Cannabis Users Need More Opioids and Have More ER Visits After Joint Replacement
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.
Quick Facts
What This Study 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.
Key Numbers
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 They Did This
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.
Why This Research 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 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.
What This Study Doesn't 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.
Questions This Raises
- ?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?
Trust & Context
- Key Stat:
- Evidence Grade:
- Large propensity-matched cohort with 2-year follow-up — methodologically strong for database research.
- Study Age:
- Published in 2026, addressing a practical clinical question as cannabis use rises among arthroplasty candidates.
- Original Title:
- Impact of preoperative cannabis use on short and mid-term postoperative outcomes following total hip and knee arthroplasty.
- Published In:
- Journal of orthopaedics, 73, 50-54 (2026)
- Authors:
- Fuller, Zachary, Lingam, Shriyaus, Chopra, Avani, Thomas, Jeremiah, Urias, Jorden, Abdo, Zuhdi E
- Database ID:
- RTHC-08269
Evidence Hierarchy
Looks back at existing records to find patterns.
What do these levels mean? →Frequently Asked 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.
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Cite This Study
https://rethinkthc.com/research/RTHC-08269APA
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
MLA
Fuller, Zachary, et al. "Impact of preoperative cannabis use on short and mid-term postoperative outcomes following total hip and knee arthroplasty.." Journal of orthopaedics, 2026. https://doi.org/10.1016/j.jor.2025.12.006
RethinkTHC
RethinkTHC Research Database. "Impact of preoperative cannabis use on short and mid-term po..." RTHC-08269. Retrieved from https://rethinkthc.com/research/fuller-2026-impact-of-preoperative-cannabis
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.