title: Total Joint Arthroplasty in Patients Taking Methadone or Buprenorphine/Naloxone Preoperatively for Prior Heroin Addiction: A Prospective Matched Cohort Study.
abstract: Preoperative narcotic use has been associated with poor outcomes after total joint arthroplasty (TJA). The purpose of this study is to compare clinical outcomes of patients undergoing elective TJA while concurrently being treated with methadone or buprenorphine/naloxone for prior heroin addiction to a matched control group.
  
  
  
  From an electronic medical record, we collected age, gender, body mass index, the presence of back pain, smoking status, history of alcohol abuse, preoperative use of a pain clinic, and use of antipsychotics, antidepressants, or systemic corticosteroids. Validated outcome measures including the 12-Item Short Form Survey, Knee Society Score (KSS), and Harris Hip Score were used to assess functional outcomes preoperatively and postoperatively. Perioperative data were retrospectively obtained from patient charts. Postoperative functional outcomes were prospectively collected at follow-up visits. Subjects were matched to 2:1 control group on the basis of procedure, sex, diagnosis, age (±5 years), and body mass index (±5 kg/m(2)). Average follow-up was 27.2 months.
  
  
  
  Significant preoperative differences between the groups included mean morphine-equivalent requirements (997.1 mg for study group vs 24.8 mg for controls), 12-Item Short Form Survey Mental Component Scores (MCS-12; 37.8 for study group vs 49.0 for controls), smoking history, and antipsychotic medication use. Perioperative referral to inpatient Acute Pain Service and mean in-hospital morphine-equivalent narcotic usage (793 mg/24 h for study group vs 109 mg/24 h for controls) also significantly differed between groups. Knee range of motion differed significantly between the cohorts at 1 year (77.5 for study group vs 109.4); however, no significant difference in KSS pain (87.6 vs 84.4), KSS function (61 vs 80.9), Harris Hip Score (89.2 vs 85.3), MCS-12 (47.1 vs 52.9), or complications was observed.
  
  
  
  Equivalent pain control and successful clinical outcome at 1 year can be achieved in patients who use methadone or buprenorphine/naloxone preoperatively.
authors.affiliation: Department of Orthopaedics, Lake Tahoe Sports Medicine, South Lake Tahoe, California.
authors.forename: Lauren E
authors.initials: LE
authors.lastname: Hansen
authors.affiliation: Tufts University School of Medicine, Boston, Massachusetts.
authors.forename: Genevra L
authors.initials: GL
authors.lastname: Stone
authors.affiliation: Tufts University School of Medicine, Boston, Massachusetts.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Matson
authors.affiliation: Tufts University School of Medicine, Boston, Massachusetts.
authors.forename: David J
authors.initials: DJ
authors.lastname: Tybor
authors.affiliation: Department of Orthopaedics, Tufts Medical Center, Boston, Massachusetts.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Pevear
authors.affiliation: Tufts University School of Medicine, Boston, Massachusetts; Department of Orthopaedics, Tufts Medical Center, Boston, Massachusetts.
authors.forename: Eric L
authors.initials: EL
authors.lastname: Smith
mesh_terms: D000368:Aged; D019643:Arthroplasty, Replacement / Q000009:adverse effects*; D002047:Buprenorphine / Q000008:administration & dosage; D015331:Cohort Studies; D005260:Female; D006556:Heroin Dependence / Q000150:complications*; D006801:Humans; D008297:Male; D008691:Methadone / Q000008:administration & dosage; D008875:Middle Aged; D009270:Naloxone / Q000008:administration & dosage; D009292:Narcotic Antagonists / Q000008:administration & dosage*; D009294:Narcotics / Q000008:administration & dosage*; D059408:Pain Management; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies; D012042:Registries; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D009292:Narcotic Antagonists; D009294:Narcotics; D009270:Naloxone; D002047:Buprenorphine; D008691:Methadone
keywords: Suboxone; heroin; methadone; pain; total joint arthroplasty