Opioid use before knee replacement surgery can lead to poorer outcomes

People who used opioids prior to surgery and more often to help them manage their pain prior to surgery were at greater risk for failed knee replacement.

Is it far-fetched to imagine that people who are waiting for knee replacement surgery or putting it off without treatments that are helping them are more prone to taking opioids and other medications to help them manage their pain?

In December 2020, researchers writing in the European Journal of Pain (1) again touched on a common theme among surgeons, that “One in five patients experiences chronic pain 12 months following total knee arthroplasty (replacement),” and again looked for those pre-operative reasons for what would put a patient at risk for a poorer outcome. Here is how this research team conducted their study and sought to help isolate those risk factors. What did they find? More medication usage.

Learning points:

“On the day before (knee replacement) surgery, 202 patients completed questionnaires that assessed pain, interference with functioning, fatigue, anxiety, depression, and illness perceptions.”
Patients without that much pre-surgical pain or who had “lower than average” and “lower than average worst” pain scores had moderate preoperative pain scores that decreased over the nine months following total knee replacement.
Patients in the “higher than average” and “higher than worst” pain classes had relatively higher preoperative pain scores that increased during the first three months and then decreased slightly over the remaining 9 months. Patients in the higher pain classes had higher interference with function scores; used opioids prior to surgery more often, were more likely to receive a continuous nerve block and ketamine (a pain killer that is seen as a better alternative to stronger pain medications); had higher preoperative fatigue severity and interference scores, and had worse perceptions of illness than patients in the lower pain classes.

1 Lindberg MF, Miaskowski C, Rustøen T, Cooper BA, Aamodt A, Lerdal A. Preoperative risk factors associated with chronic pain profiles following total knee arthroplasty. European Journal of Pain. [Google Scholar]