Opiate use after total hip arthroplasty for metastatic bone disease
DOI:
https://doi.org/10.5055/jom.0813Keywords:
total hip arthroplasty, metastatic bone disease, opioid, oncologyAbstract
Objectives: To investigate post-operative opioid use and ambulatory status following a total hip arthroplasty (THA) in metastatic bone disease (MBD) patients and to identify factors associated with post-operative opioid use.
Background: MBD commonly affects the hip, and surgical intervention including THA may be indicated for pain relief or functional improvement. Following THA, patients are often prescribed short courses of opioids for post-operative pain relief. This study investigated post-operative opioid use and ambulatory status following THA in MBD patients.
Methods: This was a retrospective review of 40 patients who underwent THA for MBD at two institutions between 2009 and 2022. Preoperative and post-operative opioid usage and ambulatory status at 6 weeks, 90 days, 6 months, and 1 year were recorded and compared using the Wilcoxon ranked-sign test or sign test. Factors associated with post-operative opioid use were compared using χ2 test or Fisher’s exact test as appropriate.
Results: Twenty-seven primary THA and 13 THA with complex acetabular reconstructions were included. Thirty patients used opiates preoperatively. There was a statistically significant decrease between preoperative and 6-month median daily morphine milligram equivalent for preoperative opioid users. There was no statistically significant change in post-operative ambulatory status compared to preoperatively.
Conclusions: To our knowledge, this is the first paper evaluating post-operative opioid use following primary THA in MBD patients. After THA in the setting of MBD, patients exhibited a significant decrease in post-operative opioid use at 6 months. Future studies with larger cohorts should characterize post-operative opioid use and ambulatory status following joint arthroplasty in MBD patients.
References
Coleman RE: Clinical features of metastatic bone disease and risk of skeletal morbidity. Clin Cancer Res. 2006; 12(20 Part 2): 6243s-6249s. DOI: 10.1158/1078-0432.CCR-06-0931.
Tsukamoto S, Kido A, Tanaka Y, et al.: Current overview of treatment for metastatic bone disease. Curr Oncol. 2021; 28(5): 3347-3372. DOI: 10.3390/curroncol28050290.
Toma CD, Dominkus M, Nedelcu T, et al.: Metastatic bone disease: A 36-year single centre trend-analysis of patients admitted to a tertiary orthopaedic surgical department. J Surg Oncol. 2007; 96(5): 404-410. DOI: 10.1002/jso.20787.
Hage WD, Aboulafia AJ, Aboulafia DM: Incidence, location, and diagnostic evaluation of metastatic bone disease. Orthop Clin North Am. 2000; 31(4): 515-528.vii. DOI: 10.1016/s0030-5898(05)70171-1.
Bongers MER, Karhade AV, Setola E, et al.: How does the skeletal oncology research group algorithm’s prediction of 5-year survival in patients with chondrosarcoma perform on international validation? Clin Orthop Relat Res. 2020; 478(10): 2300-2308. DOI: 10.1097/CORR.0000000000001305.
Mercadante S, Villari P, Ferrera P, et al.: Optimization of opioid therapy for preventing incident pain associated with bone metastases. J Pain Symptom Manage. 2004; 28(5): 505-510. DOI: 10.1016/j.jpainsymman.2004.02.024.
Migliorini F, Maffulli N, Trivellas A, et al.: Bone metastases: A comprehensive review of the literature. Mol Biol Rep. 2020; 47(8): 6337-6345. DOI: 10.1007/s11033-020-05684-0.
Issack PS, Kotwal SY, Lane JM: Management of metastatic bone disease of the acetabulum. J Am Acad Orthop Surg. 2013; 21(11): 685-695. DOI: 10.5435/JAAOS-21-11-685.
Portenoy RK: Treatment of cancer pain. Lancet. 2011; 377(9784): 2236-2247. DOI: 10.1016/S0140-6736(11)60236-5.
Janjan NA, Payne R, Gillis T, et al.: Presenting symptoms in patients referred to a multidisciplinary clinic for bone metastases. J Pain Symptom Manag. 1998; 16(3): 171-178. DOI: 10.1016/s0885-3924(98)00069-4.
Jacofsky DJ, Haidukewych GJ: Management of pathologic fractures of the proximal femur: State of the art. J Orthop Trauma. 2004; 18(7): 459-469. DOI: 10.1097/00005131-200408000-00013.
Harrington KD: Orthopedic surgical management of skeletal complications of malignancy. Cancer. 1997; 80(8 Suppl.): 1614-1627. DOI: 10.1002/(sici)1097-0142(19971015)80:8+<1614::aid-cncr12>3.0.co;2-2.
Issack PS, Barker J, Baker M, et al.: Surgical management of metastatic disease of the proximal part of the femur. J Bone Joint Surg Am. 2014; 96(24): 2091-2098. DOI: 10.2106/JBJS.N.00083.
Arvinius C, Parra JLC, Mateo LS, et al.: Benefits of early intramedullary nailing in femoral metastases. Int Orthop. 2014; 38(1): 129-132. DOI: 10.1007/s00264-013-2108-x.
Sharma H, Bhagat S, McCaul J, et al.: Intramedullary nailing for pathological femoral fractures. J Orthop Surg (Hong Kong). 2007; 15(3): 291-294. DOI: 10.1177/230949900701500309.
Steensma M, Boland PJ, Morris CD, et al.: Endoprosthetic treatment is more durable for pathologic proximal femur fractures. Clin Orthop. 2012; 470(3): 920-926. DOI: 10.1007/s11999-011-2047-z.
Harvey N, Ahlmann ER, Allison DC, et al.: Endoprostheses last longer than intramedullary devices in proximal femur metastases. Clin Orthop. 2012; 470(3): 684-691. DOI: 10.1007/s11999-011-2038-0.
Coleman RE: Metastatic bone disease: Clinical features, pathophysiology and treatment strategies. Cancer Treat Rev. 2001; 27(3): 165-176. DOI: 10.1053/ctrv.2000.0210.
Tan TL, Rondon AJ, Wilt Z, et al.: Understanding opioid use after total hip arthroplasty: A comprehensive analysis of a mandatory prescription drug monitoring program. J Am Acad Orthop Surg. 2020; 28(20): e917-e922. DOI: 10.5435/JAAOS-D-19-00676.
Bedard NA, Pugely AJ, Dowdle SB, et al.: Opioid use following total hip arthroplasty: Trends and risk factors for prolonged use. J Arthroplasty. 2017; 32(12): 3675-3679. DOI: 10.1016/j.arth.2017.08.010.
Cunningham DJ, Ryan SP, George SZ, et al.: Opioid legislation and narcotic filling in total hip arthroplasty: Descriptive study of time and state-level trends in the United States. Subst Abuse Treat Prev Policy. 2021; 16(1): 75. DOI: 10.1186/s13011-021-00410-w.
Mitera G, Zeiadin N, Kirou-Mauro A, et al.: Retrospective assessment of cancer pain management in an outpatient palliative radiotherapy clinic using the pain management index. J Pain Symptom Manage. 2010; 39(2): 259-267. DOI: 10.1016/j.jpainsymman.2009.07.005.
Kirou-Mauro AM, Hird A, Wong J, et al.: Has pain management in cancer patients with bone metastases improved? A seven-year review at an outpatient palliative radiotherapy clinic. J Pain Symptom Manage. 2009; 37(1): 77-84. DOI: 10.1016/j.jpainsymman.2007.12.014.
Vieira C, Fragoso M, Pereira D, et al.: Pain prevalence and treatment in patients with metastatic bone disease. Oncol Lett. 2019; 17(3): 3362-3370. DOI: 10.3892/ol.2019.10013.
van den Beuken-van Everdingen MHJ, Hochstenbach LMJ, Joosten EAJ, et al.: Update on prevalence of pain in patients with cancer: Systematic review and meta-analysis. J Pain Symptom Manage. 2016; 51(6): 1070-1090.e9. DOI: 10.1016/j.jpainsymman.2015.12.340.
Lee JSJ, Hu HM, Edelman AL, et al.: New persistent opioid use among patients with cancer after curative-intent surgery. J Clin Oncol. 2017; 35(36): 4042-4049. DOI: 10.1200/JCO.2017.74.1363.
Beauchemin MP, Raghunathan RR, Accordino MK, et al.: New persistent opioid use among adolescents and young adults with sarcoma. Cancer. 2022; 128(14): 2777-2785. DOI: 10.1002/cncr.34238.
Inacio MCS, Hansen C, Pratt NL, et al.: Risk factors for persistent and new chronic opioid use in patients undergoing total hip arthroplasty: A retrospective cohort study. BMJ Open. 2016; 6(4): e010664. DOI: 10.1136/bmjopen-2015-010664.
Rajamäki TJJ, Puolakka PA, Hietaharju A, et al.: Use of prescription analgesic drugs before and after hip or knee replacement in patients with osteoarthritis. BMC Musculoskelet Disord. 2019; 20(1): 427. DOI: 10.1186/s12891-019-2809-4.
Zarling BJ, Yokhana SS, Herzog DT, et al.: Preoperative and postoperative opiate use by the arthroplasty patient. J Arthroplasty. 2016; 31(10): 2081-2084. DOI: 10.1016/j.arth.2016.03.061.
Marco RAW, Sheth DS, Boland PJ, et al.: Functional and oncological outcome of acetabular reconstruction for the treatment of metastatic disease. J Bone Jt Surg. 2000; 82(5): 642-651. DOI: 10.2106/00004623-200005000-00005.
Harrington KD: The management of acetabular insufficiency secondary to metastatic malignant disease. J Bone Jt Surg A. 1981; 63(4): 653-664. DOI: 10.2106/00004623-198163040-00017.
Von Korff M, Saunders K, Thomas Ray G, et al.: De facto long-term opioid therapy for noncancer pain. Clin J Pain. 2008; 24(6): 521-527. DOI: 10.1097/AJP.0b013e318169d03b.
Dowell D, Ragan KR, Jones CM, et al.: CDC clinical practice guideline for prescribing opioids for pain—United States, 2022. MMWR Recomm Rep. 2022; 71(3): 1-95. DOI: 10.15585/mmwr.rr7103a1.
Picci P, Manfrini M, Fabbri N, et al.: Atlas of Musculoskeletal Tumors and Tumorlike Lesions. Berlin: Springer, 2014. DOI: 10.1007/978-3-319-01748-8.
Shen C, Thornton JD, Newport K, et al.: Trends and patterns in the use of opioids among metastatic breast cancer patients. Sci Rep. 2020; 10(1): 21698. DOI: 10.1038/s41598-020-78569-8.
Bennett M, Paice JA, Wallace M: Pain and opioids in cancer care: Benefits, risks, and alternatives. In American Society of Clinical Oncology Educational Book. Alexandria, VA: ASCO, 2017, vol. 37: 705-713. DOI: 10.1200/EDBK_180469.
Koyyalagunta D, Bruera E, Aigner C, et al.: Risk stratification of opioid misuse among patients with cancer pain using the SOAPP-SF. Pain Med. 2013; 14(5): 667-675. DOI: 10.1111/pme.12100.
Namba RS, Inacio MCS, Pratt NL, et al.: Postoperative opioid use as an early indication of total hip arthroplasty failure. Acta Orthop. 2016; 87 (Suppl 1.): 37-43. DOI: 10.1080/17453674.2016.1181820.
Kunkel ST, Gregory JJ, Sabatino MJ, et al.: Does preoperative opioid consumption increase the risk of chronic postoperative opioid use after total joint arthroplasty? Arthroplasty Today. 2021; 10: 46-50. DOI: 10.1016/j.artd.2021.05.012.
Prentice HA, Inacio MCS, Singh A, et al.: Preoperative risk factors for opioid utilization after total hip arthroplasty. J Bone Joint Surg. 2019; 101(18): 1670-1678. DOI: 10.2106/JBJS.18.01005.
Singh JA, Lewallen D: Predictors of pain and use of pain medications following primary total hip arthroplasty (THA): 5,707 THAs at 2-years and 3,289 THAs at 5-years. BMC Musculoskelet Disord. 2010; 11: 90. DOI: 10.1186/1471-2474-11-90.
Chaudhary MA, Dalton MK, Koehlmoos TP, et al.: Identifying patterns and predictors of prescription opioid use after total joint arthroplasty. Mil Med. 2021; 186(5-6): 587-592. DOI: 10.1093/milmed/usaa573.
Hereford TE, Porter A 3rd, Stambough JB, et al.: Prevalence of chronic opioid use in the elderly after hip fracture surgery. J Arthroplasty. 2022; 37(7S): S530-S535. DOI: 10.1016/j.arth.2022.01.071.
Agarwalla A, Liu JN, Gowd AK, et al.: Differential use of narcotics in total hip arthroplasty: A comparative matched analysis between osteoarthritis and femoral neck fracture. J Arthroplasty. 2020; 35(2): 471-476. DOI: 10.1016/j.arth.2019.09.004.
Bickels J, Dadia S, Lidar Z: Surgical management of metastatic bone disease. J Bone Jt Surg. 2009; 91(6): 1503-1516. DOI: 10.2106/JBJS.H.00175.
Published
How to Cite
Issue
Section
License
Copyright 2005-2024, Weston Medical Publishing, LLC
All Rights Reserved
