Smuda for their assistance with data collection.

Funding

This work was supported by a grant from The James Lawrence Kernan Hospital Endowment Fund, Incorporated.

Author information

Authors and Affiliations

  1. Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD, 21207, USA

    Fernando D. Albelo, Mitchell Baker, Tina Zhang, Matheus B. Schneider, Julio J. Jauregui, Vidushan Nadarajah, Sean J. Meredith, Jonathan D. Packer & R. Frank Henn III

  2. Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA

    Vidushan Nadarajah

Authors
  1. Fernando D. Albelo
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  2. Mitchell Baker
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  3. Tina Zhang
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  5. Julio J. Jauregui
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  6. Vidushan Nadarajah
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  9. R. Frank Henn III
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Each named author has substantially contributed to conducting the underlying research and drafting this manuscript.

Corresponding author

Correspondence to R. Frank Henn III.

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This study was approved by the Institutional Review Board (IRB) Committee at the University of Maryland, Baltimore (HP-00062261). All participants consented participation, as outlined in the IRB approval.

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All participants consented for deidentified publication, as outlined in the IRB approval.

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On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Albelo, F., Baker, M., Zhang, T. et al. Impact of pre-operative recreational marijuana use on outcomes two years after orthopaedic surgery. International Orthopaedics (SICOT) 45, 2483–2490 (2021). https://doi.org/10.1007/s00264-021-05069-3

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