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A qualitative study to develop materials educating patients about opioid use before and after total hip or total knee arthroplasty

David H. Smith, PhD, RPh, Jennifer Kuntz, PhD, Lynn DeBar, PhD, Jill Mesa, Xiuhai Yang, MS, David Boardman, MD, Jennifer Schneider, MPH


Objective: The authors undertook a qualitative study with open-ended, structured interviews to understand patient's educational needs for patients undergoing total hip and total knee arthroplasty (THA/TKA).

Design: Provider interviews explored their approach with THA/TKA patients on: pain management; barriers to opioid tapering; and recommendations/changes on educational materials to support pain management and opioid reduction. Patient interviews explored their experience, understanding, beliefs surrounding opioids, and recommendations on important content. A qualitative methodologist conducted interviews and content analysis to identify key themes.

Setting: Kaiser Permanente Northwest, community setting.

Patients, Participants: A purposeful sampling method identified interviewees (surgeons, advice nurses, physical therapists, physician assistants, and patients). Patients were recent THA/TKA cases in the top third of opioid use after surgery.

Interventions: N/A.

Main Outcome Measure(s): Qualitative study.

Results: Recommendations for patient educational content included: (1) clear descriptions of how opioids work in the body, how to taper, nonopioid pain management options, and problems from overuse; (2) messaging on how long to expect to use opioids and type of pain to expect; (3) visual timeline to illustrate opioid tapering and exercise expectations; (4) emphasize that pain management is multimodal, and stress the balance between opioids for recovery versus overuse; (5) provide educational messaging multiple times prior to and after surgery.

Conclusions: Patients and providers agreed that clearly stated verbal and written messaging is needed beyond what has typically been done regarding opioid expectations.


opioids, total hip arthroplasty, total knee arthroplasty

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