Introduction: A small, yet not uncommon, problem following total joint arthroplasty (TJA) is post-operative ileus (POI). The purpose of this study was two-fold. First the study sought to determine the incidence of POI after TJA in a consecutive series of patients receiving regional anesthesia and an aggressive postoperative rehabilitation protocol. Second, the influence of narcotic medications, including intrathecal medications, in the incidence of POI was examined.

Methods: 5,262 patients underwent total joint replacements, including primary and revision surgery, at our institution from 2004 to 2005. All surgeries were performed at a university-affiliated institution where complications, if any, are prospectively recorded in a comprehensive database. Demographic, clinical, surgical, and radiographic details were obtained and examined.

Results: 26 (0.5%) patients developed ileus. There were 17 males and 9 female patients, who had a mean age of 67.7 years (range, 52.7 to 91.2 years). The mean BMI was 30.2 kg/m2. The index procedures included 15 primary hip, 4 primary knee, 4 revision hip, and 3 revision knee procedures. Of the patients who developed ileus, intrathecal narcotics were administered in 16 patients (62%).

Discussion: There is a very low incidence of postoperative ileus and gastrointenstinal hypomobility following joint arthroplasty. Early patient ambulation, a reduction in the use of postoperative narcotics, supplementation of analgesia with non-narcotic drugs, and reduced length of hospital stay may all have an important role in reducing this complication. Based on our findings, it seems unlikely that intrathecal narcotics have an adverse effect on gastrointestinal motility.