Oral Opioids Are Overprescribed in the Opiate-Naive Patient Undergoing Total Joint Arthroplasty

The opioid epidemic in the United States continues to escalate and contribute to potentially preventable deaths. Because many opioid addictions begin with prescription medication, focus on limiting exposure and decreasing availability are essential. This study identifies the average number of opioid pills consumed following primary total knee and hip arthroplasty (TKA and THA) at our institution in opiate-naive patients to provide an estimate of medication required. We hypothesized that the average number of pills consumed for both TKA and THA was significantly less than the amount prescribed at discharge.

We prospectively evaluated 99 consecutive patients undergoing primary TKA (51) and THA (48). Patient characteristics and opioid prescription information were pulled from review of medical records. Patients brought remaining pain medications to their first follow-up visit (30 days). We calculated the number of pills consumed. Pill consumption was converted into opioid morphine equivalents. Current pain level and the need for pain medication refill were assessed.

Median number of pills prescribed over 30 days was 90 for both TKA and THA. Median number of pain pills consumed was 67 in TKA patients and 37 in THA patients (P < 0.001). Higher oral morphine equivalent consumption was seen in TKA patients compared with THA patients. Mean pain scores of TKA and THA patients were 3.2 and 1.8, respectively (P = 0.002). Also, TKA patients were 5 times more likely to require a refill (P = 0.006) compared with THA patients.

Pain medication was significantly overprescribed by more than 34% in TKA and 140% in THA. Prescribing practices of narcotic pain medications following total joint arthroplasty result in significantly excess amount of opioids available for potential abuse.