Key Takeaways

  • Among patients who underwent total knee replacement, those who did not use an opioid before surgery showed significant improvement in postoperative quality of life
  • Researchers found that preoperative opioid use was the strongest predictor of prolonged use of the painkillers after surgery
  • Two commonly used questionnaires were important in determining links between opioid use and the state of patients before and after surgery

Opioid painkillers can provide significant relief for patients undergoing a knee replacement—both before and after surgery. But with ongoing concerns about the rise of opioid addiction and abuse, do these powerful painkillers really help patients enough to warrant their use?

Researchers from Massachusetts General Hospital discovered that patients who used opioids before surgery reported a significantly lower postoperative quality of life.

Researching the Effects of Opioid Use Before Surgery

The Mass General team, led by Young-Min Kwon, MD, PhD, program director of the Adult Reconstructive Surgery Fellowship Program and director of the Bioengineering Laboratory in the Department of Orthopaedics, compared the records of 137 patients who did not use opioids prior to surgery to 30 patients who did use opioids. Between both groups, researchers found no differences in the range of motion or the length of hospital stays after surgery. But they were struck by how much worse the opioid users seemed to be functioning in their everyday activities after surgery.

Breaking Down Patient-reported Outcomes

The researchers determined the quality of life for patients undergoing knee replacement by examining outcomes-related questionnaires stored in the hospital's medical registry. They focused primarily on two questionnaires.

The first was the EQ-5D visual analog scale (EQ VAS). This test asks patients to classify their overall health on a scale ranging from "worst possible" to "best possible." The patients who did not use opioids preoperatively scored much higher on the EQ VAS scale after undergoing surgery than those who had taken the painkillers ahead of the procedure.

The second measure was the UCLA activity score, which requests that patients rate their level of activity on a scale of 1–10, with one being "no physical activity, dependent on others" and 10 being "regular participation in impact sports." Both groups showed improvement in their UCLA activity scores after knee replacement.

Addressing the Public Health Crisis

Dr. Kwon and his team were motivated to learn about the effects of opioid use in knee replacement surgery because of rising concerns about opioid use and abuse. In one study quoted by the researchers, out of 73,959 patients who were covered by Humana (a health insurance company) and had knee replacements between 2007 and 2014, one-third used opioids ahead of their operation. This is a 9% increase in the preoperative use of painkillers over the seven-year period. Additionally, the researchers found that preoperative opioid use was the strongest predictor of prolonged use of the painkillers after surgery.

According to the Centers for Disease Control and Prevention (CDC) the current state of drug use is epidemic with 68% of the 70,200 drug overdose deaths in 2017 involving opioids and roughly 130 Americans dying every day from opioid overdose.

Previous studies had examined the effects of opioids in patients undergoing joint replacement surgery and found that use of these drugs correlated with an increased length of hospital stays, post-operative complications and prolonged drug use. But there was a shortage of research examining how patients felt about their quality of life, and how that differed among those who used opioids for pain relief and those who did not.

The researchers hope that their new study will begin to fill that void. There are still plenty of questions to be answered, such as whether the amount of time knee replacement patients stay on opioids affects how they evaluate their quality of life. Future studies involving larger patient populations should help answer those questions.

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