Context:Currently, there is a national focus on establishing and disseminating standardized guidelines for return to play for athletes at all levels of competition. As more data become available, protocols and guidelines are being refined and implemented to assist physicians, coaches, trainers, players, and parents in making decisions about return to play. To date, no standardized criteria for returning to play exist for injuries to the spine.Evidence Acquisition:Electronic databases including PubMed and MEDLINE and professional orthopaedic, neurosurgical, and spine organizational websites were reviewed between 1980 and 2015.Study Design:Clinical review.Level of Evidence:Level 4.Results:Although clinical guidelines have been published for return to play after spine injury, they are almost exclusively derived from expert opinion and clinical experience rather than from well-designed studies. Furthermore, recommendations differ and vary depending on anatomic location, type of sport, and surgery performed.Conclusion:Despite a lack of consensus and specific recommendations, there is universal agreement that athletes should be pain free, completely neurologically intact, and have full strength and range of motion before returning to play after spinal injury.

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Introduction: The opioid epidemic in the United States continues to escalate and contribute to potentially preventable deaths. Because many opioid addictions begin with prescription medication, focus on limiting exposure and decreasing availability are essential. This study identifies the average number of opioid pills consumed following primary total knee and hip arthroplasty (TKA and THA) at our institution in opiate-naive patients to provide an estimate of medication required. We hypothesized that the average number of pills consumed for both TKA and THA was significantly less than the amount prescribed at discharge. Methods: We prospectively evaluated 99 consecutive patients undergoing primary TKA (51) and THA (48). Patient characteristics and opioid prescription information were pulled from review of medical records. Patients brought remaining pain medications to their first follow-up visit (30 days). We calculated the number of pills consumed. Pill consumption was converted into opioid morphine equivalents. Current pain level and the need for pain medication refill were assessed. Results: Median number of pills prescribed over 30 days was 90 for both TKA and THA. Median number of pain pills consumed was 67 in TKA patients and 37 in THA patients (P < 0.001). Higher oral morphine equivalent consumption was seen in TKA patients compared with THA patients. Mean pain scores of TKA and THA patients were 3.2 and 1.8, respectively (P = 0.002). Also, TKA patients were 5 times more likely to require a refill (P = 0.006) compared with THA patients. Discussion: Pain medication was significantly overprescribed by more than 34% in TKA and 140% in THA. Prescribing practices of narcotic pain medications following total joint arthroplasty result in significantly excess amount of opioids available for potential abuse.

Introduction: Previous studies demonstrate routine overprescription of pain medications after total joint arthroplasty (TJA). A standardized reduced opioid prescription protocol for TJA was initiated at our institution, which we hypothesized would lead to a reduction in opioid consumption compared with patients who had surgery before initiation of the new protocol. Methods: We evaluated 97 consecutive opioid-naive patients undergoing primary total knee arthroplasty (TKA) and total hip arthroplasty (THA) using a standardized opioid prescription protocol (standardized group). A control subject group consisted of 99 patients undergoing TKA and THA just before the adaptation of the standardized prescribing protocol (historic group). Postoperatively, patients brought their remaining pain medication to their 1-month follow-up visit. The number of pills consumed was counted and converted into oral morphine equivalents (OME). Current pain level and the need for pain medication refill was assessed. Results: Among TKA patients, mean opioid consumption in the standardized group (48.5 pills; 432 OME) was markedly less than the historic group (76.2 pills; 903 OME) (both P , 0.01). Refills were required in 50% of the standardized group and 29% of the historic group (P = 0.038). Average pain scores for the standardized and historic groups were 2.3 and 3.2, respectively (P = 0.057). Among THA patients, mean opioid consumption in the standardized group (19.1 pills; 200 OME) was markedly less than the historic group (41.3 pills; 504 OME) (both P , 0.01). Refills were required in 16% of the standardized group and 8% of the historic group (P = 0.263). Average pain scores for the standardized and historic groups were 1.7 and 1.8, respectively (P = 0.608). Discussion: Initiation of a standardized opioid prescribing protocol after TJA for opioid-naive patients led to a reduction in opioid consumption, but resulted in an increased need for refills.