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Preoperative use of methadone yielded positive clinical outcomes after TJA
Patients taking methadone, buprenorphine/naloxone had higher morphine-equivalent dose of narcotics.
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Patients who underwent total joint arthroplasty while concurrently taking methadone or buprenorphine/naloxone preoperatively for pain control exhibited positive clinical outcomes at 1 year, according to study results.
“Given a multidisciplinary team and multidisciplinary approach, [these] patients who have high pain medication requirements can be managed successfully in the short term with a total joint arthroplasty,” Eric L. Smith, MD, chief of arthroplasty at Boston Medical Center, told Orthopedics Today. “But, I state that with caution because of the high recurrence rate and relapse rate of their heroin addiction.”
Preoperative methadone use
Smith and his colleagues matched 17 patients who underwent total joint arthroplasty (TJA) and were taking methadone or buprenorphine/naloxone preoperatively with 34 patients who were not taking methadone or buprenorphine/naloxone. Researchers assessed preoperative and postoperative functional outcomes using the SF-12 survey, Knee Society score and Harris Hip score.
Results showed patients in the study group had a mean preoperative SF-12 mental component score of 37.8 compared to 49 for control patients. Thirteen patients in the study group were smokers and four patients were taking antipsychotic medications compared with 15 patients and one patient in the control group, respectively. More patients on methadone or buprenorphine/naloxone were referred to the pain service for intractable pain and had a roughly eight-fold higher mean morphine-equivalent dose of narcotics compared to the control group. At the time discharge, there was a decrease in the change in morphine dosing in the study group and an increase in the control group.
Overall, there were similar clinical experiences with respect to length of stay, functional outcomes and complications between the study group and the control group.
“The complication rate was relatively low, and the satisfaction rate was relatively high especially compared to the control groups,” Smith said. “I think that denotes the fact that our control groups, which were matched for their age, have been shown in general to have lower satisfaction rates after TJA.”
Universal protocols
Smith noted since patients with prior drug addiction need to be managed with a multidisciplinary pain management system, it is important to develop universal protocols in treating these patients to manage any potential complications that may occur.
“[We] engaged our pain management specialist aggressively throughout patients’ hospital stay and even postoperatively, and the next step is to try to define some universal protocols for treating these patients,” Smith said. “In particular, developing these multidisciplinary teams, if they do not exist in other hospitals, to establish the teams, so [doctors] can manage these potential complications for these patients as best as possible.” – by Casey Tingle
- Reference:
- Hansen LE, et al. J Arthroplasty. 2016;doi:10.1016/j.arth.2016.01.032.
- For more information:
- Eric L. Smith, MD, can be reached at Boston Medical Center, 800 Washington St., Boston, MA 02111; email: eric.smith@bmc.org.
Disclosure: Smith reports no relevant financial disclosures.