Opioid Use After Total Knee Arthroplasty: Does Tramadol Have Lower Risk Than Traditional Opioids?

Preoperative opioid use has been shown to increase postoperative opioid use following total knee arthroplasty (TKA). Tramadol is recommended for symptomatic treatment of osteoarthritis; however, it acts on opioid receptors and may confer similar adverse effects. The purpose of this study is to assess postoperative opioid use with preoperative opioid and tramadol use.

Patients undergoing primary TKA were identified in the Humana administrative claims database. Patients were stratified by whether they filled a prescription for an opioid, tramadol, either, or neither within 3 months of TKA. Prescription claims were tracked for 12 months postoperatively and relative risk for each group was calculated.

In total, 107,973 patients undergoing TKA were identified. Preoperatively, 29,890 (27.7%) patients filled a prescription for opioids, 8049 (7.5%) for tramadol, 44,403 (41.1%) for tramadol or opioids, and 63,570 (58.9%) did not fill a prescription for either. At 12 months postoperatively, an opioid prescription was filled by 6.0% of preoperative narcotic-free patients, 35.2% opioid users (relative risk [RR] 5.83 [5.63-6.03]), 9.2% tramadol users (RR 1.52 [1.40-1.63]), and 29.5% opioid or tramadol users (RR 4.88 [4.72-5.05]). Opioid or tramadol prescriptions were filled by 7.7% of preoperative narcotic-free patients, 37.3% opioid users (RR 4.84 [4.70-4.99]), 26.2% tramadol users (RR 3.40 [3.26-3.57]), and 35.7% opioid or tramadol users (RR 4.64 [4.50-4.78]) at 12 months.

Patients taking tramadol preoperatively were found to be at lower risk for prolonged postoperative opioid use following TKA. Patients taking either narcotics preoperatively continued use of these medications at a higher rate than those who were not.