Factors associated with persistent opioid use 6-12 months after primary total knee arthroplasty

Area of Science:

• Orthopedic Surgery
• Pain Management
• Pharmacology

Background:

• Persistent pain affects up to 20% of patients post-knee arthroplasty, often necessitating ongoing opioid analgesia.
• Pre-operative opioid use is a significant factor in managing post-surgical pain.
• Enhanced recovery programs aim to standardize patient care and outcomes.

Purpose of the Study:

• To analyze predictors of persistent opioid use and quantify opioid consumption up to 12 months after knee arthroplasty.
• To identify patient characteristics associated with increased opioid dosage and duration post-surgery.

Main Methods:

• Secondary analysis of data from 242 patients undergoing unilateral knee arthroplasty.
• Evaluation of opioid prescriptions (oral morphine equivalents) for 12 months pre- and post-surgery.
• Collection of demographic, functional, psychological data, quantitative sensory testing, and genetic analysis.

Main Results:

• 49% of patients had pre-operative opioid prescriptions; 27% filled prescriptions ≥6 months post-surgery.
• Persistent opioid use ≥6 months was strongly associated with pre-operative opioid use (RR 3.2).
• Predictors of higher post-operative opioid dose included pre-operative dose, higher BMI, and multiple comorbid pain sites.

Conclusions:

• Pre-operative opioid use, higher BMI, and comorbid pain sites are key risk factors for persistent opioid use post-knee arthroplasty.
• Persistent opioid use was not linked to WOMAC scores, quantitative sensory testing, or psychological distress.
• Development of strategies to limit opioid dose and duration is crucial for patients undergoing knee arthroplasty.