Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Mar 18, 2019; 10(3): 137-144
Published online Mar 18, 2019. doi: 10.5312/wjo.v10.i3.137
Comparison of implant related complications amongst patients with opioid use disorder and non-users following total knee arthroplasty
Rushabh M Vakharia, Karim G Sabeh, Ajit M Vakharia, Dhanur M Damodar, Tsun Yee Law, Martin W Roche
Rushabh M Vakharia, Tsun Yee Law, Martin W Roche, Department of Orthopedic Surgery, Holy Cross Orthopedic Institute, Fort Lauderdale, FL 33334, United States
Karim G Sabeh, Department of Orthopedic Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States
Ajit M Vakharia, Department of Medicine, Morehouse School of Medicine, Atlanta, GA 30310, United States
Dhanur M Damodar, Department of Orthopedic Surgery, University of Miami Hospital, Miami, FL 33135, United States
Author contributions: Vakharia RM, Sabeh KG, Vakharia AM, Damodar D, Law TY and Roche WM contributed significantly towards project design, analysis, and manuscript writing and editing.
Institutional review board statement: This study has been determined exempt from Institutional Review Board (IRB) review by the Holy Cross Hospital Research Office.
Informed consent statement: As this study utilizes publicly available data from a nationwide database, informed consent was not obtained from individual subjects included in the study. Study data contained no patient identifiers and cannot be linked to an individual patient.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Rushabh M Vakharia, MD, Research Fellow, Department of Orthopedic Surgery, Holy Cross Orthopedic Institute, 5597 North Dixie Highway, Fort Lauderdale, FL33308, United States. rush.vakharia@gmail.com
Telephone: +1-954-4894579 Fax: +1-954-2298698
Received: August 16, 2018
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
ARTICLE HIGHLIGHTS
Research background

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).

Research motivation

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.

Research objectives

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.

Research methods

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.

Research results

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.

Research conclusions

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.

Research perspectives

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.