Opioid use does not impair reverse shoulder arthroplasty success

Jul 28 2014

By Lucy Piper, Senior medwireNews Reporter

Taking opioids prior to reverse shoulder arthroplasty does not hamper patients’ chances of having successful outcomes, researchers have found.

They report similar improvements in shoulder function and range of motion for patients irrespective of whether or not they took opioids before surgery, even though baseline scores were better for those with no prior opioid use.

“The key is to establish a preoperative baseline and understand that a ‘one size fits all’ approach does not apply”, say the researchers led by Brent Morris (Texas Orthopedic Hospital, Houston, USA).

“Patients with a history of preoperative opioid use can obtain significant preoperative-to-postoperative improvements; yet, they should not be expected to reach the same peak outcome scores as patients without a history of preoperative opioid use.”

A total of 68 patients underwent reverse shoulder arthroplasty for rotator cuff tear arthropathy, 32 of whom had a history of preoperative opioid use for shoulder pain.

At baseline, patients with a history of opioid use had significantly worse scores on measures of shoulder function than those who did not use opioids. These included the American Shoulder and Elbow Surgeons (ASES) score (average 25.6 vs 37.4 points) and ASES–Pain score (7.0 vs 5.2 points) and the Western Ontario Osteoarthritis Shoulder (WOOS) index (79.0 vs 67.4 points). Range of motion scores were also lower among patients with a history of opioid use, for forward flexion, abduction and external rotation.

All of these scores continued to be better among patients in the nonopioid group than the opioid group after surgery, but both groups showed significant improvements that were “nearly identical” in magnitude, the researchers write in the Journal of Shoulder and Elbow Surgery.

ASES scores improved by an average of 39.4 points among patients who had taken opioids and 38.4 among those who had not, with findings similar for ASES-Pain (4.8 and 4.2 points respectively) and WOOS index scores (45.6 and 45.1 points, respectively). There was also no difference in improvements in range of motion.

“Gaining a better understanding of the effect of preoperative opioid use on outcomes after [reverse shoulder arthroplasty] is important, especially given the increasing use of opioid medications to manage chronic pain for osteoarthritis and other nonmalignant diseases,” says the team.

“This information could improve preoperative counselling and establish appropriate patient, family, and surgeon expectations.”

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