New Research Highlights Risk Factors For Opioid Misuse Following Orthopedic Surgery
There’s no shortage of media coverage when it comes to the opioid epidemic as growing numbers of people becoming addicted to these drugs, leading to health, personal, and legal troubles. And, unfortunately, the rise in these numbers is in part due to perfectly legal medical practices; many who become dependent start off taking prescription medicines like Vicodin or Oxycontin to manage pain.
This is certainly an important consideration in the field of orthopedic surgery; it’s simply unavoidable that opioids are necessary in recovery. The big question then becomes how to ensure that patients don’t become addicted and are able to stop using them. In order to figure out the right balance—between reducing suffering and preventing dependency—researchers have started taking a closer look at what can and should be done.
In fact, two recent studies have examined more closely opioid use following orthopedic surgery. Let’s take a closer look at them.
Rating Risk Factors
One study, which recently appeared in The Journal of Arthroplasty, sought to assess risk factors that impact opioid and narcotic use following hip and knee replacement surgery.  Working with a sample of 179 patients, Dr. Kipp A. Cryar and his team at the University of Arkansas’s Department of Orthopaedic Surgery, looked at pre-operative use of tobacco, opioid narcotics as well as a couple other drugs, Benzodiazepine and Tramadol—used to help with anxiety issues and panic attacks—to see if use of these correlated with higher opioid use in the three months following surgery.
The results were quite stark and clearly showed relationships between these pre-operative behaviors and use of opioids following surgery. Here’s a quick breakdown:
- Smokers: Those who were smokers prior to surgery were found to use 90 percent more opioids following surgery, based on assessments of amount of prescriptions filled.
- Narcotic Users: Opioid and Tramadol users also showed significantly higher rates of use. For the former this lead to 86 percent more use, and this figure was 38 percent for users of the latter.
- Benzodiazepine Users: Significant, too, was that pre-operative users of Benzodiazepine (commonly known as “valium”) were found to use 81 percent more opioids following surgery.
For doctors this means that habits and lifestyle factors are important to consider in the course of treatment. Since, as they put it, “[p]redisposition to substance abuse may be a characteristic which leads to increased post-operative narcotic use,” medical professionals need to be vigilant and mindful. 
Total Knee Arthroplasty & Opioid Use
Taking a longer and more wide-ranging view, Dr. Jourdan M. Cancienne and a team from the University of Virginia assessed data from 113,337 total knee replacement (TKA) patients who’d had the procedure done between 2007 and 2015, focusing on opioid use before and following surgery as it impacts health outcomes.  As with Dr. Kipp and colleagues’ study, they looked at preoperative use of opioids, which they measured based on prior prescriptions of these, as well as rates of infection, readmission to hospital, stiffness, and complications. Of the participants, 31,733 had been prescribed opioids prior to TKA, and 35,770 took them more than three months after treatment.
So what did they find? Let’s take a look:
- Preoperative Narcotic Use: The team found that use of opioids prior to surgery was related to increased emergency room visits, readmission, risk of infection, stiffness, and failure of proper bonding between prosthetic and bone.
- Prolonged Postoperative Use: For patients who ended up using opioids for longer than three months after TKA, there was increased risk of infection, stiffness in the area, and complications with the prosthetic.
- Links Between Pre and Postoperative Opioid Use: Like the other study, there was a distinct relationship found between those who had taken opioids prior to surgery and length of opioid use following surgery.
Dr. Cancienne and the team concluded that opioid use before surgery should be taken into account when managing treatment, noting that it “should be considered among the modifiable risk factors and comorbidities when deciding whether to perform TKA.” 
Figuring Out The Best Way Forward
Clearly, a history of use of opioids increases risk for dependency, while also impacting the efficacy of orthopedic surgeries overall. As we contend with the opioid epidemic in general—while balancing the necessity of patient comfort—doctors will need to be more mindful about their prescriptions. The good news, though, is that experts in the field are working on it. No doubt the more they look into this, the better off orthopedic surgery patients will be.
If you’re considering orthopedic surgery, the team at Onward Orthopedics is ready to help. These professionals employ the latest in techniques and technologies to ensure positive outcomes for all their patients. Learn more about what they do by calling (800) 577-1693 today!
- Cryar, Kipp A., Timothy Hereford, Paul K. Edwards, Eric Siegel, C.Lowry Barnes, and Simon C. Mears. 2018. “Preoperative Smoking, Narcotic, Benzodiazepine And Tramadol Use Are Risk Factors For Narcotic Use After Hip And Knee Replacement”. The Journal Of Arthroplasty. Elsevier BV. doi:10.1016/j.arth.2018.03.066.
- Cancienne, Jourdan M., Kishan J. Patel, James A. Browne, and Brian C. Werner. 2018. “Narcotic Use And Total Knee Arthroplasty”. The Journal Of Arthroplasty 33 (1): 113-118. Elsevier BV. doi:10.1016/j.arth.2017.08.006.