- Patients who underwent total hip arthroplasty (THA) reported improvements in outcomes regardless of preoperative opioid status
- However, patients who used opioids preoperatively had poorer preoperative and postoperative scores on patient-reported outcome measures; the differences were statistically significant on all scales and clinically significant on most of them
- Preoperative opioid users also had significantly longer hospital stays and were significantly more likely to be discharged to a rehabilitation facility
- Surgeons should counsel patients about minimizing or eliminating opioid use both pre- and postoperatively
A number of groups have studied the effect of preoperative opioid use on objective outcomes of total hip arthroplasty (THA), including in-hospital complications, length of stay and discharge location. Much less is known about the effect of opioid use on how patients perceive their outcomes.
Bryant E. Bonner, MD, a resident in the Department of Orthopaedics at Massachusetts General Hospital, and Young-Min Kwon, MBBS, PhD, program director of the Adult Reconstructive Surgery Fellowship Program and the director of the Bioengineering Laboratory, and colleagues found in a retrospective study, published in the Journal of the American Academy of Orthopaedic Surgeons, that regardless of whether they used opioids preoperatively, patients reported improvement after THA. However, preoperative opioid use was associated with poorer preoperative and postoperative scores on patient-reported outcome measures (PROMs), and poorer objective outcomes.
The researchers identified 389 patients who completed four PROMs before and after THA:
- The Hip Disability and Osteoarthritis Outcome Score–Physical Function Short Form (HOOS-PS), a five-item survey about hip function
- The physical subscale of the Patient-Reported Outcomes Measurement Information System (PROMIS) Global-10, which assesses overall health
- The mental subscale of the PROMIS Global-10
- The Physical Function Short Form 10a (SF10A), a 10-question survey assessing overall physical function
76 patients (24%) self-identified as preoperative opioid users and the rest identified as nonusers. There were no differences between those two groups in age, sex, laterality of surgery, ASA score, follow-up time, femoral head material used or use of intraoperative injection.
Patient-Reported Outcome Measures
- Preoperative results — Compared with the nonusers group, the preoperative opioid users group had significantly poorer average scores on all four PROMs. For three PROMs (HOOS-PS, PROMIS physical and PROMIS mental), the differences were clinically and statistically significant
- Postoperative scores — Again, opioid users had statistically significantly poorer scores on all four PROMs. The differences were clinically significant on PROMIS physical and PROMIS mental
- Change in scores after surgery — Both opioid users and nonusers showed statistically and clinically-significant improvement on all four PROMs after surgery
- Length of stay — The average length of hospital stay was longer for opioid users than for nonusers (2.38 vs. 1.99 days; P = 0.004)
- Discharge location — Opioid users were significantly more likely to be discharged to a rehabilitation facility rather than to home (30% vs. 19%; P = 0.04)
Patients who are taking opioids should be counseled preoperatively about their potentially negative effect on the outcomes of THA. This discussion is an opportunity to help them wean off the opioid and explain that it is also best to avoid or minimize opioid use postoperatively.
Some patients may need a multidisciplinary approach to minimize their preoperative opioid use and develop a plan for postoperative opioid management.
Learn more about the Center for Hip and Knee Replacement at Mass General
Refer a patient to the Department of Orthopaedics