Opioids could increase dangers of hip and knee replacement surgery

Hundreds of thousands of Australians undergo hip or knee replacement surgery each year, but now experts are warning that the use of prescription opioids in the lead up to surgery could impact recovery.

The study, published in the Journal of Bone and Joint Surgery, analysed 324,000 patients who underwent hip or knee replacement surgery between 2003 and 2014 in the United States. The results revealed that using opioids 60 days prior to surgery can actually increase the risk of a patient being readmitted to hospital or having to undergo further join-replacement surgery. 

The data, which looked at 233,000 knee replacement patients and 91,000 hip replacement patients, included patient follow-ups for at least a year. A further 160,000 patients had three years of follow-up data.

Researchers analysed the impact of preoperative opioid use when it came to hospital readmission within 30 days and repeat joint-replacement surgery. Analysing the one-year follow-up patients, the study found that 51 per cent of those with knee replacement surgery and 56 per cent of those with replacement hips had one or more opioid prescriptions filled in the six months prior to surgery. Of those, 16 per cent of knee replacement patients and 19 per cent of hip replacement patients used opioids for more than 60 days before surgery.

Read more: How to prepare for hip replacement surgery

Researchers discovered a link between this prolonged opioid use and an increase in hospital readmissions, with knee replacement opioid rates associated with a 6.17 per cent readmission rate compared to a 4.82 per cent rate for people who didn’t use opioids. For hip replacements, the rate sat at 5.85 per cent for opioid users, compared to 3.71 per cent for non-users.

“Previous studies have highlighted factors associated with poor outcomes in total joint arthroplasty, such as diabetes, chronic kidney disease, obesity and smoking,” Lead researcher Hue H. Luu said. “Our data suggests that preoperative opioid use may be another risk factor to take into consideration.”

While opioid use is needed to manage some health conditions and can’t always be taken away from patients in the lead-up to surgery, the study authors argue that diminishing or eliminating the use of the drug preoperatively could be beneficial when it comes to patient recovery.

“Both readmissions and additional revision surgeries add to the cost of healthcare and are often physically and emotionally challenging for our patients,” Luu said. “As physicians, we can help our patients and the healthcare system by reducing or eliminating preoperative opioid use in hip and knee replacement patients.”

Read more: What to expect when recovering from hip replacement surgery

Before surgery, most patients will be assessed by health professionals including anaesthetists to ensure they are suitable for surgery. Others will touch base with a cardiologist, respiratory physician for heart and lungs, an endocrinologist if they have diabetes or thyroid issues or even a urologist for men with prostate problems. It’s also common for patients to be put on a diet to lose weight before surgery, while an array of medications such as aspirin or anti-inflammatory drugs may be withheld in the days before surgery to ensure it runs as smoothly as possible.

It’s always important to discuss your medication use with a health professional before undergoing surgery. 

Have you ever had a knee or hip replacement? Were you taken off certain medications in the lead up to your surgery?