Preoperative opioid use associated with worse outcomes after anatomic shoulder arthroplasty

Abstract

Preoperative opioid use has been associated with worse clinical outcomes after orthopedic surgery. The purpose of this study was to evaluate the impact of preoperative opioid use on outcomes and patient satisfaction after anatomic total shoulder arthroplasty (TSA). We identified 224 TSAs performed for primary glenohumeral joint osteoarthritis with 2- to 5-year follow-up in a prospective shoulder arthroplasty registry. Sixty patients with a history of preoperative opioid use for shoulder pain were compared with a control group of 164 patients. Patient-reported outcome measurements, range of motion measurements, and patient satisfaction were assessed preoperatively and at most recent follow-up. Preoperative opioid use was associated with significantly worse preoperative patient-reported outcome scores for nearly all outcome measures. Both groups significantly improved on all outcome scores and range of motion measurements from preoperative to most recent follow-up; however, the nonopioid group had significantly better postoperative outcome scores. There was a statistical difference between the 2 groups regarding the number of satisfied patients, with 80% satisfied in the opioid group (48 of 60 patients) compared with 91% satisfied in the nonopioid group (149 of 164 patients) (P=.03). Patients with a history of preoperative opioid use can achieve significant improvements in patient-reported outcome measurements and patient satisfaction after anatomic TSA for primary glenohumeral joint arthritis. However, patients with preoperative opioid use have a significantly lower preoperative baseline and achieve significantly lower final outcome scores after TSA compared with patients without a history of preoperative opioid use.