Cannabis Users Need More Opioids and Have More ER Visits After Joint Replacement | Research

The takeaway

Cannabis users who had hip or knee replacement needed more opioids (91-93% vs. 86-89%), visited the ER more often, and hip replacement patients had double the risk of implant loosening at 2 years.

Patients planning joint replacement who use cannabis, orthopedic surgeons, anesthesiologists, and pain management teams.

What the researchers found

Cannabis users had significantly higher 90-day ED visits (THA: 16.1% vs. 12.6%, p=.006; TKA: 13.1% vs. 9.9%, p=.008) and opioid use (THA: 91.8% vs. 86.4%, p<.001; TKA: 92.8% vs. 88.6%, p<.001). At 2 years, THA patients had higher aseptic loosening (1.9% vs. 0.9%, p=.030). Major complications and revision rates were similar.

Why it matters

Joint replacement is one of the most common surgeries, and cannabis use is increasing. The finding that cannabis users need more opioids — not less — contradicts the hypothesis that cannabis could replace opioids for post-surgical pain. The hip implant loosening finding also warrants attention.

The numbers in context

THA: 1,504 per group. TKA: 1,354 per group. 90-day ED visits THA: 16.1% vs. 12.6%. Opioid use THA: 91.8% vs. 86.4%. TKA opioid: 92.8% vs. 88.6%. 2-year aseptic loosening THA: 1.9% vs. 0.9% (p=.030). TKA loosening, infection, revision: NS.

How the study worked

Retrospective cohort using national database. Cannabis users 1:1 propensity-matched to non-users: 1,504 THA and 1,354 TKA patients per group. Outcomes: 90-day ED visits, hospitalizations, opioid use, and 2-year orthopaedic complications.

What this study cannot tell us

ICD-10 coding likely underestimates cannabis use. Propensity matching can't capture all confounders. Cannabis users may have different pain thresholds or reporting behaviors. Small absolute differences in some outcomes.

How to read the evidence

Large propensity-matched cohort with 2-year follow-up — methodologically strong for database research.

When this study was published

Published in 2026, addressing a practical clinical question as cannabis use rises among arthroplasty candidates.

The bigger picture

The higher opioid use in cannabis users may reflect tolerance (cross-tolerance between cannabinoid and opioid systems) or simply more pain. Either way, it challenges the popular narrative that cannabis reduces post-surgical opioid needs and suggests surgeons should prepare for potentially higher pain management demands.

Questions still open

Does preoperative cannabis cessation improve arthroplasty outcomes? Is the opioid finding due to tolerance or more severe pain? Should cannabis users receive modified pain management protocols?

Common questions

Should I stop using cannabis before joint replacement?

This study found cannabis users needed more opioids (not fewer) after surgery, visited the ER more, and hip replacement patients had double the implant loosening risk. Discuss your cannabis use with your surgeon for personalized advice.

Can cannabis replace opioids after joint replacement?

This data doesn't support that — cannabis users actually used more opioids post-surgery than non-users. This may be due to tolerance effects or cannabis users having more baseline pain.

Read the original research

Impact of preoperative cannabis use on short and mid-term postoperative outcomes following total hip and knee arthroplasty.

Journal of orthopaedics, 73, 50-54

View on PubMed ↗Publisher’s paper ↗

Citation

Fuller, Zachary; Lingam, Shriyaus; Chopra, Avani; Thomas, Jeremiah; Urias, Jorden; Abdo, Zuhdi E. (2026). Impact of preoperative cannabis use on short and mid-term postoperative outcomes following total hip and knee arthroplasty.. Journal of orthopaedics, 73, 50-54. https://doi.org/10.1016/j.jor.2025.12.006