JOA - 2026-09-16 - Journal Article
Patients Undergoing Revision Total Knee Arthroplasty for Stiffness Have Similar Perioperative Pain Scores and Postoperative Opioid Consumption Compared to Patients Undergoing Revisions for Other Aseptic Indications.
Shin J, Driscoll DA, Selkridge I, Somerby H, Chalmers BP, Lee GC, Sculco PK
Topics
Key Takeaway
Revision TKA for stiffness produced similar 90-day opioid consumption (total MME 695 vs. 785, P=0.7) and pain scores compared to revision for aseptic loosening or instability, despite a significantly higher rate of preoperative opioid use in the stiffness cohort (15.4% vs. 5.7%, P=0.003).
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Summary
This study compared postoperative pain scores and opioid consumption between revision TKA patients revised for stiffness (n=162) versus aseptic loosening or instability (n=175) from 2018–2022 using phone surveys at 10, 28, and 90 days plus chart review for MME data. Despite higher preoperative opioid use in the stiffness group (15.4% vs. 5.7%, P=0.003), no significant differences were found in total MME (695 vs. 785, P=0.7), inpatient hourly MME (1.66 vs. 1.70, P=0.7), opioid refills (0.55 vs. 0.76, P=0.2), or 6-week pain scores (2.75 vs. 2.81, P=0.6). Overall opioid use rates declined from 84% at 10 days to 12% at 90 days with no between-group difference at any timepoint.
Key Limitation
The lower 90-day survey response rate in the stiffness cohort means the finding of equivalent late opioid use is not robust under worst-case non-responder analysis, making the 90-day equivalence conclusion unreliable.
Original Abstract
INTRODUCTION
Patients undergoing revision TKA (rTKA) for stiffness have inferior clinical outcomes compared to other aseptic indications, but whether they have higher or more prolonged opioid consumption is unclear. This study compared (1) postoperative pain scores, (2) 90-day postoperative opioid use, and (3) duration of opioid use in patients undergoing rTKA for stiffness versus aseptic indications.
METHODS
This study included 337 patients who underwent rTKA for stiffness (n = 162, 48.1%) or for aseptic loosening or instability (control; n = 175, 51.9%) from 2018 to 2022. Patients completed a phone survey at 10, 28, and 90 days postoperatively to assess pain and opioid use, and chart review was performed to collect demographic, pain, and Morphine Milligram Equivalents (MME) data. Stiffness and control rTKA groups were compared for each outcome using Chi-square or Student's t-tests.
RESULTS
Stiff rTKA patients had significantly higher rates of preoperative opioid usage than control patients (15.4 versus 5.7%, P = 0.003). Overall rates of opioid use were 84, 49, and 12% at 10, 28, and 90 days postoperative and did not differ between groups at any timepoint (P > 0.05). Both groups had similar pain scores at six weeks postoperatively (2.75 versus 2.81; P = 0.6), similar total MME (695.2 versus 785; P = 0.7), similar inpatient hourly MME consumption (1.66 versus 1.70; P = 0.7), and a similar number of opioid refills (0.55 versus 0.76; P = 0.2).
CONCLUSION
Patients undergoing rTKA for stiffness had similar MME, opioid refills, time to opioid discontinuation, and pain scores as control patients despite higher preoperative opioid use. Given the lower 90-day survey response rate in the stiffness cohort, these findings should be interpreted with caution, as similarity in 90-day use was not supported under the worst-case non-responder scenario. This information should help guide patient counseling and pain management expectations after rTKA for stiffness.