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Inpatient and outpatient opioid requirements after total joint replacement are strongly influenced by patient and

Austin J Roebke1, Garrhett G Via2, Joshua S Everhart3

  • 1Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.

Bone & Joint Open
|November 20, 2020
PubMed

Insights

Total knee arthroplasty (TKA) patients require more opioids post-surgery than total hip arthroplasty (THA) patients. Surgical factors and patient characteristics, not anesthesia or non-opioid drugs, predict opioid needs after joint replacement.

Area of Science:

  • Orthopedic Surgery
  • Pain Management
  • Pharmacology

Background:

  • Comprehensive national guidelines for analgesic strategies after total joint replacement are lacking.
  • Understanding opioid requirements after total hip arthroplasty (THA) and total knee arthroplasty (TKA) is crucial for optimizing patient care.
  • Identifying risk factors for increased inpatient and outpatient opioid use is essential for developing targeted pain management protocols.

Purpose of the Study:

  • To compare inpatient and outpatient opioid requirements following THA versus TKA.
  • To identify risk factors influencing opioid consumption after total hip or knee arthroplasty.
  • To evaluate the impact of regional nerve blocks (RNB), neuraxial anesthesia (NA), and non-opioid medications on opioid demand.

Main Methods:

  • Analysis of outcomes in 92 primary THA (n=43) and TKA (n=49) patients, excluding those with repeat surgery within 90 days.
  • Recording of inpatient and 90-day postoperative opioid use, including total consumption, refills, and use beyond 90 days.
  • Multivariate modeling to assess the influence of surgery type, anesthesia, non-opioid medications, demographics, length of stay, and baseline opioid use.

Main Results:

  • TKA patients exhibited significantly higher daily inpatient opioid use (median 12.0 vs 7.0) and greater 90-day use (median 224.0 vs 100.5) compared to THA patients.
  • TKA patients were more likely to require opioid refills (84% vs 33%) and had a higher risk of use beyond 90 days (adjusted OR 7.64).
  • Inpatient opioid use 24 hours before discharge was the strongest predictor of 90-day opioid use; surgical procedure, demographics, and baseline use were more influential than anesthesia or non-opioid analgesics.

Conclusions:

  • Opioid use following TKA and THA is primarily predicted by surgical and patient-specific factors.
  • Total knee arthroplasty is associated with substantially higher postoperative opioid requirements than total hip arthroplasty.
  • Regional nerve blocks, neuraxial anesthesia, and common non-opioid medications did not significantly reduce total inpatient or 90-day postoperative opioid consumption.
Abstract

Keywords:
multimodal analgesiaopioidpostoperative opioid requirementspostoperative pain controlregional anesthesiaspinal anesthesiatotal hip arthroplastytotal joint arthroplastytotal joint replacementtotal knee arthroplasty

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