In a position statement, The American Association of Hip and Knee Surgeons said opioids should be avoided for the treatment of hip and knee osteoarthritis and should be reserved for certain circumstances.
“Opioids should not be a first-line treatment, nor a maintenance therapy, for acute or chronic symptoms of osteoarthritis of the hip or knee,” Mark J. Spangehl, MD, lead author of the position statement, told Healio.com/Orthopedics. Spangehl said patients should be educated on alternative treatments for hip and knee OA such as ice, NSAIDs, acetaminophen, ambulatory walking aids, weight loss in overweight patients and non-impact exercises with or without the guidance of a physical therapist. AAHKS recommended that orthopedic surgeons follow the recommendations of the American Academy of Orthopaedic Surgeons Clinical Practice Guidelines on nonsurgical treatment and non-arthroplasty treatment of arthritis of the hip and knee.
In its position statement, AAHKS stated that opioids may be considered in a small subset of patients who cannot undergo joint replacement surgery and have failed non-opioid treatments. Patients should be prescribed a low dosage of opioids and the fewest number of opioids for the shortest time. If patients need prolonged opioid use, the AAHKS said they should be referred to a pain management specialist. In addition, patients who are prescribed opioids need to be educated about the risks of prolonged use such as addiction and dependency.
“Patients need to understand that opioids should not be used as a first-line treatment and be educated on the potential downsides of opioid use, which include dependency, drowsiness, constipation, nausea, altered mental alertness and tolerance (the need for stronger dosages to achieve the same pain-relieving effect),” Spangehl said.
AAHKS also stated that patients should understand how to properly store or dispose of opioids when they no longer need the medications.
“Furthermore, patients also need to understand that, while non-opioid treatment modalities are usually effective, OA can be a painful condition and complete resolution of symptoms with no pain whatsoever may be unrealistic in moderate or severe OA,” Spangehl said. “Patients should be educated appropriately by all members of their health care team including their primary care providers, orthopedic surgeon and physical therapists.” – by Monica Jaramillo