Cannabis Use Following Total Joint Arthroplasty is Associated With Increased Risks? A Meta-Analysis.

ABSTRACT

BACKGROUND: With the increased legalization of cannabis, a new unknown emerges for orthopaedic surgeons and their patients. This systematic review aimed to (1) evaluate complications of cannabis use; (2) determine the effects of cannabis on pain and opioid consumption; and (3) evaluate healthcare utilizations associated with cannabis use among patients undergoing total joint arthroplasty (TJA). METHODS: A systematic review was performed. A search of the literature was performed in 5 databases. We included studies between January 2012 and July 2022 reporting cannabis use and complications, pain management, opioid consumption, length of stay, costs, or functional outcomes following TJA. A meta-analysis of odds ratios (ORs) and continuous variables was performed. A total of 19 articles were included in our final analysis. RESULTS: Cannabis use was associated with higher odds for deep vein thrombosis (DVT) (OR 1.46, 95% Confidence Interval [CI] 1.13 to 1.89) and revisions (OR 1.47 [95% CI 1.41 to 1.53]) in total knee arthroplasty (TKA). Cannabis use was associated with similar odds for DVT in total hip arthroplasty (THA) (OR 1.30 [95% CI 0.79 to 2.13]), pulmonary embolus in both TKA (OR 1.29 [95% CI 0.95 to 1.77]), THA (OR 0.55 [95% CI 0.09 to 3.28]), and cardiovascular complications in TKA (OR 1.97 [95% Cl 0.93 to 4.14]). Cannabis use did not alter pain scores, opioid consumption, or cost of care in THA (estimate $2,550.51 [95% CI $356.58 to $5,457.62]) but was associated with higher costs in TKA (estimate $3,552.46 [95% CI $1,729.71 to $5,375.22]). There was no difference in lengths of stay or functional outcomes; however, there may be a potentially increased risk for prosthetic complications, pneumonia, and cerebrovascular accidents among cannabis users. CONCLUSION: Cannabis use may be associated with an increased risk of DVTs, revisions, pneumonia, cerebrovascular accidents, and cardiac complications after TJA. Higher-level studies are needed to ascertain the impact of cannabis use for patients undergoing TJA.