From surgical backlog to opioid burden : the case for opioid stewardship in arthroplasty pathways

The prolonged waiting times for hip and knee arthroplasty have resulted in numerous negative effects for patients being reported, with none more important than increasing opioid reliance due to chronic musculoskeletal pain. Opioid use prior to surgery is a factor associated with prolonged use postoperatively, and while opioids remain a valuable resource in the management of acute surgical pain, ongoing use carries substantial clinical, psychological, and societal risks. Recent Medicines and Healthcare products Regulatory Agency (MHRA) guidance and the 2024 UK consensus statement have resulted in a shift for perioperative pain management, moving away from routine modified release opioid use towards individualized care. To address these issues and changes, interventions need to be focused both preoperatively and postoperatively using improved risk stratification, patient education, and community engagement. This annotation discusses these issues and emphasizes the importance of opioid stewardship as a unifying framework to embed principles across the arthroplasty pathway, with the aims of reducing harm, improving outcomes, and supporting safer sustainable care.