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Freedom From Opioids After Total Knee Arthroplasty
Alfred C Kuo1, Karthik Raghunathan2, Alain M Lartigue3
1Department of Orthopaedic Surgery, University of California, San Francisco, CA; Orthopaedic Section, San Francisco Veterans Affairs Medical Center, San Francisco, CA.
The Journal of Arthroplasty
|February 20, 2019
Summary
Total knee arthroplasty (TKA) increases the likelihood of patients becoming opioid-free after surgery. Preoperative opioid use patterns, not patient factors, significantly influence long-term opioid freedom post-TKA.
Area of Science:
- Orthopedic Surgery
- Pain Management
- Pharmacology
Background:
- Opioids are frequently prescribed for knee pain following total knee arthroplasty (TKA) in the US.
- A significant number of patients experience chronic pain and persistent opioid use after TKA.
- Understanding the impact of TKA on opioid consumption patterns is crucial.
Purpose of the Study:
- To determine the population-level effect of TKA on opioid consumption.
- To detail opioid prescription patterns before and after TKA.
- To identify factors associated with achieving opioid freedom post-TKA.
Main Methods:
- Retrospective cohort study of 33,927 US Veterans Health Administration TKA patients (2010-2015).
- Analysis of outpatient opioid prescriptions from 18 months pre- to 18 months post-surgery.
- Definition of opioid freedom as ≥6 months without opioid prescriptions.
Main Results:
- 41% of patients were opioid-free preoperatively versus 54% at 18 months post-TKA (P < .001).
- Preoperative opioid freedom was a strong predictor (OR 4.59) of postoperative opioid freedom.
- Patient medical and social factors were less influential than preoperative opioid status.
Conclusions:
- Total knee arthroplasty is associated with improved postoperative opioid freedom.
- Opioid prescription patterns, particularly low preoperative use, are key drivers of long-term opioid use after TKA.
- Interventions targeting preoperative opioid use may enhance post-TKA recovery.
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