Prevalence and changes in analgesic medication utilisation 1 year prior to total joint replacement in an older cohort of patients

Objectives: To evaluate the prevalence and change in analgesic medications use prior to joint replacement in older patients between 2001 and 2012. 

Methods: A population based epidemiological study was conducted. Opioids, non-steroidal anti-inflammatories (NSAIDs), paracetamol, corticosteroid injections, medications for neuropathic pain, hypnotics, and muscle relaxants supplied 1 year prior to total knee replacement (TKR, n = 15,517) and hip replacement (THR, n = 10,018) were assessed. Patient characteristics and surgical indication adjusted prevalence ratios (PRs) and 95% confidence intervals (CI) are provided. 

Results: From 2001 to 2012, in the TKR cohort (median age 78.9) the prevalence of opioid use prior to surgery increased from 37% to 49% (PR = 1.01, 95% CI 1.00–1.01, P = 0.01), while in the THR cohort (median age 81.1) it increased from 44% to 54% (PR = 1.01, 95% CI 1.01–1.02, P < 0.001). Paracetamol use increased from 52% to 61% (PR = 1.0, 95% CI 1.0–1.0, P = 0.913) in the TKR cohort and from 55% to 67% (PR = 1.01, 95% CI 1.00–1.01, P = 0.005) in the THR cohort. Neuropathic pain medication use increased from 5% to 11% in the TKR cohort (PR = 1.04, 95% CI 1.02–1.06, P < 0.0001) and from 6% to 12% in the THR cohort (PR = 1.06, 95% CI 1.04–1.09, P < 0.0001). NSAID use decreased from 76% to 50% in the TKR cohort (PR = 0.96, 95% CI 0.95–0.96, P < 0.0001), and from 81% to 47% in THR cohort (PR = 0.95, 95% CI 0.94–0.95, P < 0.0001). Corticosteroid injections prevalence also decreased (TKR: 21–18%, PR = 0.97, 95% CI 0.96–0.97, P < 0.001, THR: 18–17%, PR = 0.97, 95% CI 0.96–0.98, P < 0.001). 

Conclusion: Pain medication utilization prior to joint replacement surgery changed significantly in this national older cohort of patients during the 2000s.