Opioid Use Before Hip or Knee Surgery Can Mean Trouble

Opioids are powerful medications that have benefits and risks.

“Doc, I know I need to do the surgery, but can you give me some oxycodone for pain until then? I’ll stop once I have the surgery.” This is a common conversation in the office of a joint replacement surgeon. In the past, narcotic medication, commonly known as opioids, were given by physicians hoping to alleviate their patients’ pain and suffering. Unfortunately, we have learned that these medications may do more harm than good.

Opioids are powerful prescription pain-reducing medications that have benefits and potentially serious risks. Common opioid medications prescribed include oxycodone, hydrocodone, morphine, Norco (acetaminophen/hydrocodone), Vicodin (acetaminophen/hydrocodone), Percocet (acetaminophen/oxycodone), hydromorphone (Dilaudid), and tramadol.

Overuse of opioids has become an epidemic in the United States. According to the Centers for Disease Control and Prevention, “From 1999 to 2017, almost 218,000 people died in the United States from overdoses related to prescription opioids. Overdose deaths involving prescription opioids were five times higher in 2017 than in 1999” (http://wonder.cdc.gov). Many states have now adopted new laws that limit opioid prescriptions.

Could short-term use of these opioids in weeks or months prior to total hip arthroplasty (THA) or total knee arthroplasty (TKA) still be considered safe? According to multiple studies, the answer is NO. While easing symptoms of pain, use of opioids has negative, long-term consequences such as developing tolerance, drug dependence and hyperalgesia – a condition in which sensitivity to pain increases as a result of taking opioids.

If you suffer from arthritis pain, multiple strategies other than using opioids can be employed for pain control before surgery is necessary. Read this article about how to relieve hip and knee pain without surgery.  Potential therapies include nonsteroidal anti-inflammatories (NSAIDs), injections, weight loss, and physical therapy. If these non-operative methods eventually stop working, pain can become severe enough to warrant surgery. Pain in the time between deciding to move forward with surgery and actually having surgery can be difficult to endure. But one thing is clear: opioids are not a viable treatment option for the vast majority of patients.

Multiple studies show that people who use opioids prior to THA and TKA have worse outcomes after surgery. Additional studies have shown that they also have more difficulty with pain control after surgery and are at increased risk for readmission to the hospital, infection, and revision surgery. In addition, patients who take opioids prior to THA and TKA have a more difficult time discontinuing them after surgery. Studies show that people who do not use opioids prior to surgery are less likely to need opioids in the months after surgery and will have a better outcome after surgery. It is important to discuss this subject with your physician and work together as a team to develop an opioid-free plan that works best for you.

AAHKS has written a position on prescribing opioids for arthritis pain and advises that opioids should be avoided and reserved for only exceptional circumstances. Read the statement.