Use of Tetrahydrocannabinol and Cannabidiol Products in the Perioperative Period Around Primary Unilateral Total Hip and Knee Arthroplasty

abstract Introduction Given the opioid crisis in America, patients are trying alternative medications including Tetrahydrocannabinol (THC) and other Cannabidiol (CBD) containing products in the perioperative period, especially in states where these products are legal. This study sought to analyze usage rates of CBD/THC products in the perioperative period for primary unilateral total hip and knee arthroplasty (THA/TKA) patients and identify a possible association with postoperative opioid use. Methods A prospective cohort of primary unilateral THA/TKA patients were enrolled at a single institution. Patients who completed detailed pain journals were retrospectively surveyed for CBD/THC product usage. Pain medications were converted to morphine milligram equivalents (MME). Results Data from 195 of the 210 patients (92.9% response rate) following primary arthroplasty were analyzed. Overall 16.4% of arthroplasty (22.6%(n=19) of TKA and 11.7%(n=13) of THA) patients used CBD/THC products in the perioperative period. There was a wide variety of usage patterns among those using CBD/THC products. In comparing CBD/THC users and non-users, there was no significant difference in the length of narcotic use, total MME taken, narcotic pills taken, average postop pain scores, the percentage of patients requiring a refill of narcotics, or length of stay. Conclusion Understanding that CBD/THC usage was not consistent for patients who used these products, 22.6% of TKA and 11.7% of THA patients tried CBD/THC products in the perioperative period. In this small sample, CBD/THC use was not associated with a major effect on narcotic requirements. Further studies on the effects of CBD/THC are needed as these therapies become more widely available. Level of Evidence Therapeutic Level IV. Summary 22.6% of primary unilateral TKA patients and 11.7% of THA patients are trying THC/CBD products in the perioperative period, but THC/CBD use was not associated with a major effect on narcotic requirements.