Pre-operative opioid use negatively impacts the outcomes of hip and knee arthroplasty: A systematic review

Introduction

There is increasing evidence that pre-operative administration of opioid analgesia in the management of hip and knee osteoarthritis pain negatively impacts post-operative outcomes. This article provides a literature review of the effects of pre-operative use of opioid analgesia on outcomes following hip and knee arthroplasty including patient reported outcome measures (PROMs), rate of infection, rate of revision surgery, length of hospital stay and readmission.

Methods

A systematic literature review of Medline, Embase and Cochrane CENTRAL was performed up until September 2020 according to PRISMA guidelines. Studies reporting post-operative outcomes in opioid using patients compared to non-opioid using patients undergoing total hip or knee arthroplasty were included.

Results

21 studies of the 703 studies identified from the initial search were included. The evidence suggests that pre-operative use of opioid analgesia confers worse post-operative outcomes including inferior PROMs, increased rates of revision, infection and readmission, and prolonged hospital stay.

Conclusion

Whilst more large-scale data is required to ascertain the full effect of pre-operative opioid use and to determine effective strategies of cessation, pre-operative opioid use should be considered an independently modifiable risk factor for worse post-operative outcomes, and efforts should be made to either taper or cease usage prior to major joint arthroplasty.