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Published on: September 7, 2022
Old Versus New: A Historical Comparison of Anaesthesia Trends for Total Knee Arthroplasty and Patient Outcomes
Brigid Brown1,2, Maxim Nagorny1,2, Joseph Jang1,2
1Department of Anaesthesia and Pain Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia, flinders.sa.gov.au.
Purpose:
Total knee arthroplasty (TKA) is a widely performed procedure for end-stage knee osteoarthritis, with anaesthesia techniques evolving significantly in recent decades. This retrospective study examines trends in anaesthetic practice and postoperative outcomes at an Australian tertiary hospital network, using Acute Pain Service (APS) data from two distinct time periods (1999-2004 and 2018-2022).
Methods:
Elective TKA patients enrolled in the acute pain service database from January 1999 to December 2004 (Cohort 1) and January 2018 to December 2022 (Cohort 2) were included. Baseline demographics and anaesthetic practices were compared descriptively. Postoperative outcomes were analysed using mixed-effects regression models adjusted for demographic and perioperative factors, with hospital included as a random effect. Outcomes included invasive pain management strategies, opioid consumption, pain scores, time to mobilisation, APS review duration and length of hospital stay.
Results:
A total of 1273 patients were included (150 in Cohort 1 and 1123 in Cohort 2). Use of spinal anaesthesia increased significantly in Cohort 2 compared with Cohort 1 (96.4% versus 24.0%, p < 0.001), as did the adoption of regional anaesthesia techniques (74.3% versus 1.3%, p < 0.001). After adjustment, patients in Cohort 2 had significantly lower odds of requiring invasive pain management strategies (OR: 0.02 and 95% CI: 0.00-0.09; p < 0.001), mobilised earlier (β: -0.39 days, p = 0.009), required fewer days of APS review (β: -0.59 days, p < 0.001) and had shorter hospital stays (β: -2.44 days, p = 0.001). However, postoperative day one opioid consumption was higher in Cohort 2 (β: 55.19 mg oral morphine equivalents, p < 0.001), and movement-related pain scores were modestly increased (β: 1.00, p = 0.02). Resting pain scores and opioid-related side effects were comparable between cohorts.
Conclusions:
Over two decades, anaesthetic practice for TKA has shifted substantially toward neuraxial and motor-sparing regional techniques. These changes were independently associated with earlier mobilisation, reduced reliance on invasive pain strategies and shorter hospitalisation, despite higher early postoperative opioid use. The findings reflect evolving international practice patterns and highlight the importance of ongoing evaluation of perioperative care pathways.
