Published online Mar 18, 2019. doi: 10.5312/wjo.v10.i3.137
Peer-review started: August 17, 2018
First decision: October 4, 2018
Revised: December 13, 2018
Accepted: January 9, 2019
Article in press: January 9, 2019
Published online: March 18, 2019
Processing time: 204 Days and 10.6 Hours
Opioid use has been shown to be effective method of analgesia following orthopedic surgery, and as a result, the prescribing rates of opioids have increased. Currently, orthopedic surgeons are the third highest prescribers of opioids following internists and dentists. The literature demonstrates that opioids are known to interfere with endogenous synthesis of testosterone and estrogen, which are vital for proper bone mineralization; in addition to other complications. There is no study to our knowledge which has analyzed the effects of opioid abuse and dependency on implant related complications in patients undergoing primary total knee arthroplasty (TKA).
As the number of prescriptions and abuse potential is increasing within the United States, its impact in orthopedics should be well understood. The study addresses the question on the implant related complications orthopedic surgeons may encounter in patients who have a history of opioid abuse and dependency following primary TKA. The study will allow for further studies on how to properly optimize opioid abusers prior to undergoing surgery.
The authors of this study wanted to determine the impact opioid abuse and dependency on implant related complications in patients undergoing primary TKA in patients greater than the age of 65.
Patients who underwent primary TKA with a history of opioid abuse and dependency were identified from the Medicare claims database and were randomly matched 1:1 to a control group. Two-year implant related complications were analyzed and compared, along with 90-d reimbursement rates, along with day of surgery and total global 90-d episode of care costs.
The study found that patients who with a history of opioid abuse and dependency were at greater odds of developing implant related complications compared to controls. Implant related complications which were higher in the study group consisted of: requiring a revision procedure, periprosthetic fractures, prosthetic joint infection, mechanical loosening, in addition to others. Similarly, 90-d readmission rates along with day of surgery and total global 90-d episode of care costs were higher in patients with a history of opioid abuse and dependency compared to controls.
The findings of the study demonstrate that opioid abuse and dependency increase the odds of developing implant related complications, 90-d readmission rates, and cost within patients who are undergoing primary TKA. These findings further confirm the hypothesis that patients with a history of opioid abuse or dependency would have greater complications following surgery compared to controls. The results of the study should warrant further studies on how to offset the detrimental effects of opioid abuse on bone mineralization.
Patients with a history of opioid abuse or dependency are at a significantly greater risk of implant related complications, 90-d readmission rates, and cost following primary TKA. Further research should be warranted at identifying these patients prior to surgery and adequately optimizing them prior to surgery.