These authors sought to determine whether the chronic use of preoperative narcotics adversely affected the two-year clinical and/or radiographic outcomes in seventy-three patients (79 shoulders) with primary total shoulder arthroplasty for osteoarthritis. 26 patients (28 shoulders) were taking chronic narcotic pain medication for at least 3 months before surgery while 47 patients (51 shoulders) who were not taking narcotics preoperatively.
Significant differences were noted between the narcotic and nonnarcotic groups regarding American Shoulder and Elbow Surgeons scores and visual analog scale scores, as well as forward elevation, external rotation, and all strength measurements. The nonnarcotic group had markedly higher American Shoulder and Elbow Surgeons scores, better overall range of motion and strength, and markedly lower visual analog scale scores than the narcotic group.
Radiographic analysis found no difference between the narcotic and nonnarcotic groups with regard to the number of humeral, glenoid, or combined radiolucencies. There were no instances of mechanical failure in either group. There were four (14%) complications in the narcotic group and one (2%) in the nonnarcotic group. These included one instance each of inferior positioning of the humeral head, arthrofibrosis (defined as active and passive FE less than 90 with a firm end point), rotator cuff decompensation (defined as loss of active FE), and subscapularis failure (defined as anterior glenohumeral subluxation on radiographs with accompanying loss of active FE) in the narcotic group. In the nonnarcotic group, one patient developed arthrofibrosis. There were no revision surgeries in either group.
Comment: Table 2 documents that patients on narcotics had functionally worse shoulders than the patients not on narcotics. This makes one wonder if these patients had worse arthritis. It would be of interest to know how the radiographs of the two groups compared before surgery with respect to joint space narrowing, glenoid version and Walch type.
We wonder what was the range of narcotic consumption in the narcotic group. It would seem important to quantitate the effect of narcotics over the range from one Tylenol #3 in 3 months to heavy doses of MScontin every 4 hours. It would be of interest to see a plot of narcotic consumption/day versus the improvement in ASES score.
Finally, we have the issue of what is best for patients with glenohumeral arthritis who, for whatever reason (back pain, shoulder pain, phantom pain after amputation) is taking narcotics. Is it in their best interest to delay surgery until they are "de-toxed"? Or to deny them surgery altogether? Or to go ahead warning them of increased risk of an adverse outcome?
In our practice we defer elective surgery for patients on Suboxone, MSContin, OxyContin, or large daily doses of other narcotics, explaining that the risk/benefit ratio is unfavorable for them.
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We have a new set of shoulder youtubes about the shoulder, check them out at this link.
In our practice we defer elective surgery for patients on Suboxone, MSContin, OxyContin, or large daily doses of other narcotics, explaining that the risk/benefit ratio is unfavorable for them.
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We have a new set of shoulder youtubes about the shoulder, check them out at this link.
Be sure to visit "Ream and Run - the state of the art" regarding this radically conservative approach to shoulder arthritis at this link and this link
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How you can support progress in shoulder surgery
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How you can support progress in shoulder surgery
You may be interested in some of our most visited web pages arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'
