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Ebata N, Sakai T, Yamamoto H, Toyoda T, Togo K, Deie M. Use of analgesics before and after total joint replacement in working-age Japanese patients with knee and hip osteoarthritis: A retrospective database study. Asia Pac J Sports Med Arthrosc Rehabil Technol 2024; 35:1-8. [PMID: 38025403 PMCID: PMC10659993 DOI: 10.1016/j.asmart.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 09/07/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023] Open
Abstract
Background Patterns of analgesic use before and after total joint replacement (TJR) in patients with knee/hip osteoarthritis (OA) is not well reported. Methods This retrospective longitudinal analysis used JMDC claims data of patients who underwent knee/hip replacement surgery from 2010 to 2019. Primary outcome was proportion of patients using analgesics pre-surgery, immediately post-surgery, and in post-surgery period. Factors affecting post-surgery analgesic withdrawal and opioid prescriptions were assessed using logistic regression. Results Of all (N = 3168) patients, those with knee OA (91.1 %) and hip OA (82.5 %) used analgesics pre-surgery, and 96.1 % with knee OA and 84.9 % with hip OA required analgesics even 3 months post-surgery. NSAIDs were most commonly used pre- and post-surgery in both OA groups. Before surgery, 15.6 % (knee OA) and 13.7 % of patients (hip OA) used weak opioids, and 23.1 % (knee OA) and 10.5 % (hip OA) of patients continued them post-surgery. Strong opioid use was noted in 2.2 % and 1.2 % of patients pre-surgery, and 5.8 % and 3.4 % of patients post-surgery in the knee and hip OA groups, respectively. Using pre-operative oral NSAIDs (odds ratio [OR]:0.56; 95 % confidence interval [CI]:0.44-0.72) and weak opioids (OR:0.58; 95 % CI:0.38-0.87) associated with withdrawal of post-surgery analgesics in patients with hip OA, and using intra-articular hyaluronic acid pre-surgery (OR:0.45; 95 % CI:0.21-0.97) was significant in patients with knee OA. Using weak (OR:4.59; 95 % CI:3.44-6.13) and strong opioids (OR:2.48; 95 % CI:1.01-6.07) pre-surgery associated with post-operative opioid use in patients with hip OA, and weak opioid use was significant in patients with knee OA (OR:7.00; 95 % CI:4.65-10.54). Conclusion This study reported difference in analgesic use before and after TJR, and that many patients required analgesics even 3 months after TJR surgery in Japan. Pre-operative analgesic use associated with continued use after surgery. Optimal pain management before and immediately after TJR is important to reduce post-operative analgesic use, especially opioids.
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Affiliation(s)
- Nozomi Ebata
- Pfizer Japan Inc., 3-22-7 Yoyogi, Shibuya-ku, Tokyo, 151-8589, Japan
| | - Takashi Sakai
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Hiroyuki Yamamoto
- Pfizer Japan Inc., 3-22-7 Yoyogi, Shibuya-ku, Tokyo, 151-8589, Japan
| | - Tetsumi Toyoda
- Clinical Study Support, Inc., 1-11-20 Nishiki, Naka-ku, Nagoya, Aichi, 460-0003, Japan
| | - Kanae Togo
- Pfizer Japan Inc., 3-22-7 Yoyogi, Shibuya-ku, Tokyo, 151-8589, Japan
| | - Masataka Deie
- Department of Orthopaedic Surgery, Aichi Medical University, 1-1 Yazago-Karimata, Nagakute, Aichi, 480-1195, Japan
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Liu S, Stevens JA, Collins AE, Duff J, Sutherland JR, Oddie MD, Naylor JM, Patanwala AE, Suckling BM, Penm J. Prevalence and predictors of opioid use before orthopaedic surgery in an Australian setting: A multicentre, cross-sectional, observational study. Anaesth Intensive Care 2023; 51:331-339. [PMID: 37340678 DOI: 10.1177/0310057x221147066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
Opioid analgesics are commonly used by patients awaiting orthopaedic surgery, and preoperative opioid use is associated with a greater burden of postoperative pain, suboptimal surgical outcomes and higher healthcare costs. This study aimed to examine the prevalence of total opioid use before elective orthopaedic surgery with a focus on regional and rural hospitals in New South Wales, Australia. This was a cross-sectional, observational study of patients undergoing orthopaedic surgery conducted between April 2017 and November 2019 across five hospitals that included a mix of metropolitan, regional, rural, private and public settings. Preoperative patient demographics, pain scores and analgesic use were collected during pre-admission clinic visits, held between two and six weeks before surgery. Of the 430 patients included, 229 (53.3%) were women and the mean age was 67.5 (standard deviation 10.1) years. The overall prevalence of total preoperative opioid use was 37.7% (162/430). Rates of preoperative opioid use ranged from 20.6% (13/63) at a metropolitan hospital to 48.8% (21/43) at an inner regional hospital. Multivariable logistic regression showed that the inner regional setting was a significant predictor of opioid use before orthopaedic surgery (adjusted odds ratio 2.6; 95% confidence interval 1.0 to 6.7) after adjusting for covariates. Opioid use prior to orthopaedic surgery is common and appears to vary by geographical location.
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Affiliation(s)
- Shania Liu
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Department of Pharmacy, Prince of Wales Hospital, Randwick, Australia
| | - Jennifer A Stevens
- School of Medicine, Notre Dame University, Sydney, Australia
- St Vincent's Clinical School, The University of New South Wales, Kensington, Australia
| | | | - Jed Duff
- Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Joanna R Sutherland
- Rural Clinical School Coffs Harbour Campus, The University of New South Wales, Coffs Harbour, Australia
| | | | - Justine M Naylor
- Whitlam Orthopaedic Research Centre, Ingham Institute, Liverpool, Australia
- South Wes Sydney Clinical School, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Asad E Patanwala
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Department of Pharmacy, Royal Prince Alfred Hospital, Sydney, Australia
| | - Benita M Suckling
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Pharmacy Department, Caboolture, Kilcoy and Woodford Directorate, Metro North Health, Caboolture, Australia
| | - Jonathan Penm
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Department of Pharmacy, Prince of Wales Hospital, Randwick, Australia
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Klenø AN, Sørensen HT, Pedersen AB. Time trends in use of non-steroidal anti-inflammatory drugs and opioids one year after total hip arthroplasty due to osteoarthritis during 1996-2018: a population-based cohort study of 103,209 patients. Osteoarthritis Cartilage 2022; 30:1376-1384. [PMID: 35918050 DOI: 10.1016/j.joca.2022.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/10/2022] [Accepted: 07/14/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine time trends in the use of NSAIDs and opioids for patients with osteoarthritis undergoing total hip arthroplasty (THA) during 1996-2018. METHOD Using Danish population-based medical databases, we identified 103,209 THA patients. Prevalence rates of NSAID and opioid use among preoperative users and non-users were calculated in four quarters (Q1-Q4) after THA by calendar periods (1996-2000, 2001-2006, 2007-2012 and 2013-2018). Prevalence rate ratios (PRR) were adjusted for age and gender. RESULTS Among preoperative NSAID users and non-users, NSAID use in Q1 increased from 32.6% in 1996-2000 to 48.0% in 2013-2018 (PRR = 1.49, 95% CI: 1.42-1.55) and from 12.9% to 32.0% (PRR = 2.49 (2.32-2.67)), respectively. Among preoperative opioid users and non-users, opioid use in Q1 increased from 42.7% in 1996-2000 to 76.9% in 2013-2018 (PRR = 1.81 (1.73-1.89)) and from 15.2% to 58.2% (PRR = 3.85 (3.65-4.05)), respectively. NSAID use in Q4 decreased from 24.5% in 1996-2000 to 21.4% in 2013-2018 (PRR = 0.88 (0.83-0.93)) and from 6.9% to 5.6% (PRR = 0.81 (0.73-0.91)) in preoperative NSAIDs users and non-users, respectively. Opioid use in Q4 increased from 26.6% in 1996-2000 to 28.6% (PRR = 1.08 (1.02-1.15)) in 2013-2018 and from 4.1% to 5.0% (PRR = 1.25 (1.11-1.40)) in preoperative opioid users and non-users, respectively. CONCLUSION We observed up to a 4-fold increase in NSAID and opioid use in Q1 during 1996-2018, while usage in Q4 did not change substantially. However, 5-6% of the preoperative non-users of NSAIDs and opioids were users in Q4, which might relate to inaccurate indication for or timing of THA and the post-surgical phasing out of analgesics use.
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Affiliation(s)
- A N Klenø
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Århus N, Denmark.
| | - H T Sørensen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Århus N, Denmark.
| | - A B Pedersen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Århus N, Denmark.
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Lundberg M, Johansson MS, Søndergaard J, Thorlund JB. Opioid use among Danish patients with severe knee osteoarthritis: a drug utilization study. Eur J Clin Pharmacol 2022; 78:1481-1486. [PMID: 35695903 DOI: 10.1007/s00228-022-03350-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 05/30/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Knee osteoarthritis (OA) is one of the most common musculoskeletal diseases. Opioids have been increasingly used in the treatment of severe knee OA-related pain, particularly in the USA. Less is known about the patterns of use of opioids among Danish patients with severe knee OA. We investigated opioid use among Danish patients with severe knee OA in the 5 years preceding knee replacement surgery (KR). METHODS We identified adults who had undergone KR from January 1st, 2005, to December 31st, 2018, using the Danish National Patient Register. These patients were considered to have severe knee OA in the 5-year period leading up to KR. Individual-level data on prescribed opioids were retrieved from the Danish National Prescription Registry. RESULTS We identified 77,168 severe knee OA patients (mean age 66 years). The prevalence of opioid users increased from 21% 5 years before KR to 40% 1 year before. Total use of opioids increased each year and doubled from 3254 mg oral morphine equivalents (OMEQ)/1000 individuals/day 5 years before to 6396 mg OMEQ/1000 individuals/day the year before KR corresponding to an increase of 3141 mg OMEQ (95% confidence interval 3010 to 3273). Tramadol was the most frequently used opioid. About 10% of the population accounted for 90% of the total opioid use. CONCLUSION Among patients with severe knee OA, the prevalence and total use of opioids doubled during the 5 years before KR. In addition, 10% of the study population was responsible for 90% of the opioids used.
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Affiliation(s)
- Matilde Lundberg
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.
| | - Melker Staffan Johansson
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.,Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Jens Søndergaard
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jonas Bloch Thorlund
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.,Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Niazi F, Ong KL, Kidd VD, Lau E, Kurtz SM, Dysart SH, Malanga G. Decrease in opioid and intra-articular corticosteroid burden after intra-articular hyaluronic acid for knee osteoarthritis treatment. Pain Manag 2020; 10:387-397. [DOI: 10.2217/pmt-2020-0057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Aim: We studied changes in opioid prescriptions and corticosteroid injection use for knee osteoarthritis patients before and after intra-articular hyaluronic acid (HA) use and opioid prescriptions before and after knee arthroplasty (KA). Materials & methods: A total of 1,017,578 knee osteoarthritis members were ascertained from a commercial claims database (Health Intelligence Company LLC, IL, USA) using ICD9/ICD10 diagnosis codes. Results: Eighty two percent of HA patients did not fill opioid prescriptions postinjection, with 54% of opioid users discontinuing fills. Two-thirds of KA patients filled opioid prescriptions within 6 months postsurgery, with 78% of opioid users continuing fills and 62% of nonusers initiating use. Conclusion: Alternative therapies, such as HA, that reduce opioid use may alleviate opioid addiction risks for KA patients who use opioids in the pre- and postoperative periods.
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Affiliation(s)
- Faizan Niazi
- Ferring Pharmaceuticals, Inc., 100 Interpace Parkway, Parsippany, NJ 07054, USA
| | - Kevin L Ong
- Exponent, Inc., 3440 Market St, Suite 600, Philadelphia, PA 19104, USA
| | - Vasco Deon Kidd
- Department of Orthopaedic Surgery, University of California Irvine (UCI Health), 101 The City Drive South, Orange, CA 92868, USA
| | - Edmund Lau
- Exponent, Inc., 149 Commonwealth Ave, Menlo Park, CA 94025, USA
| | - Steven M Kurtz
- Exponent, Inc., 3440 Market St, Suite 600, Philadelphia, PA 19104, USA
| | - Stanley H Dysart
- Pinnacle Orthopaedics & Sports Medicine Specialists, 652 Church Street, Marietta, GA 30060, USA
| | - Gerard Malanga
- New Jersey Regenerative Institute, 197 Ridgedale Ave #210, Cedar Knolls, NJ 07927, USA; Clinical Professor Dept. of Physical Medicine & Rehabilitation, Rutgers School of Medicine – NJ Medical School Newark, NJ 07109, USA
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Sicras-Mainar A, Tornero-Tornero C, Vargas-Negrín F, Lizarraga I, Rejas-Gutierrez J. Health outcomes and costs in patients with osteoarthritis and chronic pain treated with opioids in Spain: the OPIOIDS real-world study. Ther Adv Musculoskelet Dis 2020; 12:1759720X20942000. [PMID: 32994809 PMCID: PMC7502862 DOI: 10.1177/1759720x20942000] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 06/16/2020] [Indexed: 12/17/2022] Open
Abstract
Objective: The objective of this study was to analyze health outcomes, resource utilization, and costs in osteoarthritis patients with chronic nociceptive pain who began treatment with an opioid in real-world practice in Spain. Methods: We designed a non-interventional, retrospective, longitudinal study with 36 months of follow-up using electronic medical records (EMRs) from primary care centers, of patients aged 18+ years who began a new treatment with an opioid drug in usual practice for chronic pain due to osteoarthritis. Health/non-health resource utilization and costs, treatment adherence, pain change, cognitive functioning, and dependence for basic activities of daily living (BADL) were assessed. Results: A total of 38,539 EMRs [mean age (SD); 70.8 (14.3) years, 72.3% female; 53.3% hip/knee, 25.0% spine, and 21.7% other sites] were recruited. A total of 19.1% of patients remained on initial opioid at 36 months, without significant differences by osteoarthritis site (p = 0.125). Mean total adjusted cost was €17,915, with 27.7% corresponding to healthcare resources and 72.3% to lost productivity. Hospital admissions for osteoarthritis-related surgical interventions accounted for 15.8% of total healthcare cost. A slight mean pain reduction was observed: –1.3 points, –16.9%, p < 0.001, with increases in cognitive deficit (+3.3%, p < 0.001) and moderate to total dependence for BADL (+15.6%, p < 0.001) in a median duration of opioid use of 203 days (IQR: 89–696). Conclusions: In real-world practice in Spain, opioid use in osteoarthritis was high, but with low adherence. There were meaningful increases in resource use and costs for the National Health System. Pain reduction was modest, whereas cognitive impairment and dependence for BADL increased significantly.
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Affiliation(s)
- Antoni Sicras-Mainar
- Health Economics and Outcomes Research, Real Life Data SLU. Edifici BCIN, Carrer Marcus Porcius, núm. 1, Polígon les Guixeres, Badalona, Barcelona 08915, Spain
| | - Carlos Tornero-Tornero
- Department of Anesthesiology, Hospital Clínico Universitario de Valencia, Valencia, Spain
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Murphy LB, Cisternas MG, Theis KA, Brady TJ, Bohm MK, Guglielmo D, Hootman JM, Barbour KE, Boring MA, Helmick CG. All-Cause Opioid Prescriptions Dispensed: The Outsized Role of Adults With Arthritis. Am J Prev Med 2020; 59:355-366. [PMID: 32763134 DOI: 10.1016/j.amepre.2020.03.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/28/2020] [Accepted: 03/16/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Limited estimates of prescribed opioid use among adults with arthritis exist. All-cause (i.e., for any condition) prescribed opioid dispensed (referred to as opioid prescription in the remainder of this abstract) in the past 12 months among U.S. adults aged ≥18 years (n=35,427) were studied, focusing on adults with arthritis (n=12,875). METHODS In 2018-2019, estimates were generated using Medical Expenditure Panel Survey data: (1) 2015 prevalence of 1 or more opioid prescriptions to U.S. adults overall and by arthritis status and (2) in 2014-2015, among adults with arthritis, multivariable-adjusted associations between 1 or more opioid prescriptions and sociodemographic characteristics, health status, and healthcare utilization characteristics. RESULTS In 2015, the age-standardized prevalence of 1 or more opioid prescriptions among adults with arthritis (29.6%) was almost double of that for all adults (15.4%). Adults with arthritis represented more than half of all adults (55.3%) with at least 1 opioid prescription; among those with 1 or more prescriptions, 43.2% adults had 4 or more prescriptions. The strongest multivariable-adjusted associations with 1 or more opioid prescriptions were ambulatory care visits (1-4: prevalence ratios=1.9-2.0, 5-8: prevalence ratios=2.5-2.7, 9 or more: prevalence ratios=3.4-3.7) and emergency room visits (1: prevalence ratios=1.6, 2-3: prevalence ratios=1.9-2.0, 4 or more: prevalence ratios=2.4); Ref for both: no visits. CONCLUSIONS Adults with arthritis are a high-need target group for improving pain management, representing more than half of all U.S. adults with 1 or more opioid prescriptions. The association with ambulatory care visits suggests that providers have routine opportunities to discuss comprehensive and integrative pain management strategies, including low-cost evidence-based self-management approaches (e.g., physical activity, self-management education programs, cognitive behavioral therapy). Those with multiple opioid prescriptions may need extra support if transitioning to nonopioid and nonpharmacologic pain management strategies.
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Affiliation(s)
- Louise B Murphy
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | | | - Kristina A Theis
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Teresa J Brady
- Retired, Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Clarity Consulting and Communications, Atlanta, Georgia
| | - Michele K Bohm
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Dana Guglielmo
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Jennifer M Hootman
- Retired, Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kamil E Barbour
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Charles G Helmick
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia
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9
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Are medical comorbidities contributing to the use of opioid analgesics in patients with knee osteoarthritis? Osteoarthritis Cartilage 2020; 28:1030-1037. [PMID: 32387761 DOI: 10.1016/j.joca.2020.04.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 04/24/2020] [Accepted: 04/27/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Although opioid analgesics are not generally recommended for treatment of knee osteoarthritis (OA), they are frequently used. We sought to determine the association between medical comorbidities and self-reported opioid analgesic use in these patients. METHODS This cross-sectional study recruited patients referred to two provincial hip and knee clinics in Alberta, Canada for consideration of total knee arthroplasty. Standardized questionnaires assessed demographic (age, gender, income, education, social support, smoking status) and clinical (pain, function, total number of troublesome joints) characteristics, comorbid medical conditions, and non-surgical OA management participants had ever used or were currently using. Multivariable Poisson regression with robust estimate of the standard errors assessed the association between comorbid medical conditions and current opioid use, controlling for potential confounders. RESULTS 2,127 patients were included: mean age 65.4 (SD 9.1) years and 59.2% female. Currently used treatments for knee OA were: 57.6% exercise and/or physiotherapy, 61.1% NSAIDs, and 29.8% opioid analgesics. In multivariable regression, controlling for potential confounders, comorbid hypertension (RR 1.18, 95% CI 1.02-1.37), gastrointestinal disease (RR 1.31, 95% CI 1.07-1.60), depressed mood (RR 1.25, 95% CI 1.05-1.48) and a higher number of troublesome joints (RR 1.04 per joint, 95% CI 1.00-1.09) were associated with opioid use, with no association found with having ever used recommended non-opioid pharmacological or non-pharmacological treatments. CONCLUSIONS In a large cohort of patients with knee OA, of 12 comorbidities assessed, comorbid hypertension, gastrointestinal disease, and depressed mood were associated with current use of opioid analgesics, in addition to total burden of troublesome joints. Improved guidance on the management of painful OA in the setting of common comorbidities is warranted.
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Shadbolt C, Gould D, Camacho X, Knight J, Rele S, Thuraisingam S, Zhang Y, Dowsey MM, Choong PF. Preoperative opioid use and complications following total joint replacement: a protocol for a systematic review and meta-analysis. BMJ Open 2020; 10:e035377. [PMID: 32554741 PMCID: PMC7304809 DOI: 10.1136/bmjopen-2019-035377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 04/03/2020] [Accepted: 05/06/2020] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Mounting evidence now indicates that preoperative opioid use is associated with an array of complications following total joint replacement (TJR). However, evidence of these risks remains fragmented. A comprehensive and well-integrated understanding of this body of evidence is necessary to appropriately inform treatment decisions, the allocation of limited healthcare resources, and the direction of future clinical research. The proposed systematic review and meta-analysis aims to identify and synthesise the available evidence of an association between opioid use prior to TJR and postoperative complications, categorised by complication type. METHODS AND ANALYSIS We will search MEDLINE, EMBASE, CINAHL, PsycINFO, and Web of Science from inception to April 2020. Observational and experimental studies that compare preoperative opioid users who have undergone elective TJR to opioid naïve TJR patients will be included. The primary outcomes will be postoperative complications, which will be categorised as either mortality, morbidity, or joint-related complications. The secondary outcomes will be persistent postoperative opioid use, readmission, and length of stay. Individual study quality will be assessed using the relevant NIH-NHLBI study quality assessment tools. Findings will be reported in narrative and tabular form, and, where possible, odds ratios (dichotomous outcomes) or standardised mean differences (continuous outcomes) will be reported with 95% confidence intervals. Where appropriate, random effect meta-analyses will be conducted for each outcome, and heterogeneity will be quantified using the I2 statistic and Cochran's Q test. This study will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-analyses Of Observational Studies in Epidemiology (MOOSE) guidelines. ETHICS AND DISSEMINATION Ethics approval will not be required as no primary or private data are being collected. Findings will be disseminated through peer-reviewed publication and presentation at academic conferences. PROSPERO REGISTRATION NUMBER CRD42020153047.
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Affiliation(s)
- Cade Shadbolt
- Department of Surgery, The University of Melbourne, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Daniel Gould
- Department of Surgery, The University of Melbourne, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Ximena Camacho
- Centre for Digital Transformation of Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Josh Knight
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Siddharth Rele
- Department of Surgery, The University of Melbourne, St Vincent's Hospital, Melbourne, Victoria, Australia
- Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sharmala Thuraisingam
- Department of Surgery, The University of Melbourne, St Vincent's Hospital, Melbourne, Victoria, Australia
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Yuting Zhang
- Melbourne Institute: Applied Economic & Social Research, Faculty of Business & Economics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Michelle M Dowsey
- Department of Surgery, The University of Melbourne, St Vincent's Hospital, Melbourne, Victoria, Australia
- Department of Orthopaedics, St Vincent's Hospital, Melbourne, Fitzroy, Victoria, Australia
| | - Peter Fm Choong
- Department of Surgery, The University of Melbourne, St Vincent's Hospital, Melbourne, Victoria, Australia
- Department of Orthopaedics, St Vincent's Hospital, Melbourne, Fitzroy, Victoria, Australia
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Naumov AV, Khovasova NO, Moroz VI, Tkacheva ON, Shavlovskaya OA. [The clinical status and treatment options for osteoarthritis in patients with frailty]. TERAPEVT ARKH 2019; 91:135-141. [PMID: 32598601 DOI: 10.26442/00403660.2019.12.000487] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Indexed: 01/06/2023]
Abstract
Aging is an independent risk factor for the development of many diseases and geriatric syndromes. Osteoarthritis (OA), as the most common joint disease in the elderly, can be attributed to age - associated conditions. And the most significant geriatric syndrome, which dramatically affects the management and prognosis of an elderly, is frailty. The review provides current information on the prevalence of OA and frailty, their clinical and prognostic significance, and also shows the mutually aggravating role of these two conditions. The difference between non - and medication management of patients with OA and frailty is emphasized.
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Affiliation(s)
- A V Naumov
- Pirogov Russian National Research Medical University
| | - N O Khovasova
- Pirogov Russian National Research Medical University
| | - V I Moroz
- Pirogov Russian National Research Medical University
| | - O N Tkacheva
- Pirogov Russian National Research Medical University
| | - O A Shavlovskaya
- Sechenov First Moscow State Medical University (Sechenov University)
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12
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Eriksson K, Wikström L, Broström A, Pakpour AH. Predictors for Early Physical Recovery for General and Orthopedic Patients after Major Surgery: Structural Equational Model Analyses. Pain Manag Nurs 2019; 21:371-378. [PMID: 31712064 DOI: 10.1016/j.pmn.2019.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 10/07/2019] [Accepted: 10/07/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Attention to factors that may affect patients' ability to experience enhanced recovery after surgery is essential in planning for postoperative care. AIMS To create models of predefined pre,- peri-, and postoperative variables in order to analyze their impact on patients' physical recovery on postoperative days 1 and 2 after major orthopedic and general surgery. DESIGN An exploratory design with repeated measures was used, including 479 patients who had undergone orthopedic (289) or general surgery (190) at three hospitals. METHODS Pain, nausea, and level of physical ability were measured preoperatively and on postoperative days 1 and 2 by using the Numerical Rating Scale and items from the Postoperative Recovery Profile. Structural equation modeling was used to explore the impact of the predefined variables on patients' physical recovery. RESULTS The orthopedic group contained significantly more women and significantly more patients with pain and opioid use. Although the models showed good fit, "traditional" preoperative (pain, nausea, physical abilities, chronic pain, opioid use) and perioperative variables (anesthesia, length of surgery) constituted few (orthopedic) or no (general surgery) predictive properties for physical recovery. Postoperative average pain intensity, average nausea intensity, and physical ability explained physical recovery on day 1, and physical recovery on day 1 predicted physical recovery on day 2. CONCLUSIONS "Traditional" predictors had little effect on patients' postoperative physical recovery, while associations with common postoperative symptoms were shown. Further research is needed to explore additional variables affecting early physical recovery and to understand how soon patients are physically ready to return home.
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Affiliation(s)
- Kerstin Eriksson
- School of Health and Welfare, Jönköping University, Jönköping, Sweden; Department of Anesthesia and Intensive Care, Ryhov County Hospital, Jönköping, Sweden.
| | - Lotta Wikström
- School of Health and Welfare, Jönköping University, Jönköping, Sweden; Department of Anesthesia and Intensive Care, Ryhov County Hospital, Jönköping, Sweden
| | - Anders Broström
- School of Health and Welfare, Jönköping University, Jönköping, Sweden; Department of Clinical Neurophysiology, University Hospital, Linköping, Sweden
| | - Amir H Pakpour
- School of Health and Welfare, Jönköping University, Jönköping, Sweden; Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
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13
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Bannuru RR, Osani MC, Vaysbrot EE, Arden NK, Bennell K, Bierma-Zeinstra SMA, Kraus VB, Lohmander LS, Abbott JH, Bhandari M, Blanco FJ, Espinosa R, Haugen IK, Lin J, Mandl LA, Moilanen E, Nakamura N, Snyder-Mackler L, Trojian T, Underwood M, McAlindon TE. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage 2019; 27:1578-1589. [PMID: 31278997 DOI: 10.1016/j.joca.2019.06.011] [Citation(s) in RCA: 1492] [Impact Index Per Article: 298.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 05/21/2019] [Accepted: 06/20/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To update and expand upon prior Osteoarthritis Research Society International (OARSI) guidelines by developing patient-focused treatment recommendations for individuals with Knee, Hip, and Polyarticular osteoarthritis (OA) that are derived from expert consensus and based on objective review of high-quality meta-analytic data. METHODS We sought evidence for 60 unique interventions. A systematic search of all relevant databases was conducted from inception through July 2018. After abstract and full-text screening by two independent reviewers, eligible studies were matched to PICO questions. Data were extracted and meta-analyses were conducted using RevMan software. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Evidence Profiles were compiled using the GRADEpro web application. Voting for Core Treatments took place first. Four subsequent voting sessions took place via anonymous online survey, during which Panel members were tasked with voting to produce recommendations for all joint locations and comorbidity classes. We designated non-Core treatments to Level 1A, 1B, 2, 3, 4A, 4B, or 5, based on the percentage of votes in favor, in addition to the strength of the recommendation. RESULTS Core Treatments for Knee OA included arthritis education and structured land-based exercise programs with or without dietary weight management. Core Treatments for Hip and Polyarticular OA included arthritis education and structured land-based exercise programs. Topical non-steroidal anti-inflammatory drugs (NSAIDs) were strongly recommended for individuals with Knee OA (Level 1A). For individuals with gastrointestinal comorbidities, COX-2 inhibitors were Level 1B and NSAIDs with proton pump inhibitors Level 2. For individuals with cardiovascular comorbidities or frailty, use of any oral NSAID was not recommended. Intra-articular (IA) corticosteroids, IA hyaluronic acid, and aquatic exercise were Level 1B/Level 2 treatments for Knee OA, dependent upon comorbidity status, but were not recommended for individuals with Hip or Polyarticular OA. The use of Acetaminophen/Paracetamol (APAP) was conditionally not recommended (Level 4A and 4B), and the use of oral and transdermal opioids was strongly not recommended (Level 5). A treatment algorithm was constructed in order to guide clinical decision-making for a variety of patient profiles, using recommended treatments as input for each decision node. CONCLUSION These guidelines offer comprehensive and patient-centered treatment profiles for individuals with Knee, Hip, and Polyarticular OA. The treatment algorithm will facilitate individualized treatment decisions regarding the management of OA.
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Affiliation(s)
- R R Bannuru
- Center for Treatment Comparison and Integrative Analysis (CTCIA), Division of Rheumatology, Tufts Medical Center, Boston, MA, USA.
| | - M C Osani
- Center for Treatment Comparison and Integrative Analysis (CTCIA), Division of Rheumatology, Tufts Medical Center, Boston, MA, USA
| | - E E Vaysbrot
- Center for Treatment Comparison and Integrative Analysis (CTCIA), Division of Rheumatology, Tufts Medical Center, Boston, MA, USA
| | - N K Arden
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Oxford, Nottingham, UK; MRC Lifecourse Epidemiological Unit, University of Southampton, Southampton, UK
| | - K Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Carlton, Victoria, Australia
| | - S M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, the Netherlands; Department of Orthopedics, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - V B Kraus
- Duke Molecular Physiology Institute and Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - L S Lohmander
- Dept. of Clinical Sciences, Orthopedics, Lund University, Lund, Sweden
| | - J H Abbott
- Centre for Musculoskeletal Outcomes Research (CMOR), Dept. of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - M Bhandari
- Dept. of Orthopedic Surgery, McMaster University, Ontario, Canada
| | - F J Blanco
- Grupo de Investigación de Reumatología, INIBIC-Hospital Universitario, A Coruña, La Coruña, Spain; CICA-INIBIC Universidad de A Coruña, A Coruña, La Coruña, Spain
| | - R Espinosa
- National Institute of Rehabilitation, México City, Mexico; National Autonomous University of México, México City, Mexico
| | - I K Haugen
- Dept. of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - J Lin
- Arthritis Clinic and Research Center, Peking University People's Hospital, Peking University, Beijing, China
| | - L A Mandl
- Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, USA
| | - E Moilanen
- The Immunopharmacology Research Group, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland
| | - N Nakamura
- Institute for Medical Science in Sports, Osaka Health Science University, Osaka, Japan
| | - L Snyder-Mackler
- Dept. of Physical Therapy, STAR University of Delaware, Newark, DE, USA
| | - T Trojian
- Division of Sports Medicine, Drexel Sports Medicine, Philadelphia, PA, USA
| | - M Underwood
- Warwick Clinical Trials Unit, Warwick Medical School, Coventry, UK; University Hospitals of Coventry and Warwickshire, Coventry, UK
| | - T E McAlindon
- Center for Treatment Comparison and Integrative Analysis (CTCIA), Division of Rheumatology, Tufts Medical Center, Boston, MA, USA
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Rajamäki TJ, Puolakka PA, Hietaharju A, Moilanen T, Jämsen E. Use of prescription analgesic drugs before and after hip or knee replacement in patients with osteoarthritis. BMC Musculoskelet Disord 2019; 20:427. [PMID: 31521139 PMCID: PMC6745067 DOI: 10.1186/s12891-019-2809-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 08/30/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Analgesic drugs are recommended to treat pain caused by osteoarthritis, and joint replacement should decrease the need for them. We aimed to determine the user rates of analgesic drugs before and after joint replacement. METHODS All patients who underwent a primary hip or knee replacement for osteoarthritis from 2002 to 2013 in a region of 0.5 million people were identified. Patients with revision or other joint replacements during the study period (operation date +/- two years) were excluded, leaving 6238 hip replacements (5657 patients) and 7501 knee replacements (6791 patients) for analyses. Medication data were collected from a nationwide Drug Prescription Register and the prevalence (with its 95% confidence intervals) of acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), mild opioids, strong opioids, and medications used for neuropathic pain was calculated in three-month periods two years before and after surgery. RESULTS Between two years and three months preoperatively, the proportion of patients who redeemed at least one type of analgesic drug increased from 28% (95% CI, 27-30%) to 48% (47-50%) on hip replacement patients and from 33% (32-34%) to 41% (40-42%) on knee replacement patients. Postoperatively, the proportions decreased to 23% (22-24%) on hip and to 30% (29-31%) on knee patients. Hip replacement patients used more NSAIDs (34% (32-35%) hip vs 26% (25-27%) knee, p < 0.001), acetaminophen (14% (13-15%) vs 12% (11-13%), p < 0.001), and mild opioids (14% (13-15%) vs 9% (8-9%), p < 0.001) than knee patients preoperatively, but postoperatively hip patients used less NSAIDs (12% (11-13%) vs 16% (15-16%), p < 0.001), acetaminophen (9% (8-10%) vs 11% (11-12%), p < 0.001), and mild opioids (5% (5-6%) vs 8% (7-8%), p < 0.001). CONCLUSION Use of analgesic drugs increases prior to joint replacement, and is reduced following surgery. However, a considerable proportion of patients continue to use analgesics in two-year follow-up.
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Affiliation(s)
- Tuomas J Rajamäki
- Faculty of Medicine and Health Technology, Tampere University, FI-33014, Tampere, Finland.
| | - Pia A Puolakka
- Department of Emergency Medicine and Anaesthesia, Tampere University Hospital, PO box 2000, FI-33521, Tampere, Finland
| | - Aki Hietaharju
- Faculty of Medicine and Health Technology, Tampere University, FI-33014, Tampere, Finland.,Department of Neurology, Tampere University Hospital, PO box 2000, FI-33521, Tampere, Finland
| | - Teemu Moilanen
- Coxa, Hospital for Joint Replacement, PO box 652, FI-33101, Tampere, Finland
| | - Esa Jämsen
- Faculty of Medicine and Health Technology, Tampere University, FI-33014, Tampere, Finland.,Coxa, Hospital for Joint Replacement, PO box 652, FI-33101, Tampere, Finland
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15
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Vascular cell adhesion molecule 1 in patients with severe osteoarthritis of the hip : A prospective cross-sectional study. Wien Klin Wochenschr 2019; 131:369-373. [PMID: 31037360 PMCID: PMC6702185 DOI: 10.1007/s00508-019-1497-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 04/03/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Osteoarthritis (OA) of the hip is a frequent and debilitating joint disease. Only few clinical risk factors for hip OA are established and clinically applicable biomarkers to identify patients at risk are still lacking. The glycoprotein vascular cell adhesion molecule 1 (VCAM-1) is expressed by chondrocytes and synovial tissue and was a predictive marker for development of severe large joint OA in a previous study. OBJECTIVE It was tested whether increased serum levels of VCAM-1 are prevalent in patients with severe OA of the hips. METHODS In this prospective, multicenter, cross-sectional study, risk factors of severe hip OA were investigated in patients scheduled for hip joint arthroplasty and 100 patients were randomly selected for validation of VCAM-1 as a potential biomarker for hip OA. Serum samples were analyzed by an enzyme-linked immunosorbent assay and compared with a sex and age-matched control cohort. RESULTS The groups were similar in age, gender ratio and prevalence of diabetes. Serum concentrations of VCAM-1 were 8% higher in OA patients compared to controls, without reaching statistical significance (818 ng ml-1, 95% confidence interval, CI 746-891 ng ml-1 versus 759 ng m-1, 95% CI 711-807 ng ml-1; P = 0.4839). CONCLUSION The results of this study show that serum concentrations of VCAM-1 cannot distinguish patients with severe hip OA from age and sex-matched controls.
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Abstract
Osteoarthritis is a leading cause of disability and source of societal cost in older adults. With an ageing and increasingly obese population, this syndrome is becoming even more prevalent than in previous decades. In recent years, we have gained important insights into the cause and pathogenesis of pain in osteoarthritis. The diagnosis of osteoarthritis is clinically based despite the widespread overuse of imaging methods. Management should be tailored to the presenting individual and focus on core treatments, including self-management and education, exercise, and weight loss as relevant. Surgery should be reserved for those that have not responded appropriately to less invasive methods. Prevention and disease modification are areas being targeted by various research endeavours, which have indicated great potential thus far. This narrative Seminar provides an update on the pathogenesis, diagnosis, management, and future research on osteoarthritis for a clinical audience.
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Affiliation(s)
- David J Hunter
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, NSW, Australia.
| | - Sita Bierma-Zeinstra
- Departments of General Practice and Orthopaedic Surgery, Erasmus University Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
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17
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Carlos Rodriguez-Merchan E, Vaquero-Picado A, Ruiz-Perez JS. Opioid-Free Total Knee Arthroplasty? Local Infiltration Analgesia Plus Multimodal Blood-Loss Prevention Make it Possible. HSS J 2019; 15:17-19. [PMID: 30863227 PMCID: PMC6384215 DOI: 10.1007/s11420-018-9636-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 09/13/2018] [Indexed: 02/07/2023]
Abstract
Opioids have been widely used in the USA for pain control after total knee arthroplasty (TKA). However, adverse effects, especially the possibility of addiction, have increased interest in opioid-free pain management after surgery. We therefore sought to review current pain management protocols after TKA, focusing especially on opioid-free alternatives. We reviewed the literature on pain management after TKA using Medline (PubMed), through June 30, 2018, using the keywords "TKA" and "analgesia." We found 388 articles but chose to analyze the 34 that presented high-quality (levels I and II) evidence. Local infiltration analgesia (LIA) is a good option for reducing the use of post-operative opioids; many reports have compared LIA against a nerve block or studied the synergies between two protocols of loco-regional anesthesia. Multimodal blood-loss prevention is sometimes recommended in combination with opioid-free analgesia. In most studies, however, no differences are reported or contradictory results exist. Post-operative pain management protocols vary so much that it is difficult to strongly favor a determined pathway.
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Affiliation(s)
- E. Carlos Rodriguez-Merchan
- Department of Orthopedic Surgery, Knee Surgery Unit, La Paz University Hospital—IdiPaz, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Alfonso Vaquero-Picado
- Department of Orthopedic Surgery, Knee Surgery Unit, La Paz University Hospital—IdiPaz, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Juan S. Ruiz-Perez
- Department of Orthopedic Surgery, Knee Surgery Unit, La Paz University Hospital—IdiPaz, Paseo de la Castellana 261, 28046 Madrid, Spain
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18
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Tarakji BA, Wynkoop AT, Srivastava AK, O'Connor EG, Atkinson TS. Improvement in Depression and Physical Health Following Total Joint Arthroplasty. J Arthroplasty 2018; 33:2423-2427. [PMID: 29681494 DOI: 10.1016/j.arth.2018.03.051] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 03/15/2018] [Accepted: 03/15/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Depression is a common co-morbid condition seen in arthroplasty patients. Pain and depression have been understood to influence one another, which may explain why this patient group experiences higher rates of depression than the general population. Arthroplasty can relieve pain and improve function, which may thereby initiate an improvement in the patient's depressive symptoms. METHODS This retrospective study examined physical and mental domain outcomes of Short Form-36 health-related quality of life questionnaire among 146 patients who underwent primary hip or knee arthroplasty for osteoarthritis at a single institution during 2001-2004. These patients were classified into "depressed/anxious" and "non-depressed" groups based on their pre-operative mental component summary (MCS), with MCS < 42 defining depression. MCS and the subscales from the 36-Item Short-Form Health Survey form expected to be influenced by arthroplasty, Physical Function, Pain, and Role Physical were examined at 3 months and 1 year post-operative. RESULTS At 1 year, 66.7% of the "depressed/anxious" group reported MCS > 42, suggesting improvement of their depressive symptoms. Both groups reported similar improvements in their 36-Item Short-Form Health Survey subscale scores for Pain and Physical Function. However, the depressed group's scores were lower than the non-depressed group's at all time points. CONCLUSION Arthroplasty significantly improved Physical Function and Pain in depressed patients, while their depressive symptoms improved. This improvement may be in response to the resolution of physical symptoms and represents an additional benefit to this elective surgery. Further studies, in larger populations, are needed to establish patient characteristics associated with non-resolution of depressive symptoms and the role of mental health interventions to optimize outcomes for hip and knee arthroplasty patients.
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Affiliation(s)
| | | | | | | | - Theresa S Atkinson
- Department of Orthopaedic Surgery, McLaren Flint, Flint, MI; Department of Mechanical Engineering, Kettering University, Flint, MI
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19
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Deveza LA, Hunter DJ, Van Spil WE. Too much opioid, too much harm. Osteoarthritis Cartilage 2018; 26:293-295. [PMID: 29277676 DOI: 10.1016/j.joca.2017.12.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 12/08/2017] [Indexed: 02/02/2023]
Affiliation(s)
- L A Deveza
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - D J Hunter
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, NSW, Australia.
| | - W E Van Spil
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
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