Cbd oil for knee replacement surgery

Recovering after knee surgery: How CBD and marijuana can help

With America being slow to warm to understanding cannabis’s role in medicine, a clinical trial sponsored by McMaster University in Canada is looking into the role of cannabis in post-surgical pain. Photo by iStock / Getty Images Plus

Article content

With knee pain, everything seems to be a chore. From climbing stairs, to getting in-and-out of the car, individuals that suffer from prolonged knee soreness and discomfort often benefit from surgery, with many stating that after-care can be almost as difficult as the pain itself. In fact, Googling “knee surgery aftercare” often brings up results in how to avoid surgery altogether.

Advertisement 2

Article content

However, delaying surgery can have subtle effects that patients often don’t realize. BoneSmart, a website by AESCULAP Implant Systems, found research on why delaying surgery could bring additional complications. From a risk of deformities to the increased inability to manage pain, BoneSmart also found that delaying the procedure could prolong time under anesthesia.

Recovering after knee surgery: How CBD and marijuana can help Back to video

The Arthritis Foundation also echoed the research of others like BoneSmart on the internet but added the caveat that most patients could make an informed decision with knowledge of weighing the pros and cons of having immediate surgery or choosing to delay the procedure.

More On This Topic

Why These 4 Professional Athletes Use CBD To Manage Pain

Doug McNish: Wake and bake with munchie-satisfying Red-Fife Pancakes

Joint apology needed: New York man said he found a cannabis roach in his Popeyes’ sandwich

Advertisement 3

Article content

Additionally, the Foundation shared a study by the Agency for Healthcare Research and Quality, showcasing the fact that demand for the total knee replacement procedure has been steadily rising since 2011, as has patient questions about avoiding opioid addiction and additional therapies available in after care.

Multiple studies have shown that THC and CBD offer an alternative to opioids and other pain medicines but often patients don’t know where to look for proven studies on the effects of cannabis on pain within the body. As Brandon May from Clinical Pain Advisor shares, “Research examining the therapeutic effects of CBD remains limited, as the majority of clinical studies focus on THC, which binds CB1 receptors rather than on CBD itself.”

Advertisement 4

Article content

The role of THC and CBD

With America being slow to warm to understanding cannabis’s role in medicine, a clinical trial sponsored by McMaster University in Canada is looking into the role of cannabis in post-surgical pain. In their trial brief, they explain:

“Medicinal cannabis has begun to emerge as a potential therapy for pain reduction and produces effects largely due to 2 active components: (1) cannabidiol (CBD), and (2) tetrahydrocannabinol (THC). Studies of CBD have shown analgesic, anti-inflammatory, and anti-anxiety properties, but without the psychoactive effects (feeling ‘high’) that THC produces. This study will assess the feasibility of a definitive trial to explore whether adding CBD vs. placebo to usual care before and after surgery can reduce the rate of persistent post-surgical pain after total knee replacement. This study will randomize 40 patients to receive either CBD or placebo and follow them for six months to confirm our ability to recruit patients, adhere to protocol, and capture full outcome data for at least 90% of patients.”

Advertisement 5

Article content

As the U.S. continues to struggle in hosting trials and studies due to the classification of cannabis, pressure continues to mount on all involved in healthcare to explore additional therapies.

How technology is improving patient outcomes

With many patients choosing to move forward with surgery, there seems to be a feeling of apprehension of what to expect after, as each individual’s recovery plan is usually customized. Medicare’s Comprehensive Care for Joint Replacement Model started recommending immediate discharge after surgery instead of placing patients in after-care facilities, which some say has added depth to the opioid-epidemic for those unable to discontinue pain medicine at proper times.

Advertisement 6

Article content

Dr. Michael Suk, chair of Geisinger’s Musculoskeletal Institute, shared recently with Modern Healthcare that while after-surgery care is set individually with each patient, certain best practices are a guideline. These include timeframes for check-ins with the health care team and offering specific resources for education. Noticing a need to offer home-bound patients a way to connect to resources throughout their recovery, Dr. Suk and his team partnered with Force Therapeutics to offer an app that allows patients to not only have touchpoints with nurses and gives access to detailed care plans. Geisinger’s strategic partnership has helped create big cost savings, and helped patients feel empowered.

Advertisement 7

Article content

Other technologists and entrepreneurs have taken notice of recent trends in helping patients stay connected after surgery. The MyMobility app has been rolled out at Hoag Orthopedic Institute to allow patients to showcase their rehabilitation statistics (steps taken, amount of time spent in activity) so the care team can make further recommendations for follow-up care.

Technology is helping care teams to better align best practices with patients who may need extra support or experience hesitation at completing physical therapy at home with the added bonus that more frequent communication may help identity an opioid addiction, with more eyes and ears on care. However, patients must feel empowered to share that they are dependent on opioids, which often is kept silent due to a myriad of reasons.

Advertisement 8

Article content

Tackling opioid addictions after surgery

A 2018 report looked at opioid use after knee replacement surgery and found:

  • While the number of opioid pills prescribed is dropping from 85 pills to 82, surgeons often feel pressure to prescribe more opioids than they feel are necessary.
  • Patients were often prescribed more than double the 20 morphine milligram equivalents (MMEs) dose when many were given opioids of 50+ MMEs, which poses not only an overdose risk, but could lead to complications to the liver and body.
  • Most interesting, patients undergoing a knee replacement surgery reported an incidence of later dependence of 15.2% versus the overall average of 12%, (an increase from a rate of 9% of a 2017 study.)

With opioid addiction facing unprecedented scrutiny, doctors and rehabilitation specialists are not only looking to new technologies to combat a dependence on painkillers, but also demonstrating a want to understand new ways of treating ancient issues of pain.

Advertisement 9

Article content

Here’s the bottom line

Survey data indicates that the use of cannabis is common among patients with chronic pain[2] and patients who use it for this indication typically report it to be an effective treatment.[3] Majorities further report that cannabis possesses fewer side effects than conventional pain medications and that it provides greater symptom management than opioids.[4]” (NORML.org)

NORML, a national organization committed to revamping the U.S.’ marijuana believes in the power of cannabis in relieving pain and other organizations are starting to post their own guides for patients. The Arthritis Foundation, The Rheumatoid Arthritis Support Network, and many more organizations are starting to give their members new information on CBD and THC for pain. Even more, other studies are popping up from around the world, hoping to recruit individuals who are recovering from knee surgery to identify the benefits of THC and CBD in after-care.

Advertisement 10

Article content

If you’re readying for surgery, consider discussing CBD and THC with your medical practitioner and care team. Not only might the compounds play a role in decreasing a long-term dependence on opioids, but they may also provide other benefits as well.

TheFreshToast.com, a U.S. lifestyle site, that contributes lifestyle content and, with their partnership with 600,000 physicians via Skipta, medical marijuana information to The GrowthOp.

Want to keep up to date on what’s happening in the world of cannabis? Subscribe to the Cannabis Post newsletter for weekly insights into the industry, what insiders will be talking about and content from across the Postmedia Network.


As an increasing number of states begin to legalize marijuana for either medical or recreational use, it is important to determine its effects on joint arthroplasty. The purpose of this study is to determine the impact of cannabis use on total knee arthroplasty (TKA) revision incidence, revision causes, and time to revision by analyzing the Medicare database between 2005 and 2014. A retrospective review of the Medicare database for TKA, revision TKA, and causes was performed utilizing Current Procedural Terminology (CPT) and International Classification of Disease ninth revision codes (ICD-9). Patients who underwent TKA were cross-referenced for a history of cannabis use by querying ICD-9 codes 304.30–32 and 305.20–22. The resulting group was then longitudinally tracked postoperatively for revision TKA. Cause for revision, time to revision, and gender were also investigated. Our analysis returned 2, 718,023 TKAs and 247,112 (9.1%) revisions between 2005 and 2014. Cannabis use was prevalent in 18,875 (0.7%) of TKApatients with 2,419 (12.8%) revisions within the cannabis cohort. Revision incidence was significantly greater in patients who use cannabis (p < 0.001). Time to revision was also significantly decreased in patients who used cannabis, with increased 30- and 90-day revision incidence compared to the noncannabis group (P < 0.001). Infection was the most common cause of revision in both groups (33.5% nonusers versus 36.6% cannabis users). Cannabis use may result in decreasing implant survivorship and increasing the risk for revision within the 90-day global period compared to noncannabis users following primary TKA.


Substance misuse and dependence are a growing problem in the United States with approximately 8.1% of the population over the age of 12 being classified with substance use disorder in the past year. 1 Cannabis dependence has increased over time, reflected by a 22% increase in global burden since 1990, making it one of the most commonly used substances. 2 Smoking cannabis produces a wide array of psychotropic effects, as the plant contains multiple cannabinoids, of which delta-9-tetra hydrocannabinol (THC) is the most recognized, in addition to an estimated 340 additional chemical compounds. 3 Regular use has been associated with decreased pulmonary function and increased risk of anxiety, depression, and psychotic illness. 4–7

People utilize cannabis for the perception of euphoria, alterations in mood, and changes in the per ception of time and place. 8 Alternatively, negative side effects can also occur, such as dysphoria, anxiety, sedation, dizziness, and cross tolerance to other substances. 9,10 Therefore, in the perioperative setting, all aspects of cannabis use must be taken into account. Anecdotal reports detail high anesthetic requirements, and a recent study demonstrated an increase in Propofol doses required to achieve successful laryngeal mask insertion and intubation in cannabis users. 11 Although rare, case reports have described reports of coronary ischemia, myocardial infarction, pulmonary edema, and cerebral ischemia even in young adult cannabis users. 7,12

There is a paucity of literature describing the effects of cannabis use in patients undergoing joint arthroplasty. Multiple studies have described increased complication rates with drug misuse following hip and knee arthroplasty; however, such complications are characteristic of intravenous drug injection as opposed to inhalation or ingestion. 13–16 One study analyzing drug misuse in general describes increased surgery-related complications and longer hospital stays in substance abusing patients who undergo total hip and knee replacements. However, this study did not limit its analysis to cannabis use alone. 16 The purpose of the present study is to determine the effects of cannabis on total knee arthroplasty (TKA) revision incidence, revision causes, and time to revision by analyzing the Medicare database between 2005 and 2014.

II. Methods

A retrospective review of the Medicare database within the PearlDiver Supercomputer (Warsaw, IN) for TKA, cannabis use, revisions, and causes was performed. The PearlDiver database is a publicly available Health Insurance Portability and Accountability Act (HIPAA)-compliant national database compiled from a collection of Medicare records from 2005 to 2014. The database contains Current Procedural Terminology (CPT) and International Classification of Disease ninth revision codes (ICD-9).

Patients who underwent TKA were identified with CPT-27447 and ICD-9 81.54. These patients were then cross-referenced for a history of cannabis use by querying ICD-9 codes 304.30–32, and 305.20 – 22. The resulting patients were then longitudinally tracked postoperatively for TKA revision (TKAR) by CPT codes 27486 and 27487, and ICD-9 codes 00.80–00.84 and 81.55. Causes for revision were identified with ICD-9 codes 996.40 – 47, 996.49, 996.66–67, 996.77–78, 718.46, 718.56, and 718.86. These codes correspond with mechanical loosening, failure/break, periprosthetic fracture, osteolysis, infection, pain, arthrofibrosis, instability, and trauma, respectively. Time to revision and gender were also investigated.

Statistical analysis of this study was primarily descriptive. A Kaplan Meier Survival analysis was performed to determine significance of survival and time to revision. Statistical analysis was performed with SPSS Version 21 (IBM, Armonk, NY).


Our analysis returned 2,718,023 nonuser TKAs and 247,112 (9.1 %) revisions between 2005 and 2014. Cannabis use was prevalent in 18,875 TKA patients with 2,419 (12.8%) revisions within the cannabis cohort. A description of annual trends in the TKA revision rate between cannabis users compared to nonusers is found in Table 1 , which demonstrates a significantly higher revision incidence ratio in cannabis users (p < 0.001).