Preoperative Reduction of Opioid Use Before Total Joint Arthroplasty.
The purpose of this study was to assess whether weaning of opioid use in the preoperative period improved total joint arthroplasty (TJA) outcomes.



Forty-one patients who regularly used opioids and successfully weaned (defined as a 50% reduction in morphine-equivalent dose) before a primary total knee or hip arthroplasty were matched with a group of TJA patients who did not wean and a matched control group of TJA patients who did not use opioids preoperatively. The difference between preoperative and postoperative (at 6-12 months follow-up) patient-reported outcomes were assessed using the change in University of California, Los Angeles (UCLA) activity score, SF12v2, and The Western Ontario and McMaster Universities Arthritis Index (WOMAC). Paired t tests and 1-way repeated measures analysis of variance were performed to assess differences in TJA outcomes between groups.



Patients using opioids who successfully weaned had greater improvements in both disease-specific and generic measures of health outcomes than patients who did not wean (WOMAC 43.7 vs 17.8, P < .001; SF12v2 Physical Component Score 10.5 vs 1.85, P = .003; UCLA activity score 1.49 vs 0, P < .001). There was no statistical difference between the 2 groups on SF12v2 Mental Component Score 2.48 vs 4.21, P = .409. Patients who successfully weaned from opioids had similar outcomes to control patients who did not use opioids: WOMAC 39.0 vs 43.7, P = .31; SF12v2 Physical Component Score 12.5 vs 10.5, P = .35; SF12v2 Mental Component Score 3.08 vs 2.48, P = .82; UCLA activity 1.90 vs 1.49, P = .23.



Patients with a history of chronic opioid use who successfully decreased their use of opioids before surgery had substantially improved clinical outcomes that were comparable to patients who did not use opioids at all.
University of California San Francisco School of Medicine, San Francisco, California.
Long-Co L
LC
Nguyen
University of California San Francisco School of Medicine, San Francisco, California.
David C
DC
Sing
Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Austin, Texas.
Kevin J
KJ
Bozic
D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects*; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D005260:Female; D006801:Humans; D007719:Knee Joint; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods*; D000071066:Patient Reported Outcome Measures; D011184:Postoperative Period; D057234:Preoperative Period; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000701:Analgesics, Opioid
opioids; pain management; patient-reported outcomes; total hip arthroplasty; total knee arthroplasty