Total hip replacement in patients with history of illicit injecting drug use

Abstract

We use this unacceptable high failure rate as evidence when counseling patients and their health care professionals about the appropriate treatment of osteoarthritis in patients with a history of illicit drug use. Furthermore, we support the request of hair analysis for drugs documenting abstinence of at least 1 year before indicating THA.

Outcomes Following Primary Total Hip or Knee Arthroplasty in Substance Misusers

“…Although individuals who misuse drugs are thought to be at increased risk of inflammatory arthropathies, the indication for surgery in this population is complicated by a higher risk of infection [7,8]. The results of this study show that patients who misuse drugs face prolonged hospital lengths of stay and higher odds of leaving against medical advice, mortality and complications following primary THA or TKA.…”

“…In addition to joint prosthesis infection, the present study showed that other device complications were also higher in the drug misusers group. Wieser et al [7], retrospectively analyzed 27 primary THAs in patients with a history of drug use and found the five-and 10-year implant survival rates with failure for any reason were 61% and 52.3% and for septic reasons were 70.6% and 60.5%, respectively. The risk of infection is increased by the use of drugs [9,10] and the rate of periprosthetic joint infection after bacteremia, like that often seen in drug abusers, is reported to range from 30 to 40% [30].…”

“…Previous groups have found decreased implant survival rates [7], increased rates of infection [12], and high rates of postoperative substance withdrawal delirium [11] in substance abusers who underwent total joint arthroplasty, but these studies were limited by small sample size. The purpose of the present study was to measure the influence of drug misuse on inpatient perioperative outcomes following primary THA or TKA using a large national database.…”

“…The lifetime prevalence of drug abuse and dependence among U.S. adults is estimated at 7.7% and 2.6%, respectively [6]. The risk of secondary osteoarthritis among drug users is thought to be higher than the general population due to increased rates of osteonecrosis of the femoral head and inflammatory arthropathies due to repetitive bacteremia [7,8]. Additionally, when joint arthroplasty is considered, the risk of a septic complication is of concern as injection or inhalation of drugs is felt to increase the risk of infection [9,10].…”

“…Additionally, when joint arthroplasty is considered, the risk of a septic complication is of concern as injection or inhalation of drugs is felt to increase the risk of infection [9,10]. Despite the rates of drug abuse and dependence in the U.S., few studies have evaluated their influence on outcomes following primary total hip (THA) or knee (TKA) arthroplasty [7,11,12].…”