title: Chronic opioid use prior to total knee arthroplasty.
abstract: BACKGROUND
  Chronic use of opioid medications may lead to dependence or hyperalgesia, both of which might adversely affect perioperative and postoperative pain management, rehabilitation, and clinical outcomes after total knee arthroplasty. The purpose of this study was to evaluate patients who underwent total knee arthroplasty following six or more weeks of chronic opioid use for pain control and to compare them with a matched group who did not use opioids preoperatively.
  
  
  METHODS
  Forty-nine knees in patients who had a mean age of fifty-six years (range, thirty-seven to seventy-eight years) and who had regularly used opioid medications for pain control prior to total knee arthroplasty were compared with a group of patients who had not used them. Length of hospitalization, aseptic complications requiring reoperation, requirement for specialized pain management, and clinical outcomes were assessed for both groups.
  
  
  RESULTS
  Knee Society scores were significantly lower in the patients who regularly used opioid medications at the time of final follow-up (mean, three years; range, two to seven years); the opioid group had a mean of 79 points (range, 45 to 100 points) as compared with a mean of 92 points (range, 59 to 100 points) in the non-opioid group. A significantly higher prevalence of complications was seen in the opioid group, with five arthroscopic evaluations and eight revisions for persistent stiffness and/or pain, compared with none in the matched group. Ten patients in the opioid group were referred for outpatient pain management, compared with one patient in the non-opioid group.
  
  
  CONCLUSIONS
  Patients who chronically use opioid medications prior to total knee arthroplasty may be at a substantially greater risk for complications and painful prolonged recoveries. Alternative non-opioid pain medications and/or earlier referral to an orthopaedic surgeon prior to habitual opioid use should be considered for patients with painful degenerative disease of the knee.
authors: Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada.
authors: Michael G
authors: MG
authors: Zywiel
authors: D Alex
authors: DA
authors: Stroh
authors: Seung Yong
authors: SY
authors: Lee
authors: Peter M
authors: PM
authors: Bonutti
authors: Michael A
authors: MA
authors: Mont
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000379:methods*; D016022:Case-Control Studies; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007720:Knee Prosthesis; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery*; D059408:Pain Management / Q000379:methods; D010148:Intractable Pain / Q000188:drug therapy* / Q000503:physiopathology; D010149:Postoperative Pain / Q000175:diagnosis / Q000628:therapy*; D016059:Range of Motion, Articular / Q000187:drug effects / Q000502:physiology; D020127:Recovery of Function / Q000187:drug effects; D012016:Reference Values; D012189:Retrospective Studies
chemical_list: D000701:Analgesics, Opioid