The American Association of Hip and Knee Surgery (AAHKS) has issued a new position statement titled, “Opioid Use for the Treatment of Osteoarthritis of the Hip and Knee.”
Mark Spangehl, M.D., associate professor of Orthopaedic Surgery at the Mayo Clinic College of Medicine and one of the surgeons who crafted the new statement, explained the process behind AAHKS’s position paper to OTW. “The process initially involved a literature review of pertinent articles to 1) determine the extent of the opioid crisis in the United states (i.e., various statistics on usage and mortality) 2) evaluate methods of management of chronic pain secondary to osteoarthritis [OA] of the hip and knee.”
“The initial draft was composed and then reviewed by members of the AAHKS board of directors and representatives of the Hip Society and Knee Society who added further comment and edits. Once all the edits and changes were incorporated, the final version was presented to the AAHKS Board of Directors for approval.”
Dr. Spangehl, who is also program director for the Mayo Orthopaedic Residency Program in Arizona, explained further, “The take home message is that opioids should not be used as a first line treatment for acute or chronic symptoms of hip and knee osteoarthritis. Patients on chronic opioids have poorer outcomes following hip and knee replacement surgery. There is strong (including level 1) evidence that opioids are not superior to non-opioid medication for long-term pain relief from osteoarthritis of the hip and knee.”
Asked about any nuances involved in such prescribing that perhaps all surgeons are not familiar with, Dr. Spangehl added, “It is important the surgeon understand that opioids do not provide superior long-term relief for hip and knee OA symptoms over non-opioid medications.”
“If opioids are prescribed, patients should be made aware of the potential side effects which include dependency, drowsiness, constipation, nausea, altered mental alertness and tolerance (the need for strong dosages to achieve the same pain-relieving effect).”
“Additionally, these patients should ideally be under the care of a pain management specialist. The lowest effective dose, for the shortest possible duration, should be the goal if opioids are prescribed. Furthermore surgeons should also educate patients that, while non-opioid treatment modalities (ice, non-steroidal anti-inflammatories, acetaminophen, ambulatory walking aids, weight loss (in overweight individuals), modest non-impact exercises (with or without the guidance of a physical therapist) are usually effective, osteoarthritis can be a painful condition, and complete resolution of symptoms with no pain whatsoever may be unrealistic in moderate or severe OA.”
