Opioid Consumption Trends in Resurfaced versus Unresurfaced Patellae in Total Knee Arthroplasty

Patellar resurfacing in total knee arthroplasty (TKA) is a highly debated topic, with equivocal results. While past literature has investigated pain, functional outcomes, and the cost of resurfaced versus unresurfaced patellae, examining opioid consumption is critical in the wake of the opioid epidemic. We sought to compare postoperative opioid consumption in patients who did and did not undergo patellar resurfacing in primary TKA.

This was a retrospective review of primary TKAs between 2018 and 2022 performed at a single high-volume institution with arthroplasty surgeons who practiced either selective or universal patellar resurfacing. Preoperative sunrise radiographs were reviewed to assess the severity of patellofemoral arthritis using the Iwano classification. Opioid prescription data were obtained from the Prescription Drug Monitoring Program and converted to morphine milligram equivalents (MMEs). Primary outcomes included total MME consumption and prescriptions filled. Secondary outcomes included length of stay, readmission, and patient-reported outcome measures. Of the 982 knees included, 447 were unresurfaced and 535 were resurfaced. There was a greater proportion of men in the unresurfaced versus the resurfaced group (52.8 versus 33.1%; P < 0.001); however, there was no difference in age (67.2 versus 67.7; P = 0.431).

For the first 30 days postoperatively, the resurfaced group had a greater average MME consumption than the unresurfaced group (705 versus 551 MME, respectively [P < 0.001]). The resurfaced group also filled more prescriptions during this period (2.56 versus 2.09 [P < 0.001]). The percentage of patients who met the minimal clinically important difference (MCID) for the Knee Osteoarthritis and Outcome Score for Joint Replacement was equivalent.

Patients who had resurfaced patellae had a greater opioid consumption in the first 30 days postoperatively compared to those who had unresurfaced patellae. Surgeons should be cognizant that patellar resurfacing in the setting of limited patellar arthritis may influence postoperative opioid consumption.