PT reduces opioid use by knee replacement patient

A team of researchers have discovered a promising way to reduce knee replacement patients’ risk of opioid addiction: Participate in physical therapy (PT) either before or after total knee replacement surgery.

The findings of the study were published in the ‘JAMA Network Open’. The world’s most common form of arthritis, knee osteoarthritis, causes sufferers pain and hurts their quality of life. Total knee replacement is the only option for people with severe knee osteoarthritis, but even that invasive surgery still leaves up to a third of patients with chronic knee pain. Many people who undergo total knee replacement surgery go on to become chronic opioid users.

“Osteoarthritis is one of the most common conditions for which opioids are prescribed [in the United States],” said Kosaku Aoyagi, a physical therapist and researcher at Boston University.

“With the aging of the population and rising prevalence of osteoarthritis, the number of total knee replacement procedures is expected to rise exponentially over the next decade,” added Aoyagi.

In the largest study of its kind, Deepak Kumar, a BU College of Health and Rehabilitation Sciences: Sargent College assistant professor of physical therapy, and collaborators analysed more than 67,000 patient records and discovered that even low levels of physical therapy were associated with lower risk of chronic opioid use after total knee replacement.

Specifically, they found that participation in physical therapy within 90 days before or after total knee replacement was associated with a lower risk of chronic opioid use. Going further, they found that six or more sessions of physical therapy post-surgery were linked to a reduced chance of chronic opioid use, as were instances when physical therapy was initiated within 30 days of surgery.

Kumar, a physical therapist by training, said that their analysis revealed that the longer a patient waits to start physical therapy, the greater their odds of chronic opioid use.

The findings excited the researchers because they suggested that physical therapy could be considered an effective initial therapy for knee osteoarthritis patients, rather than relying on steroid shots, nonsteroidal anti-inflammatory drugs (NSAIDs), or other pain relievers.