Retrospective Evaluation of Inpatient Celecoxib
Use After Total Hip and Knee Arthroplasty at a
Veterans Affairs Medical Center
Rashid Kazerooni, PharmD,*y Mark Bounthavong, PharmD,*y
Josephine N. Tran, PharmD, MS,*y Daniel T. Boggie, PharmD,z
and Robert Scott Meyer, MD§
Abstract: A retrospective cohort study (1.5 years) was performed to investigate the efficacy of
celecoxib vs non–celecoxib use in patient who underwent total knee arthroplasty (TKA) and total
hip arthroplasty (THA). Study time frame encompassed a pre and post period of a local policy
decision opening access to short-term celecoxib use after TKA/THA. Primary end point was the
amount of opioid use during their inpatient stay postprocedure. The TKA (n = 81) and THA (n =
60) groups were analyzed independently. Both celecoxib groups used significantly less opioids
during their inpatient stay vs noncelecoxib groups, given in oral morphine milligram equivalents
(TKA: 203 vs 337 mg, P = .002; THA: 214 vs 336 mg, P = .005). Other secondary outcome
measures showed that the celecoxib groups also reported reduction in pain scores, total as needed
(PRN) opioid doses, PRN opioid doses per day, average dose of PRN opioids, total PRN opioids, use
of intravenous opioids, and rehabilitation facility admissions (in the TKA group only). Linear
regression analysis showed a statistically significant inverse relationship between opioid
consumption and age. Short-term celecoxib use after TKA/THA may lead to a reduction in
overall opioid use and improved pain scores; however, further studies will be required to validate
the results of this study. Keywords: celecoxib, arthroplasty, postoperative pain, joint arthroplasty.
Published by Elsevier Inc.
Postoperative pain control has been an area of great
interest, as evidenced by the recently accepted standard
that pain control is considered a vital sign monitor .It
is integral not only from a quality of life perspective for
patients but also from a clinical standpoint, as it can
have an inﬂuence in surgical outcomes . Adequate
pain control has been shown to improve clinical
outcomes after surgery ; moreover, current evidences
demonstrate that opioids, nerve block, and anesthesia
are effective at postoperative pain control. New litera-
ture support for a multimodal strategy for pain control
has started to gain acceptance by the practicing
community [4-7]. However, there is a paucity of data
to support celecoxib use as part of the multimodal
strategy for pain control.
The activation of the cyclooxygenase inﬂammatory
pathway and subsequent prostaglandin synthesis is a
part of the body's response to surgical trauma . These
prostaglandins activate peripheral nociceptors, leading to
central sensitization of pain symptoms. Mechanistically,
this provides a foundation for using nonsteroidal anti-
inﬂammatory drugs (NSAIDs) as good candidates for
adjunctive treatment of pain control postoperatively by
controlling the inﬂammatory response [9,10]. Nonste-
roidal anti-inﬂammatory drugs are typically used syner-
gistically with opioids and have been reported to
decrease pain scores postoperatively as well decrease
opioid consumption [11-23]. The reduction in opioid use
provides clinical beneﬁt for patients who receive THA/
TKA surgeries because they are heavily opioid tolerant
From the *Pharmacoeconomics and Formulary Management, Veterans
Affairs San Diego Healthcare System, San Diego, California;
School of Pharmacy and Pharmaceutical Sciences, San Diego, California;
Pharmacy Information Technology Application Coordination, Veterans
Affairs San Diego Healthcare, System, San Diego, California; and
Department of Orthopedics, Veterans Affairs San Diego Healthcare System,
San Diego, California.
Submitted June 9, 2011; accepted January 20, 2012.
The Conflict of Interest statement associated with this article can be
found at doi:10.1016/j.arth.2012.01.020.
All authors participated in the research, have read the manuscript,
and agree with its contents. Article has not been submitted elsewhere.
Institutional review board approval was received for this study. There
are no relevant financial interests to report. This study was unfunded.
Reprint requests: Rashid Kazerooni, PharmD, BCPS, Veterans
Affairs San Diego Healthcare System, 3350 La Jolla Village Drive
(119), San Diego, CA 92161.
Published by Elsevier Inc.
The Journal of Arthroplasty Vol. 27 No. 6 2012