Duration of Opioid Use Following Revision Total Knee Arthroplasty Varies Significantly With Reason for Revision

Few studies have evaluated postoperative opioid use after revision total knee arthroplasty (TKA). The primary objective of this study was to evaluate postoperative opioid (in-hospital and outpatient) use in revision TKA.

A retrospective review of 164 revision TKA patients that were age- and sex-matched to a primary TKA control group was conducted. The number of opioids prescribed, in-hospital morphine milligram equivalents (MME), total MME, and days between surgery and last date an opioid was dispensed were collected and calculated. Reason for revision TKA and type of revision TKA performed were determined. Medical comorbidities were collected and the Charlson Comorbidity Index (CCI) was calculated. Significance for all statistical tests was accepted at P ≤ 0.05.

Revision TKA patients had significantly higher in-hospital MME compared to primary TKA patients (P = 0.003). Primary TKA patients had a longer duration between surgery and the last date an opioid was dispensed versus revision patients (P = 0.006). A higher percentage of revision TKA patients used anti-depressants and benzodiazepines compared to primary TKA patients (P = 0.036 and P = 0.003, respectively). Acute infection and infection stage 1 spacer implantation demonstrated the highest in-hospital MME (> 200 MME). The number of opioids sold within three months post-operation and the duration of opioid use post-surgery varied significantly depending on the revision reason (P = 0.0001 and P = 0.04). Periprosthetic femur fracture had the highest mean days and required extended opioid use.

Revision TKA for arthrofibrosis and periprosthetic femur fractures required more intensive pain management, likely due to post-operative stiffness and increased rehabilitation demands for arthrofibrosis patients and fracture-related pain and weight-bearing restrictions for periprosthetic fracture patients, respectively. This information can help tailor postoperative pain management strategies based on the etiology of revision, to optimize patient recovery and opioid use.