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Ding C, Xu D, Cheng T. Cannabis Use Disorder Associated With Increased Risk of Postoperative Complications After Hip or Knee Arthroplasties: A Meta-analysis of Observational Studies. J Am Acad Orthop Surg 2024:00124635-990000000-00988. [PMID: 38759231 DOI: 10.5435/jaaos-d-23-00407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/02/2023] [Indexed: 05/19/2024] Open
Abstract
INTRODUCTION With the legalization of marijuana in the United States, the number of patients with cannabis use disorder (CUD) in the joint arthroplasty population has increased markedly. The primary purpose of this meta-analysis was to determine whether there were differences in clinical and economic outcomes after total joint arthroplasty (TJA) between patients with and without perioperative CUD. METHODS We searched PubMed, Embase, Scopus, and Web of Science databases up to July 2018 to identify all eligible studies investigating the association of CUD with postoperative outcomes in patients undergoing TJA. Postoperative outcomes assessed consisted of complications, readmission, length of stay (LOS), implant revision, and cost of care. For dichotomous outcomes, pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated using a random effects model. RESULTS We identified 10 retrospective cohort studies with a total of 17,981,628 study participants. Patients with CUD had significantly higher odds of medical complications (OR 1.33 [95% CI 1.07 to 1.66], P = 0.01) and implant-related complications (OR 1.75 [95% CI: 1.64 to 1.88], P < 0.00001) than noncannabis users. Specifically, CUD was associated with significantly increased odds of cardiac complications (OR 1.95 [95% CI 1.50 to 2.54], P < 0.00001), cerebrovascular accidents (OR 2.06 [95% CI 1.66 to 2.57], P < 0.00001), postoperative infections (OR 1.68 [95% CI 1.34 to 2.10], P < 0.00001), periprosthetic fracture (OR 1.42 [95% CI 1.19 to 1.70], P < 0.0001), mechanical loosening (OR 1.54 [95% CI 1.42 to 1.66], P < 0.00001), and dislocation/instability (OR 1.88 [95% CI 1.32 to 2.68], P = 0.0005). Longer LOS and higher cost of care were also found in patients with CUD. CONCLUSION This study strengthens the body of evidence that patients with CUD face higher risk of postoperative complications and greater financial burden after knee and hip arthroplasties. Physicians should inform patients about adverse outcomes and undertake appropriate risk adjustments before elective orthopaedic surgery. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Cheng Ding
- From the Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, The People's Republic of China
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Remily EA, Bains SS, Dubin J, Hameed D, Reich J, Livesey MG, Chen Z, Moore MC, Ingari JV. Elevated risk of prosthetic infections in cannabis users after shoulder arthroplasty. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1381-1387. [PMID: 38183443 DOI: 10.1007/s00590-023-03802-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 11/25/2023] [Indexed: 01/08/2024]
Abstract
INTRODUCTION An increasing number of states are beginning to legalize recreational cannabis use, and as such, more patients using cannabis are undergoing shoulder arthroplasty procedures. The present study sought to examine the impact of cannabis use on post-operative outcomes. The primary outcomes of interest were postoperative complications, which included infection, periprosthetic fractures, periprosthetic joint infections (PJI), dislocations, and aseptic loosening as well as medical complications. Secondary outcomes were risk factors for PJI and aseptic loosening at two-years. METHODS A private, nationwide, all-payer database (Pearldiver Technologies) was queried to identify shoulder arthroplasty patients from 2010 to 2020. Those not using tobacco or cannabis ("control", n = 10,000), tobacco users (n = 10,000), cannabis users (n = 155), and concurrent tobacco and cannabis users (n = 9,842) were identified. Risk factors for PJI and aseptic loosening at two-years were further quantified utilizing multivariable logistic regression analysis. RESULTS Compared to non-users, cannabis users experienced the highest odds for PJI and aseptic revisions, which were followed by concurrent cannabis and tobacco users and tobacco-only users. Concurrent users, as well as tobacco users were at higher risk for dislocation. Cannabis use was the most significant risk factor for PJI, followed by concurrent use and male sex. CONCLUSIONS Our study found cannabis use to cause greater risk for superficial and deep infection. More research involving randomized trials are needed to fully elucidate the impact of cannabis use on shoulder arthroplasty procedures. Clinically, these findings can appropriately guide surgeons and patients alike regarding expectations prior to undergoing TSA.
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Affiliation(s)
- Ethan A Remily
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Sandeep S Bains
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Jeremy Dubin
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Daniel Hameed
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Jeremy Reich
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Michael G Livesey
- Department of Orthopaedic Surgery, University of Maryland, Baltimore, MD, USA
| | - Zhongming Chen
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Mallory C Moore
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - John V Ingari
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA.
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Burney E, Bash J, Robinson E, Scull D, Bassale S, Barton C, Chouhan JD. Outcomes of a Standardized Pain Pathway for Transgender Patients Undergoing Vaginoplasty and Vulvoplasty. Urology 2024:S0090-4295(24)00147-X. [PMID: 38467283 DOI: 10.1016/j.urology.2024.02.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 11/13/2023] [Accepted: 02/06/2024] [Indexed: 03/13/2024]
Abstract
OBJECTIVE To establish and evaluate a multimodal, opioid-minimizing pathway for gender-affirming vaginoplasty (GAVa) and vulvoplasty (GAVu) in treating postoperative pain. METHODS A standardized pain pathway including opioids, non-opioid analgesics, and patient counseling was implemented at a single academic institution with a center for transgender care. Postoperative pain levels, analgesia methods, and opioid use for 84 GAVa and 64 GAVu patients were prospectively gathered during inpatient postoperative days 2-4 and outpatient follow-up at 2 weeks. Pertinent patient, operative, and medication administration data were extracted from patient charts and outpatient pain was measured with the Brief Pain Inventory short form (BPI-sf). RESULTS On average, GAVa patients used 89.3 MME and GAVu patients used 41.8 MME during inpatient stay. MME decreased daily for both groups. There was no difference in MME between open and robotic GAVa. Forty-nine percent of GAVa patients and 54% of GAVu patients used ketorolac with decreasing daily inpatient use. Postoperative pain levels were similar between GAVa and GAVu patients. Fifty percent of respondents denied postoperative pain in the 24 hours preceding the survey. Forty-four percent of GAVa and of GAVu patients did not use any opioid medications in the outpatient setting, while 81% of GAVa and 83% of GAVu patients used fewer than 20 of 30 prescribed opioid tablets. Ibuprofen and acetaminophen were rated the most effective outpatient analgesics among GAVa and GAVu patients, respectively. CONCLUSION The multimodal pathway demonstrated effective postoperative pain control for GAVa and GAVu patients while minimizing opioid use and has changed institutional prescribing practice.
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Affiliation(s)
- Emily Burney
- School of Medicine, Oregon Health & Science University, Portland, OR
| | - Jasper Bash
- Department of Urology, Oregon Health & Science University, Portland, OR
| | - Eric Robinson
- School of Medicine, Oregon Health & Science University, Portland, OR
| | - Dorian Scull
- Department of Urology, Oregon Health & Science University, Portland, OR
| | - Solange Bassale
- Biostatistics Shared Resources, Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | - Chandler Barton
- School of Medicine, Oregon Health & Science University, Portland, OR
| | - Jyoti D Chouhan
- Department of Urology, Oregon Health & Science University, Portland, OR.
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D'Antonio ND, Lambrechts MJ, Heard JC, Siegel N, Karamian BA, Huang A, Canseco JA, Woods B, Kaye ID, Hilibrand AS, Kepler CK, Vaccaro AR, Schroeder GD. The Effect of Preoperative Marijuana Use on Surgical Outcomes, Patient-Reported Outcomes, and Opioid Consumption Following Lumbar Fusion. Global Spine J 2024; 14:568-576. [PMID: 35849499 PMCID: PMC10802534 DOI: 10.1177/21925682221116819] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Retrospective Cohort Study. OBJECTIVES To (1) investigate the effect of marijuana use on surgical outcomes following lumbar fusion, (2) determine how marijuana use affects patient-reported outcomes measures (PROMs), and (3) determine if marijuana use impacts the quantity of opioids prescribed. METHODS Patients > 18 years of age who underwent primary one- or two-level lumbar fusion with preoperative marijuana use at our institution were identified. A 3:1 propensity match incorporating patient demographics and procedure type was conducted to compare preoperative marijuana users to non-marijuana users. Patient demographics, surgical characteristics, surgical outcomes (90-day all-cause and 90-day surgical readmissions, reoperations, and revision surgeries), pre- and postoperative narcotic usage, and PROMs were compared between groups. Multivariate regression models were created to determine the effect of marijuana on surgical reoperations patient-reported outcomes (PROMs) 1-year postoperatively. RESULTS Of the 259 included patients, 65 used marijuana preoperatively. Multivariate logistic regression analysis demonstrated that marijuana use (OR = 2.28, P = .041) significantly increased the likelihood of having a spine reoperation. No other surgical outcome was found to be significantly different between groups. Multivariate linear regression analysis showed that marijuana use was not significantly associated with changes in 1-year postoperative PROMs (all, P > .05). The quantity of pre- and postoperative opioids prescriptions was not significantly different between groups (all, P > .05). CONCLUSIONS Preoperative marijuana use increased the likelihood of a spine reoperation for any indication following lumbar fusion, but it was not associated with 90-day all cause readmission, surgical readmission, the magnitude of improvement in PROMs, or differences in opioid consumption. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Nicholas D D'Antonio
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Mark J Lambrechts
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Jeremy C Heard
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Nicholas Siegel
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Brian A Karamian
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Angela Huang
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Jose A Canseco
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Barrett Woods
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Ian David Kaye
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Alan S Hilibrand
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Christopher K Kepler
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Gregory D Schroeder
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
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Malige A, Boyd A, Limpisvasti O. Perceptions of Orthopaedic Sports Medicine Surgeons About Medical Cannabidiol Use: A Survey Study. Cureus 2024; 16:e51759. [PMID: 38318555 PMCID: PMC10843240 DOI: 10.7759/cureus.51759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 02/07/2024] Open
Abstract
INTRODUCTION Multiple studies exist identifying cannabidiol (CBD) as an effective part of an orthopaedic patient's pain regimen; however, there is a paucity of studies elucidating orthopaedic surgeons' perception of the use and prescription of CBD in the medical setting. This study surveys orthopaedic sports medicine surgeons about their previous education on and current perceptions and usage of CBD in their medical practice. METHODS Between April 2023 and July 2023, orthopaedic sports medicine surgeons from across the country were surveyed. This survey was designed in hopes of identifying physician perceptions and current use of CBD as well as their previous education and training on its use. RESULTS Overall, 75 orthopaedic surgeons responded. More than three-fourths of responders had not received formal education on medical CBD use, nor did they have partners or colleagues who used CBD in their practice. More than half of all surgeons believed that there is a stigma associated with CBD use. A higher proportion of surgeons from CBD legal states recommended CBD to help patients control their pain (53.7% vs. 37.5%). Less than 15% of responders believed that CBD can adversely affect surgical outcomes. Finally, four-fifths of all responders believed that CBD is easy to legally access and affordable to buy by patients who desire it. DISCUSSION The relative novelty of CBD inclusion in medicine has led to a lack of early education and overall experience with its use among orthopaedic sports medicine surgeons. Still, surgeons believe that CBD is a safe and effective option to control pain. As surgeons continue to gain more familiarity and trust with CBD's medical uses over time, it has the potential to be a mainstay in orthopaedic multimodal pain regimens.
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Affiliation(s)
- Ajith Malige
- Orthopaedic Surgery, Cedars-Sinai Kerlan-Jobe Institute, Los Angeles, USA
| | - Alexandra Boyd
- Orthopaedic Surgery, Cedars-Sinai Kerlan-Jobe Institute, Los Angeles, USA
| | - Orr Limpisvasti
- Orthopaedic Surgery, Cedars-Sinai Kerlan-Jobe Institute, Los Angeles, USA
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Pasqualini I, Huffman N, Keller SF, McLaughlin JP, Molloy RM, Deren ME, Piuzzi NS. Team Approach: Bone Health Optimization in Orthopaedic Surgery. JBJS Rev 2023; 11:01874474-202312000-00007. [PMID: 38100611 DOI: 10.2106/jbjs.rvw.23.00178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
» Bone health optimization (BHO) has become an increasingly important consideration in orthopaedic surgery because deterioration of bone tissue and low bone density are associated with poor outcomes after orthopaedic surgeries.» Management of patients with compromised bone health requires numerous healthcare professionals including orthopaedic surgeons, primary care physicians, nutritionists, and metabolic bone specialists in endocrinology, rheumatology, or obstetrics and gynecology. Therefore, achieving optimal bone health before orthopaedic surgery necessitates a collaborative and synchronized effort among healthcare professionals.» Patients with poor bone health are often asymptomatic and may present to the orthopaedic surgeon for reasons other than poor bone health. Therefore, it is imperative to recognize risk factors such as old age, female sex, and low body mass index, which predispose to decreased bone density.» Workup of suspected poor bone health entails bone density evaluation. For patients without dual-energy x-ray absorptiometry (DXA) scan results within the past 2 years, perform DXA scan in all women aged 65 years and older, all men aged 70 years and older, and women younger than 65 years or men younger than 70 years with concurrent risk factors for poor bone health. All women and men presenting with a fracture secondary to low-energy trauma should receive DXA scan and bone health workup; for fractures secondary to high-energy trauma, perform DXA scan and further workup in women aged 65 years and older and men aged 70 years and older.» Failure to recognize and treat poor bone health can result in poor surgical outcomes including implant failure, periprosthetic infection, and nonunion after fracture fixation. However, collaborative healthcare teams can create personalized care plans involving nutritional supplements, antiresorptive or anabolic treatment, and weight-bearing exercise programs, resulting in BHO before surgery. Ultimately, this coordinated approach can enhance the success rate of surgical interventions, minimize complications, and improve patients' overall quality of life.
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Affiliation(s)
| | - Nickelas Huffman
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Sarah F Keller
- Department of Rheumatology and Immunology, Cleveland Clinic, Cleveland, Ohio
| | | | - Robert M Molloy
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Matthew E Deren
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Nicolas S Piuzzi
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
- Department of Biomedical Engineering, Cleveland Clinic Foundation, Cleveland, Ohio
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Barkay G, Solomito MJ, Kostyun RO, Esmende S, Makanji H. The effect of cannabis use on postoperative complications in patients undergoing spine surgery: A national database study. NORTH AMERICAN SPINE SOCIETY JOURNAL 2023; 16:100265. [PMID: 37745195 PMCID: PMC10514216 DOI: 10.1016/j.xnsj.2023.100265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/08/2023] [Accepted: 08/15/2023] [Indexed: 09/26/2023]
Abstract
Background With the increased use of cannabis in the US, there is a significant need to understand the medical complications associated with its use in relationship to a surgical population. Cannabis has mainly been studied with respect to its qualities of pain treatment, yet few studies have investigated post-surgical complications associated with its use. Therefore, the purpose of this study was to explore the effect of cannabis use on complications in spine surgery, and compare these complications rates to opioid-related complications. Methods This was a retrospective study conducted using the PearlDiver Database. Using ICD codes 40,989 patients that underwent lumbar spine fusion between January 2010 and October 2020 were identified and divided into 3 study groups (i.e., control, patients with known opioid use disorder, and patients identified as cannabis users). Differences in the incidence of complications within 30 days of the index procedure and pseudarthrosis rates at 18 months postindex procedure were assessed among study groups using a multivariate logistic regression. Results Of 12.4% study population used cannabis and 38.8% had a known opioid use disorder. Results indicated increased odds of experiencing a VTE, hypoxia, myocardial infarction, and arrhythmia for both opioid and cannabis users compared to controls; however, when controlling for tobacco use there were no increased odds of complications within the cannabis group. The pseudarthrosis rate was greater in cannabis users (2.4%) than in controls (1.1%). Conclusions The pseudarthrosis rate was significantly greater in patients using cannabis and opioids compared to the control group. However, when controlling for tobacco use, results suggested a possible negative synergistic between cannabis use and concomitant tobacco use that may influence bone fusion.
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Affiliation(s)
- Gal Barkay
- Department of Orthopedic Surgery, University of Connecticut Medical School, 263 Farmington Ave., Farmington, CT 06032
| | - Matthew J. Solomito
- Department of Orthopedic Research, Hartford Healthcare Bone and Joint Institute, 31 Seymour St. Hartford, CT 06106
| | - Regina O. Kostyun
- Department of Orthopedic Research, Hartford Healthcare Bone and Joint Institute, 31 Seymour St. Hartford, CT 06106
| | - Sean Esmende
- Orthopedic Associates of Hartford, 31 Seymour St., Hartford, CT 06106
| | - Heeren Makanji
- Department of Orthopedic Research, Hartford Healthcare Bone and Joint Institute, 31 Seymour St. Hartford, CT 06106
- Orthopedic Associates of Hartford, 31 Seymour St., Hartford, CT 06106
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Livesey MG, Bains SS, Stern JM, Chen Z, Dubin JA, Monárrez R, Remily EA, Ingari JV. Cannabis Use in Patients With Distal Radius Fractures: A Moment of Unity? Hand (N Y) 2023:15589447231196905. [PMID: 37787484 DOI: 10.1177/15589447231196905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
BACKGROUND As legalization of cannabis spreads, an increasing number of patients who use cannabis are being seen in the clinical setting. This study examined the impact of cannabis and tobacco use on postoperative complications following open reduction and internal fixation (ORIF) of distal radius fractures. METHODS A national, all-payer database was queried to identify patients who underwent ORIF of a distal radius fracture between 2015 and 2020 (n = 970 747). Patients were stratified into the following groups: (1) tobacco use (n = 86 941), (2) cannabis use (n = 898), (3) tobacco and cannabis use (n = 9842), and (4) neither tobacco nor cannabis use ("control", 747 892). Multivariable logistic regression was used to identify risk factors for infection, nonunion, and malunion within the first postoperative year. RESULTS Concomitant use of tobacco and cannabis was associated with a higher rate of nonunion (5.0%) compared to tobacco or cannabis use alone (P < .001). Multivariate analysis identified cannabis-only use (odds ratio [OR] 1.25), tobacco-only use (OR 2.17), and concurrent tobacco and cannabis use (OR 1.78) as risk factors for infection within the first postoperative year. Similarly, cannabis-only use (OR 1.47), tobacco-only use (OR 1.92), and concurrent tobacco and cannabis use (OR 2.52) were associated with an increased risk of malunion. CONCLUSIONS Cannabis use is associated with an elevated risk of infection and malunion following operative management of a distal radius fracture. Concomitant use of cannabis and tobacco poses an elevated risk of nonunion and malunion compared to tobacco use alone.
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Affiliation(s)
- Michael G Livesey
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sandeep S Bains
- Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | | | - Zhongming Chen
- Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Jeremy A Dubin
- Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Rubén Monárrez
- Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Ethan A Remily
- Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - John V Ingari
- Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
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Rao NM, Ligas C. The Ankle Joint: Revision Ankle Fusion Options, Nonunion, Malunion, Protocol for Best Outcome. Clin Podiatr Med Surg 2023; 40:703-710. [PMID: 37716746 DOI: 10.1016/j.cpm.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
Ankle arthrodesis has been a time-tested procedure for osteoarthritis, avascular necrosis of the talus, deformity correction, and significant trauma of the ankle. Technique guides have created dissection pearls, ease of fixation, and arthroscopic techniques to mitigate complications of the procedure. Major complications, such as nonunion, malunion, or implant infection are the most worrisome and cumbersome complications to handle. The aim of this article is to provide the practicing surgeon evidence to provide innovative management techniques for nonunion, malunion, and infection following primary ankle arthrodesis.
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Affiliation(s)
- Nilin M Rao
- Foot Specialists of Austin, 1600 West 38th Street, #210, Austin, TX, USA.
| | - Chandler Ligas
- Podiatric Surgery, Silicon Valley Reconstructive Foot and Ankle Fellowship- Palo Alto Medical Foundation, 701 E El Camino Real 1st Floor, Mountain View, CA 94040, USA; Sunnyvale, CA, USA
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Dhodapkar MM, Oghenesume OP, Halperin SJ, Modrak M, Yoo BJ, Grauer JN. Adverse Events After Ankle Fracture Open Reduction Internal Fixation Among Patients With and Without Documented Cannabis and Tobacco Use. Foot Ankle Int 2023; 44:941-948. [PMID: 37698277 DOI: 10.1177/10711007231189698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
BACKGROUND Ankle fractures are common orthopaedic injuries that may be indicated for open reduction internal fixation (ORIF). Although the negative impact of tobacco use on perioperative outcomes of ankle fracture ORIF has been described, the potential impact of cannabis use on related outcomes is not as well established. METHODS Retrospective database study of adult patients undergoing ankle ORIF for closed, isolated, ankle fractures from the 2010-2021 Q1 PearlDiver M151 data set. Subcohorts without and with cannabis and/or tobacco use were identified based on coding and matched based on patient age, sex, and Elixhauser Comorbidity Index (ECI) scores to yield groups of nonusers, tobacco users, tobacco and cannabis users, and cannabis users. Ninety-day adverse events were assessed between matched subcohorts with multivariable logistic regression controlling for age, sex, and ECI. RESULTS A total of 149 289 patients met study inclusion criteria for whom tobacco only use was documented for 14 989 (10.0%), tobacco and cannabis use for 2726 (1.8%), and cannabis only use for 867 (0.6%). Matching yielded 823 for each group. On multivariable analyses, isolated tobacco users were at higher odds of 90-day urinary tract infections (UTIs) (odds ratio [OR] 2.64), minor adverse events (OR 2.33), all-cause adverse events (OR 2.17), readmissions (OR 1.85), and severe adverse events (OR 1.84). Tobacco and cannabis comorbid users were at a marginally higher odds of 90-day UTI (OR 2.82), minor adverse events (OR 2.51), readmissions (OR 2.39), and any adverse events (OR 2.22). Cannabis only users were not at greater odds of 90-day adverse events relative to nonusers. CONCLUSION Patients with tobacco use (alone or with cannabis) were at greater odds of 90-day adverse events following ankle fracture ORIF, but cannabis only users were not. LEVEL OF EVIDENCE Level III, Retrospective database study.
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Affiliation(s)
- Meera M Dhodapkar
- Department of Orthopedics & Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | | | - Scott J Halperin
- Department of Orthopedics & Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Maxwell Modrak
- Department of Orthopedics & Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Brad J Yoo
- Department of Orthopedics & Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Jonathan N Grauer
- Department of Orthopedics & Rehabilitation, Yale School of Medicine, New Haven, CT, USA
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Kayani B, Howard LC, Neufeld ME, Garbuz DS, Masri BA. Cannabis and Pain Control After Total Hip and Knee Arthroplasty. Orthop Clin North Am 2023; 54:407-415. [PMID: 37718080 DOI: 10.1016/j.ocl.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Cannabis use among the elderly has increased over the previous 2 decades. This has translated to a greater proportion of orthopedic procedures being undertaken on these patients. This review provides clinicians with evidence-based information on the effects of cannabis on pain control in THA and TKA, to help counsel these patients and facilitate their perioperative management. The review specifically focuses on the following: origins of cannabis; biochemistry of cannabis; medical versus recreational cannabis; pharmacology of cannabis; effects of cannabis on bone metabolism; preoperative pain control; preoperative systemic considerations; intraoperative considerations; postoperative pain control, postoperative systemic considerations; and scope for future work.
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Affiliation(s)
- Babar Kayani
- Division of Lower Limb Reconstruction & Oncology, Vancouver General Hospital, Vancouver, British Columbia V5Z 1M9, Canada; Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada.
| | - Lisa C Howard
- Division of Lower Limb Reconstruction & Oncology, Vancouver General Hospital, Vancouver, British Columbia V5Z 1M9, Canada; Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
| | - Michael E Neufeld
- Division of Lower Limb Reconstruction & Oncology, Vancouver General Hospital, Vancouver, British Columbia V5Z 1M9, Canada; Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
| | - Donald S Garbuz
- Division of Lower Limb Reconstruction & Oncology, Vancouver General Hospital, Vancouver, British Columbia V5Z 1M9, Canada; Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
| | - Bassam A Masri
- Division of Lower Limb Reconstruction & Oncology, Vancouver General Hospital, Vancouver, British Columbia V5Z 1M9, Canada; Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
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Boyd A, Malige A, Limpisvasti O. Physician Trainees' Perception of Cannabidiol Use in Medicine: A Survey Study. Cureus 2023; 15:e47228. [PMID: 38022327 PMCID: PMC10653979 DOI: 10.7759/cureus.47228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
PURPOSE Given the ongoing national opiate crisis, physicians have been challenged with mitigating the risk of opiate dependence in their patients. With current physician efforts to mitigate the risks of treating pain with opioid prescriptions, this study evaluates medical students' and residents' understanding and perceptions regarding cannabidiol (CBD) in current medical care and their future medical practice. METHODS Orthopedic residents from all American programs and medical students from 50 medical schools, regardless of training year or future specialty plans, were eligible to participate in this survey-based study administered from December 2022 to March 2023. The surveys ask questions about demographic information, what education they receive on CBD utilization in medicine, thoughts on CBD effectiveness in pain control, and future plans on utilizing CBD. RESULTS A total of 55 residents (1.4%) and 53 medical students (5.1%) responded. Trainees in CBD-legal states were more likely to work with physicians who use CBD in their practice. Most trainees, regardless of location, believe CBD use has a stigma attached to it. Many responders were concerned about the role of CBD in pain control. Finally, most trainees believed that CBD is easy to access if desired and is affordable to purchase. CONCLUSION The trajectory of CBD use in the United States indicates that the therapeutic benefits of CBD will be targeted, and future physicians are not always provided adequate educational opportunities to learn about its potential medical uses. Continued training as well as interactions with patients may help decrease the stigma surrounding medical CBD use and help solidify its therapeutic use in pain control.
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Affiliation(s)
- Alexandra Boyd
- Orthopaedic Surgery, Cedars-Sinai Kerlan-Jobe Institute, Los Angeles, USA
| | - Ajith Malige
- Orthopaedic Surgery, Cedars-Sinai Kerlan-Jobe Institute, Los Angeles, USA
| | - Orr Limpisvasti
- Orthopaedic Surgery, Cedars-Sinai Kerlan-Jobe Institute, Los Angeles, USA
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Ihejirika-Lomedico R, Patel K, Buchalter DB, Kirby DJ, Mehta D, Dankert JF, Muiños-López E, Ihejirika Y, Leucht P. Non-psychoactive Cannabidiol Prevents Osteoporosis in an Animal Model and Increases Cell Viability, Proliferation, and Osteogenic Gene Expression in Human Skeletal Stem and Progenitor Cells. Calcif Tissue Int 2023; 112:716-726. [PMID: 37093268 DOI: 10.1007/s00223-023-01083-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 04/08/2023] [Indexed: 04/25/2023]
Abstract
Cannabidiol (CBD), the non-psychoactive component of the Cannabis sativa plant, is marketed as a potential therapeutic agent and has been studied for its roles in reducing inflammation and managing neuropathic pain. Some studies have reported that CB1 and CB2 receptor activation can attenuate and reverse bone loss in experimental animal models. Despite this, little is known about the impact of CBD on fracture healing. We investigated the effects of CBD in vitro using human osteoprogenitor cells and in vivo via murine femur fracture and osteoporosis models. In vitro mesenchymal stem cells were treated with increasing concentrations of crystalized pharmaceutical grade CBD or vehicle solution. Cell viability and proliferation were significantly increased in cells treated with CBD compared to vehicle control. Osteocalcin expression was also significantly higher in the CBD-treated human stem cells compared to vehicle control. In vivo the effect of CBD on bone mineral density and fracture healing in mice was examined using a two-phase experimental approach. Fluoxetine was used for pharmacologic induction of osteoporosis and surgical oophorectomy (OVX) was used for hormonal induction of osteoporosis. X-ray and microCT analysis showed that CBD prevented both fluoxetine- and OVX-induced osteoporosis. We found that while OVX resulted in delayed bone healing in control mice, CBD-pretreated mice exhibited normal bone healing. Collectively these in vitro and in vivo findings suggest that CBD exerts cell-specific effects which can be exploited to enhance bone metabolism. These findings also indicate that CBD usage in an osteoporotic population may positively impact bone morphology, warranting further research.
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Affiliation(s)
- Rivka Ihejirika-Lomedico
- Department of Orthopaedic Surgery, NYU Langone Orthopedics, NYU Grossman School of Medicine, 550 First Avenue, MSB 251A, New York, NY, 10016, USA
| | - Karan Patel
- Department of Orthopaedic Surgery, NYU Langone Orthopedics, NYU Grossman School of Medicine, 550 First Avenue, MSB 251A, New York, NY, 10016, USA
| | - Daniel B Buchalter
- Department of Orthopaedic Surgery, NYU Langone Orthopedics, NYU Grossman School of Medicine, 550 First Avenue, MSB 251A, New York, NY, 10016, USA
| | - David J Kirby
- Department of Orthopaedic Surgery, NYU Langone Orthopedics, NYU Grossman School of Medicine, 550 First Avenue, MSB 251A, New York, NY, 10016, USA
| | - Devan Mehta
- Department of Orthopaedic Surgery, NYU Langone Orthopedics, NYU Grossman School of Medicine, 550 First Avenue, MSB 251A, New York, NY, 10016, USA
| | - John F Dankert
- Department of Orthopaedic Surgery, NYU Langone Orthopedics, NYU Grossman School of Medicine, 550 First Avenue, MSB 251A, New York, NY, 10016, USA
| | - Emma Muiños-López
- Department of Orthopaedic Surgery, NYU Langone Orthopedics, NYU Grossman School of Medicine, 550 First Avenue, MSB 251A, New York, NY, 10016, USA
| | - Yael Ihejirika
- Department of Orthopaedic Surgery, NYU Langone Orthopedics, NYU Grossman School of Medicine, 550 First Avenue, MSB 251A, New York, NY, 10016, USA
| | - Philipp Leucht
- Department of Orthopaedic Surgery, NYU Langone Orthopedics, NYU Grossman School of Medicine, 550 First Avenue, MSB 251A, New York, NY, 10016, USA.
- Department of Cell Biology, NYU Grossman School of Medicine, 550 First Avenue, MSB 251A, New York, NY, 10016, USA.
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