2023 ISAKOS Biennial Congress Paper
Opioid Use and Patient Outcomes in an Australian Knee Arthroplasty Cohort
Phil Huang, FRACS, FAOrthA, BEng, MPhil CANTAB, Cremorne Point, NSW AUSTRALIA
Matt Lyons, FRACS, Mosman, NSW AUSTRALIA
Benjamin Gooden, MBBS, FRACS, PhD, Sydney, NSW AUSTRALIA
Michael Dudley O'Sullivan, MBBS FRACS FAOrth, Wollstonecraft, NSW AUSTRALIA
Leo A. Pinczewski, MBBS, FRACS, FAOA, Sydney, NSW AUSTRALIA
Jack Brownrigg, BSc, MD, Ballarat Central, VIC AUSTRALIA
Kaka Martina, RN, Sydney, NSW AUSTRALIA
Joanna Crighton, BNursing, North Sydney, NSW AUSTRALIA
Lucy J. Salmon, PhD, Sydney, NSW AUSTRALIA
Justin P. Roe, MB BS BSc(Med) Hons FRACS, A/Prof., Sydney, NSW AUSTRALIA
North Sydney Orthopaedic and Sports Medicine Centre, Sydney, New South Wales, AUSTRALIA
FDA Status Cleared
Summary
One in five used opioids before TKA and one in 10 at 6 months after TKA. Prolonged opioid use was rarely observed in the opioid naïve (<5%), and persisting opioid tolerant users represented <1% after TKA.
Abstract
Introduction
There is considerable variation in rates of opioid use across arthroplasty populations, with ranges from 16-90% before, and 11%-41% >3 months after arthroplasty. Most of these epidemiological studies arise from populations in the US, where there are much higher rates of opioid use, compared to Australasia and Europe. The purpose of this study was to determine the prevalence of opioid use in Australian total knee arthroplasty (TKA) cohort, and its association with outcomes.
Methods
395 primary TKA subjects enrolled in the study and prospectively completed Oxford Scores, Knee Osteoarthritis Outcomes Score(KOOS) and General Health Score before arthroplasty. Subjects were surveyed regarding their consumption of any opioids within the previous 7 days before surgery, at six weeks and at six months following surgery. Subjects repeated the baseline survey at 6 months, with additional questions regarding satisfaction.
Results
Opioid use was reported by 17% preoperatively, 46% at 6 weeks and 10% at 6 months after TKR. 68% of patients taking opioids before surgery had ceased by 6 months, and 5% of preoperative non users reported opioid use at 6 months. Preoperative TKA opioid users had a lower preoperative mean KOOS Score (39 vs 51, p=0.001), Oxford Score (17 vs 24, p=0.001), and EQ5D General Health Score (60 vs 68, p=0.004), than non users. Preoperative opioid use was associated with back pain(OR 2.2, p=0.006), anxiety or depression(OR 2.8, p=0.001) and Oxford knee scores <30(OR 5.6, p=0.021).
There was no difference between preoperative opioid users and non-users for satisfaction, or KOOS scores at 6 months. Opioid use at 6 months was associated with preoperative use (OR 6.6, p<0.001), and lower 6 month oxford scores (OR 4.4, P<0.01).
Conclusion
One in five used opioids before TKA and one in ten at 6 months after TKA. Pre-operative opioid use was the strongest risk factor for opioid use at 6 months, increasing odds 7 times. Prolonged opioid use was rarely observed in the opioid naïve (<5%), and persisting opioid tolerant users represented <1% after TKA. Preoperative opioid use did not diminish the post-operative improvement nor the absolute pain and function scores, or rates of satisfaction after TKA.