Cannabis Use Tied to Poorer Outcomes of Total Hip, Knee Replacement

By Megan Brooks

September 03, 2021

NEW YORK (Reuters Health) - Cannabis use before total knee or hip replacement is associated with increased medical and implant-related complications, according to new research presented at the annual meeting of the American Academy of Orthopaedic Surgeons.

Cannabis use is on the rise in the United States, particularly in middle-aged and older adults. Yet, the impact, if any, on outcomes of total knee arthroplasty (TKA) and total hip arthroplasty (THA) are not well established.

"Primary total hip replacements are one of the most common orthopedic procedures performed around the United States. With increasing rates of cannabis usage among the general population, we felt it was important to analyze the medical and economic impact of cannabis use on the outcomes for patients undergoing total hip replacement procedures," Dr. Asad Ashraf of Maimonides Medical Center, in Brooklyn, New York, told Reuters Health by email.

"The ability to identify the types of complications these patients may be at risk for could allow for surgeons to identify them early on or find ways to prevent them from developing altogether," said Dr. Ashraf.

Using a private-payer claims database, he and his colleagues took a look back at more than 44,000 patients who underwent THA between 2008 and 2018, including 7,361 diagnosed with cannabis use disorder and 36,793 without CUD.

Following THA, compared with the non-CUD group, the CUD group stayed in the hospital one day longer (four vs. three days); had more adverse events (11.2% vs. 4.8%), including higher rates of pneumonia, respiratory failure, cerebrovascular accidents, urinary-tract infections, and acute renal failure; and incurred significantly higher costs of care within 90 days of surgery ($24,586 vs. $23,725).

"It is important for providers to adequately counsel CUD patients on the elevated risks that they may face when they pursue total hip replacements. Additionally, this study identifies a need for further research into the mechanisms that cannabis may impact patients undergoing orthopedic procedures overall," Dr. Ashraf told Reuters Heath.

Similar results emerged in a retrospective study of patients undergoing TKA.

Dr. Rushabh Vakharia, also at Maimonides Medical Center, and colleagues analyzed data on 55,553 patients who underwent TKA between 2008 and 2018, including 9,260 with CUD and 46,293 without CUD.

They too found that CUD patients remained in the hospital significantly longer than patients without CUD; were significantly more likely to develop medical complications including pneumonia, respiratory failures, heart attack, cerebrovascular accidents, and acute kidney injuries; had higher rates of prostheses-related complications; and incurred significantly higher day-of-surgery costs and 90-day care costs.

"Orthopedic surgeons should be mindful of patients who have CUD presenting to the clinic considering surgical options for their end-stage knee or hip osteoarthritis," Dr. Vakharia told Reuters Health by email.

"Adequate optimization working in conjunction with mental-health providers such as psychiatrists or substance-abuse professionals can potentially help to mitigate the incidence of the adverse events which were observed within the study," Dr. Vakharia added.

SOURCE: https://www.aaos.org/annual/ American Academy of Orthopaedic Surgeons Annual Meeting, presented August 31 and September 1, 2021.

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