Opioids remain widely used after hip and knee arthroplasty, but the evidence behind their short-term benefits and harms is surprisingly thin. Across ten small randomized trials spanning several decades, oral opioids such as tramadol, morphine, and oxycodone offered only modest reductions in postoperative pain—improvements that were statistically significant but fell short of meaningful clinical thresholds. At the same time, opioids carried a noticeably higher risk of nausea, dizziness, and itching, even over just a few days of use. Longer-term outcomes, including dependency, remain largely untested in randomized studies despite growing concern about persistent opioid prescribing after joint replacement. The overall picture underscores a clear gap: better trials with longer follow-up are urgently needed to define how opioids should be used—how much, how long, and for whom—to balance pain control with safety.