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Opioid Use and Total Joint Replacement

  • Surgery and Perioperative Care (S Goodman, Section Editor)
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Abstract

Purpose of Review

We provide an overview of recent research into the relationship between preoperative opioid use and total joint replacement outcomes.

Recent Findings

Recent findings indicate that total joint replacement patients with a history of preoperative opioid use experience higher rates of infection, revision, short-term complications, and prolonged postoperative opioid use, along with fewer improvements in pain and function following surgery. These risks are particularly pronounced among chronic opioid users. While the baseline risk profiles of these patients may contribute to higher rates of adverse outcomes, it is also plausible that certain outcomes are directly impacted by opioid use through mechanisms such as opioid-induced hyperalgesia and immunosuppression. There is little available data on the efficacy of interventions that aim to mitigate these risks.

Summary

Well-designed clinical trials are needed to evaluate the efficacy of targeted perioperative interventions that aim to improve outcomes for this high-risk surgical population. Where such trials are not feasible, additional high-quality observational studies are necessary to further our understanding of the mechanisms underlying the relationships between opioid use and specific adverse outcomes.

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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Funding

CS is supported by an Australian Government Research Training Program Scholarship. MCI is supported by a Mid-Career Fellowship from The Hospital Research Foundation. MMD holds an NHMRC Career Development Fellowship (APP1122526) and University of Melbourne Dame Kate Campbell Fellowship. PFMC holds an NHMRC Practitioner Fellowship (APP1154203).

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Authors and Affiliations

  1. Department of Surgery, St Vincent’s Hospital, The University of Melbourne, Melbourne, Victoria, Australia

    Cade Shadbolt, Chris Schilling, Peter F. M. Choong & Michelle M. Dowsey

  2. Department of Orthopaedics, St Vincent’s Hospital, Melbourne, Fitzroy, Victoria, Australia

    Peter F. M. Choong & Michelle M. Dowsey

  3. Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia

    Maria C. Inacio

  4. Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia

    Maria C. Inacio

  5. Centre for Musculoskeletal Outcomes Research, University of Otago, Dunedin, New Zealand

    J. Haxby Abbott, Yana Pryymachenko & Ross Wilson

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  1. Cade Shadbolt
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Correspondence to Michelle M. Dowsey.

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• CS, CSch, MCI, RW, and YP have nothing to disclose

• JHA reports grants from Otago Medical Research Foundation Jack Thomson Arthritis Grant outside the submitted work.

• PFMC reports personal fees from Stryker, Johnson & Johnson, and Kluwer, and grants from Medacta, outside the submitted work.

• MMD reports personal fees from Pfizer and grants from Medacta, outside the submitted work

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Shadbolt, C., Schilling, C., Inacio, M.C. et al. Opioid Use and Total Joint Replacement. Curr Rheumatol Rep 22, 58 (2020). https://doi.org/10.1007/s11926-020-00929-0

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