Efficacy of NSAID Transdermal Patch for Postoperative Management in Total Knee Arthroplasty

Background: While topical NSAID patches are effective in non-surgical knee conditions, their efficacy following total knee arthroplasty (TKA) remains understudied. The intention behind this study was the comparison of pain and functional score between esflurbiprofen and placebo patches for postoperative pain control after TKA. Methods: A triple-blinded randomized controlled trial was conducted among patients aged 55-80 years with primary knee osteoarthritis. Patients who had an allergy to study medications, had chronic kidney disease, had diabetes, used steroids, were unsuitable for spinal and subsartorial block, or were unwilling to participate were excluded. All eligible participants were randomized and assigned to either esflurbiprofen 40 mg transdermal patch or placebo patch starting from postoperative day 3 to 16 blindly and followed up for 3 months. Outcome assessment was a visual analog scale (VAS), morphine use, minimum daily VAS, time to minimum VAS, knee osteoarthritis outcome score, joint replacement (KOOS, JR), knee circumference, flexion angle, and adverse events. Results: Seventy patients underwent primary TKA (n = 35 each group). The average age and body mass index were 67.5 ± 13.7 years and 26.8 ± 4.5 kg/m². There was no statistically significant difference in baseline characteristics between the two groups. When compared with the placebo group, the esflurbiprofen group presented statistically significantly diminished VAS scores after day 7 and morphine use at day 3 (p < 0.001), as well as subsequently enhanced KOOS scores at 6 weeks and 3 months (p < 0.001). No statistically significant difference between groups was found in terms of knee circumference, flexion angle, or time to minimum VAS (p > 0.05 for all). One patient in the esflurbiprofen group (2.86%) reported a mild skin reaction. Conclusions: Esflurbiprofen patches significantly reduce postoperative pain and improve short-term function after TKA without major complications.