Most patients undergoing hip (THA) and knee arthroplasty (TKA) are prescribed opioid analgesia post-operatively, with the expectation that use will be limited to the early post-operative period. However, it is known that some patients have persistent pain following THA and TKA, which may prolong opioid use. Furthermore, post-operative opioid use has been implicated in long term opioid dependency and addiction, and is further associated with increased healthcare utilisation and costs. While pre-operative opioid use is a known risk factor for prolonged post-operative use, the likelihood of persistent use in previously opioid nai?ve patients is not well understood. The main purpose of this study was to determine the proportion of patient who were opioids nai?ve prior to hip and knee arthroplasty who ae still using opioids medications at one year after surgery and whether any baseline variable factors predict the like hood of persistent opioid use. This was a retrospective analysis of a prospectively-collected database of 1011 patients who underwent total hip or knee arthroplasty at single academic institution between October 1, 2014, and December 1, 2022. A range of demographic variables and patient-reported outcome measures were collected pre-operatively, as well as at six weeks, three and six months and one year post-surgery. Patients were stratified based on whether they did or did not use opioid pain medications pre-operatively. Descriptive statistics were obtained. Multivariable logistic regression was used to evaluate whether any of a range of baseline factors were predictive of opioid use at one year in the previously opioid nai?ve cohort. One thousand one hundred and ninety three patients were included (643 knees and 550 hips), 72% (861) of whom were opioid nai?ve before surgery. Of those who were opioid nai?ve, 5% (44) were still consuming opioids one year after surgery. On multivariable analysis, the only significant predictor of persistent opioid use at one year was the preoperative presence of neuropathic pain as measured using the painDETECT instrument (p=0.035). Eighty percent of those who were still using opioids daily at one year had possible or likely neuropathic pain at baseline, as compared to 36% of those using opioids sometimes and 28% of those no longer using at all. A relatively small proportion of patient who undergoing hip and knee arthroplasty who are opioids nai?ve prior to surgery will continue to use them at one year. The presence of neuropathic pain prior to surgery is associated with a higher likelihood of persistent opioid use, with four out of five patients with persistent daily opioid use having an elevated baseline painDETECT score. Clinicians and surgeons should consider screening for preoperative neuropathic pain, and be aware of the elevated risk of persistent opioid use in this subgroup of patients.
Hakim et al. (Wed,) studied this question.