Total knee arthroplasty is associated with greater immediate post-surgical pain and opioid use than total hip arthroplasty.
Archives of orthopaedic and traumatic surgery
BACKGROUND: As greater emphasis is being placed on opioid reduction strategies and implementation of multimodal analgesia, we sought to determine whether immediate post-surgical opioid consumption was different between THA and TKA.
METHODS: A single-institution total joint arthroplasty database was used to identify patients who underwent elective THA and TKA from 2016 to July 2019. Baseline demographic data, operative time (defined by incision time), and American Society of Anesthesiologist (ASA) class were collected. Morphine milligram equivalents (MME) were calculated and derived from prospectively documented nursing opioid administration events, while visual analog scale (VAS) scores represented pain levels, both of which were collected as part of our institution's standard protocols. Activity Measure for Post-Acute Care (AMPAC) was used to determine physical therapy progress.
RESULTS: A total of 11,693 cases were identified: 5,909 THA (50.53%) and 5784 (49.47%) TKA. THA patients tended to be slightly younger (63.38 years, SD 11.61 years, vs 65.72 years, SD 9.56 years; p < 0.01) and have lower BMIs (28.92 kg/m2 vs 32.52 kg/m2; p < 0.01). THA patients had lower ASA scores in comparison to TKA patients (p < 0.01). Aggregate opioid consumption (93.76 MME vs 147.55 MME; p < 0.01) along with first 24-h and 48-h usage was significantly less for THA as compared to TKA. Similarly, mean pain scores (4.15 vs 5.08; p < 0.01) were lower for THA, while AMPAC mobilization scores were higher (20.88 vs 19.29; p < 0.01) when compared to TKA.
CONCLUSION: THA patients reported lower pain scores and were found to require less opioid medication in the immediate post-surgical period than TKA patients.
Kugelman DN, Mahure SA, Feng JE, Rozell JC, Schwarzkopf R, Long WJ. Total knee arthroplasty is associated with greater immediate post-surgical pain and opioid use than total hip arthroplasty. Arch Orthop Trauma Surg. 2021 May 15. doi: 10.1007/s00402-021-03951-8. Epub ahead of print. PMID: 33991234.