Higher Perioperative Opioid Use Is Associated With Reduced Early Ambulation Following Total Hip and Knee Arthroplasty

Although opioids remain a cornerstone of pain management in total hip (THA) and knee arthroplasty (TKA), they are associated with adverse effects that may impair postoperative recovery. This study assessed whether perioperative opioid use correlates with early postoperative ambulation and length of stay (LOS) in patients undergoing THA and TKA.

A retrospective review of 456 THA and 485 TKA opioid-naive patients from 2020 to 2022 was conducted. Demographic, surgical, and opioid usage data, measured in morphine milligram equivalents (MMEs), were collected. Ambulation distance, LOS, and PT performance on postoperative day (POD) 0 were recorded. Descriptive statistics summarized patient characteristics, and subgroup analyses examined ambulation by demographic factors. Correlation and multivariate regression analyses were done to adjust for age, sex, and surgical approach.

In 456 THA patients, mean MME was 66.2 ± 28.6, whereas in 485 TKA patients, mean MME was 59.5 ± 27.7. A weak negative correlation was observed between MMEs and ambulation in both THA and TKA groups (r = -0.06, P = 0.250 and r = -0.10, P = 0.060, respectively). Each additional 1 MME consumed reduced a patient's ambulation distance by 3 feet (P = 0.030 for THA, P = 0.003 for TKA). For both THA and TKA cohorts, total MME did not predict LOS (P = 0.899 for THA, P = 0.639 for TKA), but age was found to be an independent predictor of LOS (P < 0.001 for THA, P = 0.004 for TKA).

Increased perioperative opioid use is associated with decreased early ambulation. More judicious and individualized opioid protocols may improve outcomes and support early discharge in arthroplasty.

III (Therapeutic).