- Among patients who underwent total knee arthroplasty (TKA), those who did not use an opioid preoperatively showed significant improvement in all postoperative patient-reported outcome measures
- Patients who used opioids preoperatively showed significant improvement only in the UCLA activity score, but the average postoperative EQ VAS score was significantly worse in the group of opioid users than in nonusers
- Patients who plan to undergo TKA should avoid opioid pain medication before surgery in order to optimize postoperative health-related quality of life
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In previous studies of patients undergoing joint arthroplasty, objective outcomes have been worse in patients who used opioids preoperatively than in those who were opioid-naïve. Examples include increased in-hospital complications, increased length of stay, prolonged narcotic use and increased postoperative opioid consumption.
However, only a limited amount of research has focused on patient-reported outcomes after joint arthroplasty. Researchers at Massachusetts General Hospital recently helped fill the knowledge gap, determining that opioid use prior to total knee arthroplasty (TKA) negatively affects patient-reported outcomes including quality of life. The results were reported in The Knee.
In the study, a Mass General team led by Young-Min Kwon, MD, PhD, program director for the Adult Constructive Surgery Fellowship Program and director of the Bioengineering Laboratory in the Department of Orthopaedics, evaluated TKA patients with three outcome measures stored in the Mass General medical registry:
- EQ-5D index score
- EQ-5D visual analog scale (EQ VAS)
- University of California Los Angles (UCLA) activity score
Dr. Kwon's team identified two cohorts of patients: 137 who did not use opioids before TKA and 30 who did. The nonusers were carefully selected to match the users: same sex, less than 10 years difference in age and less than 5 kg/m2 difference in body mass index.
On average, patients who used opioids preoperatively were significantly younger than nonusers. The two groups were similar with regard to sex, preoperative body mass index, preoperative Charnley class, preoperative and postoperative range of motion, improvement in range of motion after surgery, length of hospital stay and type of continuing care after discharge.
After surgery, patients who had not used opioids preoperatively showed significant improvement in the EQ-5D index score, EQ VAS and UCLA score. In contrast, opioid users showed significant improvement only in the UCLA score, but the average postoperative EQ VAS score was significantly worse in the group of opioid users than in nonusers.
Based on the study findings, the researchers recommend patients who plan to undergo TKA should avoid opioid pain medication before surgery in order to optimize postoperative health-related quality of life.
These study findings provide useful clinical information that can be used by surgeons in counseling patients prior to undergoing TKA.
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