ArticleJournal of shoulder and elbow arthroplasty2026
Pre-operative narcotic use is associated with worse outcomes following primary anatomic and reverse shoulder arthroplasty.
Article in Journal of shoulder and elbow arthroplasty, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Pre-operative narcotic use is common among patients undergoing shoulder arthroplasty and has been associated with worse baseline function and higher pain. However, its effect on long-term post-operative outcomes and ongoing narcotic use after anatomic and reverse total shoulder arthroplasty remains unclear. The purpose of this study was to evaluate the impact of pre-operative narcotic use on post-operative pain, function, and narcotic persistence following primary shoulder arthroplasty. Methods: A retrospective review of a single institution's shoulder and elbow surgery repository identified patients who underwent primary anatomic total shoulder arthroplasty or reverse shoulder arthroplasty by a single fellowship-trained surgeon from 2006 to 2023 with a minimum of 2-year follow-up. Patients were categorized based on their response to the pre-operative questionnaire item, "Do you take narcotic pain medication (codeine or stronger)?" Patient demographics, comorbidities, complications, and patient-reported outcomes (American Shoulder and Elbow Surgeons [ASES], Simple Shoulder Test, Single Assessment Numeric Evaluation [SANE], visual analog scale pain) were collected pre-operatively and at most recent follow-up (minimum 2-year follow-up). Outcomes and changes in patient-reported outcome measure scores were compared between pre-operative narcotic users and non-users. Results: A total of 1,689 primary shoulder arthroplasty patients met inclusion criteria with a median follow-up of 53 months (range 22-192 months). Of those, 389 (23%) reported pre-operative narcotic use. Narcotic users were more often female (58.9% vs. 48.3%, Conclusion: Patients using narcotics pre-operatively experience meaningful improvement after shoulder arthroplasty but achieve inferior post-operative outcomes and are significantly more likely to continue narcotics long term. These findings reinforce the need for counseling and opioid-sparing strategies in patients undergoing anatomic total shoulder arthroplasty or reverse shoulder arthroplasty.
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