Study Urges Caution in Giving Some Patients Opioids Before Knee Surgery

A new study suggests that in some patients undergoing a total knee replacement, taking opioid painkillers before the operation may increase the risk of being on opioids much longer afterwards. The drugs may also increase the risk of complications after surgery, Medscape reports.

Total knee replacement, or total knee arthroplasty, is a surgical procedure in which parts of the knee joint are replaced with artificial parts.

“Narcotic use can be dangerous. We need to understand how much to give and why we’re giving it,” lead researcher Robert Westermann, MD of the Department of Orthopedics at the University of Iowa said at the recent American Academy of Orthopaedic Surgeons 2016 Annual Meeting. He added that initiatives that encourage orthopedic surgeons to decrease the use of opioids are needed.

In his study, Dr. Westermann identified 112,569 patients who underwent total knee replacement from 2007 to 2014. Of these, 44 percent had no history of opioid use. Thirty-one percent filled at least one opioid prescription in the three months before surgery, while 28 percent filled at least one prescription more than three months before surgery.

Of the patients who used opioids before surgery, 83 percent filled an opioid prescription in the month after surgery, compared with 52 percent who had not used opioids before surgery.

After one year, 24 percent of those who used opioids before surgery were still filling an opioid prescription, compared with 2.7 percent of those who had not used opioids before surgery.

Patients who filled an opioid prescription in the three months before surgery were more likely to have other medical conditions, such as diabetes, kidney or heart disease.

The study found 90-day complication rates were higher in patients who took opioids before surgery. “We hope to do further research to see whether complication rates will come down if opiate users stop taking medication before surgery,” Dr. Westermann said.