Preoperative chronic opiate use associated with a worse joint-specific function and quality of life before and after total hip and knee arthroplasty

Listen to Simon and Amy discuss the paper 'Preoperative chronic opiate use associated with a worse joint-specific function and quality of life before and after total hip and knee arthroplasty' published in the April 2025 issue of Bone & Joint Open.

Click here to read the paper.

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Transcript

[00:00:00] Welcome back to another episode of AI Talks with Bone & Joint, brought to you by the publishers of Bone & Joint Open. Today we'll be discussing a compelling paper titled 'Preoperative chronic opiate use associated with a worse joint-specific function and quality of life before and after total hip and knee arthroplasty'. Published in April 2025 by ES Martinson, ND Clement, DJ MacDonald, CEH Scott, and CR Howie. I am Simon, and joining me is my co-host Amy. 

Hello Simon. This is indeed a significant topic. Chronic opiate use is quite concerning, particularly for patients awaiting major surgeries such as total hip and knee arthroplasty. This study offers valuable insights into the effects of preoperative opiate use on patient outcomes. 

To provide some context, osteoarthritis is a degenerative joint disease primarily affecting the knees and hips. It's the most prevalent joint disease among older adults, impacting around ten million individuals in the United Kingdom alone. Patients with severe osteoarthritis often endure [00:01:00] considerable pain and diminish quality of life, leading many to be prescribed opiates while awaiting surgery.

Exactly and this study sought to determine if chronic opiate use before surgery influence joint-specific function and quality of life post total hip and knee arthroplasty. They examined a substantial sample of 1,487 patients, almost equally divided between those undergoing hip and knee replacements.

Regarding methodology, the researchers categorized the opiate group as patients who reported opiate use for over one month prior to their surgery. They gathered information on patient demographics, comorbidities, and patient-reported outcome measures such as the Oxford Hip and Knee scores, the EuroQol five-dimension questionnaire, and pain scores both preoperatively and six months postoperatively.

Their findings were quite notable. Patients in the opiate group exhibited worse scores pre- and postoperatively compared to those who had not used opiates. This included worse joint-specific function and quality of life scores. For instance, [00:02:00] the preoperative Oxford Hip Score for the opiate group averaged 14.67, whereas it was 21.16 for the opiate naive group.

Indeed, and this trend persisted post-surgery. The postoperative Oxford Hip Score for the opiate group averaged 34.47 compared to 40.93 in the opiate naive group. Similarly, quality of life scores as measured by the EQ-5D were significantly lower for the opiate group both before and after surgery.

Interestingly, there was no significant difference in patient satisfaction between the two groups. This suggests that despite worse scores, opiate users were just as satisfied with their surgical outcomes, which is somewhat paradoxical. 

Another intriguing finding was that opiate use had a more pronounced negative impact on those undergoing total hip arthroplasty compared to those undergoing total knee arthroplasty. The reasons for this are not entirely clear and warrant further investigation. 

The study also noted that opiate users had higher BMIs and more comorbidities such as myocardial [00:03:00] infarction, connective tissue disease, and kidney disease. This underscores the complexity of managing these patients. 

Before we conclude, it's important to note that the findings of this study align with the National Institute for Health and Care Excellence, NICE guidelines, which advise against the use of strong opiates for managing osteoarthritic pain.

Indeed, and with increasing surgery wait times due to factors such as the COVID-19 pandemic, there is a tendency to prescribe more opiates during this waiting period. This study clearly highlights the need to prioritize alternative pain management strategies to avoid negatively affecting surgical outcomes.

In summary, preoperative chronic opiate use is linked to worse joint-specific function and quality of life in patients undergoing total hip and knee arthroplasty. While it does not appear to impact patient satisfaction, it is a consideration healthcare providers must carefully weigh when managing osteoarthritis patients preoperatively.

Agreed. Simon. This research calls for the adoption of more effective non-opiate pain management strategies and a holistic [00:04:00] approach to patient care. Thank you for joining us and see you next time on AI Talks with Bone & Joint.