JOA - 2026-04-24 - Journal Article
Duration of Opioid Use Following Revision Total Knee Arthroplasty Varies Significantly with Reason for Revision.
Barton KI, Salimi M, Rosen NF, Behun MA, Dennis DA, Jennings JM
Topics
Key Takeaway
Revision TKA for periprosthetic femoral fracture required the longest duration of postoperative opioid use, while acute infection and stage-1 spacer implantation generated the highest in-hospital MME (>200 MME), with opioid pill count within 3 months varying significantly by revision etiology (P=0.0001).
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Summary
This study compared postoperative opioid consumption across revision TKA etiologies (arthrofibrosis, infection, instability, periprosthetic fracture, aseptic loosening) and against matched primary TKA controls, quantifying in-hospital MME, total MME, pills dispensed, and days to last opioid fill. Revision TKA patients had significantly higher in-hospital MME than primary TKA (P=0.003), but primary TKA patients had longer duration of outpatient opioid use (P=0.006). Periprosthetic femoral fracture carried the longest opioid duration, acute infection the highest inpatient MME (>200 MME), and revision etiology significantly predicted 3-month opioid pill count (P=0.0001).
Key Limitation
Retrospective single-center design without a standardized multimodal analgesia protocol means opioid prescribing reflects individual surgeon practice rather than a controlled pain management strategy, limiting generalizability.
Original Abstract
BACKGROUND
Few studies have evaluated postoperative opioid use after revision total knee arthroplasty (TKA), and no studies have assessed the reason for revision TKA (i.e., arthrofibrosis, infection, instability) with opioid use or stratified postoperative inpatient and outpatient opioid use. The primary objective of this study was to evaluate postoperative opioid use in revision TKA. The secondary objectives were to determine how the reason for revision TKA, type of revision TKA performed, history of opioid use, and medical comorbidities affect opioid use after surgery and understand differences in opioid use between primary TKA and revision TKA.
METHODS
There were 164 revision TKAs included in this study that were age- and sex-matched to a primary TKA control group. A retrospective review of revision TKA patients was conducted. Demographic information, nicotine use, and a history of opioid, antidepressant, benzodiazepine, and cannabis use were collected. The number of opioid pills prescribed, in-hospital morphine milligram equivalents (MME), and total MME were calculated. Also, the days between surgery and the last date the opioid was dispensed were collected. The reason for revision TKA and type of revision TKA performed were determined. Medical comorbidities were collected, and the Charleston Comorbidity Index (CCI) was calculated. Significance for all statistical tests was accepted at P ≤ 0.05.
RESULTS
Revision TKA patients had significantly higher in-hospital MME consumption 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 TKA patients (P = 0.006). A higher percentage of revision TKA patients used antidepressants 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 (greater than 200 MME). The number of opioids dispensed within three months postoperation varied significantly depending on the TKA revision reason (P = 0.0001). Also, the duration of opioid use postoperation also varied significantly with the revision TKA reason (P = 0.04), with periprosthetic femoral fracture having the highest mean number of days and requiring extended opioid use.
CONCLUSIONS
Revision TKA for arthrofibrosis and periprosthetic femoral fractures required more intensive pain management, likely due to postoperative stiffness and increased rehabilitation demand 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, aiming to optimize patient recovery and opioid use.