Perioperative ketorolac use following total ankle arthroplasty is associated with increased infection and revision...

Intravenous ketorolac is widely used for perioperative pain control in arthroplasty, but its impact on wound healing, infection, and implant outcomes after total ankle arthroplasty (TAA) remains unclear.

This study aims to compare the outcomes of patients that were given intravenous ketorolac on the day of surgery with patients who are not.

Retrospective cohort study using a large national database.

A retrospective analysis was performed using the TriNetX Research Network, identifying patients who underwent primary TAA. Patients who received intravenous ketorolac on the day of surgery were compared with those who did not and were matched 1:1 using propensity score matching with a caliper of 0.1. Outcomes were assessed at 90 days and 1 year.

Among all TAA patients, 10.4% received IV ketorolac. A total of 2,200 ketorolac patients were matched to 2,200 controls with balanced baseline characteristics (p > 0.05). At 90 days, ketorolac use was associated with higher rates of surgical site infection (5.10% vs 2.85%, RR 1.79, p = 0.0001), wound dehiscence (4.00% vs 1.98%, RR 2.02, p < 0.0001), and acute post-hemorrhagic anemia (5.00% vs 2.91%, RR 1.72, p = 0.0004). At 1 year, ketorolac recipients had higher rates of periprosthetic joint infection (4.89% vs 3.66%, RR 1.34, p = 0.0436) and revision surgery (2.74% vs 1.28%, RR 2.14, p = 0.0006).

Perioperative ketorolac exposure during TAA was associated with higher ninety-day and one-year complications. However, these findings should be interpreted cautiously given ketorolac's short half-life and limited exposure.