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October 02, 2023
2 min read
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Cannabis use may be associated with complications after TJA

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Key takeaways:

  • Cannabis use may be associated with higher odds of deep vein thrombosis and revisions after total knee arthroplasty.
  • Cannabis use was associated with higher costs in total knee but not total hip arthroplasty.
Perspective from Jason M. Jennings, MD, DPT

Published results indicated a possible link between cannabis use with an increased risk of deep vein thrombosis, revision, pneumonia, cerebrovascular accidents and cardiac complications after total joint arthroplasty.

“The main message [is] a word of caution,” Nicolas S. Piuzzi, MD, staff surgeon in the Adult Reconstruction Center at the Cleveland Clinic and director of the Cleveland Clinic Adult Reconstruction Research Group, told Healio. “It does not mean that it’s a causation at all. We’re not claiming that. We’re not saying that cannabis causes this increased risk of complications, but there was an association. At least for the counseling perspective, this is something that we need to be aware of as a field.”

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Cannabis use

Piuzzi and colleagues performed a systematic review of the literature for studies published between January 2012 and July 2022 that reported cannabis use and complications, pain management, opioid consumption, length of stay, costs or functional outcomes following TJA. Researchers also performed a meta-analysis of odds ratios and continuous variables.

Among the 19 articles included in the final analysis, results showed an association between cannabis use with higher odds of deep vein thrombosis and revision among patients who underwent total knee arthroplasty. Patients who underwent total hip arthroplasty had a similar association between cannabis use and odds for deep vein thrombosis, according to researchers. Researchers also found cannabis use may be associated with similar odds of pulmonary embolus in both TKA and THA, as well as cardiovascular complications in TKA.

Areas of further study

Results showed cannabis use was associated with higher costs of care in TKA but did not alter pain scores, opioid consumption or cost of care in THA. Although researchers found no differences in lengths of stay or functional outcomes with cannabis use, patients who used cannabis may be at a potentially increased risk for prosthetic complications, pneumonia and cerebrovascular accidents.

“We need to do a better job in documenting and having a better knowledge of and data curation of cannabis use during elective procedures and be able to create better studies to be able to guide and understand if there’s a role for cannabis in the process and care pathway of total joint or to understand, as well, if there are risks,” Piuzzi said. “Until we have that level of detail and that increased level of data, we will not be able to make firm these conclusions.”