In a study reported in the American Journal of Bone and Joint Surgery in November of 2011, Dr. Zywiel and co-authors reviewed the results of patients who are using chronic narcotics prior to knee replacement and compared them to a group of patients not using narcotics prior to the knee replacement surgery. They noted that the patients in the preop narcotic use group had poorer outcomes, had longer length of stays in the hospital after surgery, had a higher rate of re-operation for manipulation of stiff knees, and a higher revision rate for pain.
With the increased use by primary care physicians of narcotics to treat the pain of osteoarthritis, this trend should be dampened somewhat by the poorer outcomes in patients who are taking narcotics prior to their knee replacement surgery. For this reason, if the patients fail to obtain pain relief with over-the-counter analgesics and oral anti-inflammatory medications, perhaps earlier referral to an orthopedic surgeon for evaluation of a painful, weightbearing joint would make sense prior to starting a patient on chronic narcotic use which may ultimately jeopardize the outcome of their subsequent joint replacement procedure.
William P. Barrett, MD