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Total knee arthroplasty is associated with greater immediate post-surgical pain and opioid use than total hip arthroplasty

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

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.

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References

  1. Lawrence RC, Felson DT, Helmick CG, Arnold LM, Choi H, Deyo RA et al (2008) Estimates of the prevalence of arthritis and other rheumatic conditions in the United States: Part II. Arthritis Rheum 58(1):26–35

    Article  Google Scholar 

  2. Neogi T (2013) The epidemiology and impact of pain in osteoarthritis. Osteoarthr Cartil 21(9):1145–1153

    Article  CAS  Google Scholar 

  3. Kurtz S, Mowat F, Ong K, Chan N, Lau E, Halpern M (2005) Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002. JBJS 87(7):1487–1497

    Google Scholar 

  4. Bachmeier CJ, March LM, Cross MJ, Lapsley HM, Tribe KL, Courtenay BG et al (2001) A comparison of outcomes in osteoarthritis patients undergoing total hip and knee replacement surgery. Osteoarthr Cartil 9(2):137–146

    Article  CAS  Google Scholar 

  5. Hamel MB, Toth M, Legedza A, Rosen MP (2008) Joint replacement surgery in elderly patients with severe osteoarthritis of the hip or knee. Arch Intern Med 168:1430–1440

    Article  Google Scholar 

  6. Mahomed NN, Barrett JA, Katz JN et al (2003) Rates and outcomes of primary and revision total hip replacement in the United States medicare population. J Bone Joint Surg Am 85-A(1):27–32

    Article  Google Scholar 

  7. Aarons H, Hall G, Hughes S, Salmon P (1996) Short-term recovery from hip and knee arthroplasty. J Bone Joint Surg [Br] 78:555–558

    Article  CAS  Google Scholar 

  8. Fortin PR, Clarke AE, Joseph L, Liang MH, Tanzer M, Ferland D et al (1999) Outcomes of total hip and knee replacement: preoperative functional status predicts outcomes at six months after surgery. Arthritis Rheum 42(8):1722–1728

    Article  CAS  Google Scholar 

  9. Wylde V, Rookerb J, Halliday L, Blom A (2011) Acute postoperative pain at rest after hip and knee arthroplasty: severity, sensory qualities and impact on sleep. Orthop Traumatol Surg Res 97:139–144

    Article  CAS  Google Scholar 

  10. Winther SB, Foss OA, Klaksvik J, Husby VS (2020) Pain and load progression following an early maximal strength training program in total hip-and knee arthroplasty patients. J Orthop Surg 28(2):2309499020916392

    Google Scholar 

  11. Centers for Disease Control and Prevention (2009) Overdose deaths involving prescription opioids among Medicaid enrollees-Washington, 2004–2007. MMWR Morb Mortal Wkly Rep 58(42):1171–1175

    Google Scholar 

  12. Carter GT, Javaher SP, Nguyen MH, Garret S, Carlini BH (2015) Re-branding cannabis: the next generation of chronic pain medicine? Pain Manag 5(1):13–21

    Article  Google Scholar 

  13. Volkow ND, McLellan AT (2016) Opioid abuse in chronic pain—misconceptions and mitigation strategies. N Engl J Med 374(13):1253–1263

    Article  CAS  Google Scholar 

  14. Pinto PR, McIntyre T, Araújo-Soares V, Costa P, Ferrero R, Almeida A (2017) A comparison of predictors and intensity of acute postsurgical pain in patients undergoing total hip and knee arthroplasty. J Pain Res 10:1087

    Article  Google Scholar 

  15. Haley SM, Coster WJ, Andres PL et al (2004) Score comparability of short forms and computerized adaptive testing: simulation study with the activity measure for postacute care. Arch Phys Med Rehabil 85:661–666

    Article  Google Scholar 

  16. Jette DU, Stilphen M, Ranganathan VK, Passek SD, Frost FS, Jette AM (2014) Validity of the AM-PAC “6-Clicks” inpatient daily activity and basic mobility short forms. Phys Ther 94:379–391

    Article  Google Scholar 

  17. Salmon P, Hall GM, Peerbhoy D, Shenkin A, Parker C (2001) Recovery from hip and knee arthroplasty: patients’ perspective on pain, function, quality of life, and well-being up to 6 months postoperatively. Arch Phys Med Rehabil 82(3):360–366

    Article  CAS  Google Scholar 

  18. Norman-Taylor FH, Palmer CR, Villar RN (1996) Quality-of-life improvement compared after hip and knee replacement. J Bone Joint Surg Br vol 78(1):74–77

    Article  CAS  Google Scholar 

  19. Hall GM, Peerbhoy D, Shenkin A, Parker CJR, Salmon P (2000) Hip and knee arthroplasty: a comparison and the endocrine, metabolic and inflammatory responses. Clin Sci 98(1):71–79

    Article  CAS  Google Scholar 

  20. Pang WW, Hsu TC, Tung CC, Hung CP, Chang DP, Huang MH (2000) Is total knee replacement more painful than total hip replacement? Acta Anaesthesiol Sin 38(3):143–148

    CAS  PubMed  Google Scholar 

  21. Morris BJ, Mir HR (2015) The opioid epidemic: impact on orthopaedic surgery. JAAOS 23(5):267–271

    Article  Google Scholar 

  22. Menendez ME, Ring D, Bateman BT (2015) Preoperative opioid misuse is associated with increased morbidity and mortality after elective orthopaedic surgery. Clin Orthop Relat Res 473(7):2402–2412

    Article  Google Scholar 

  23. Zywiel MG, Stroh DA, Lee SY, Bonutti PM, Mont MA (2011) Chronic opioid use prior to total knee arthroplasty. JBJS 93(21):1988–1993

    Article  Google Scholar 

  24. Kidner CL, Mayer TG, Gatchel RJ (2009) Higher opioid doses predict poorer functional outcome in patients with chronic disabling occupational musculoskeletal disorders. J Bone Joint Surg Am 91(4):919–927

    Article  Google Scholar 

  25. Bohnert AS, Valenstein M, Bair MJ et al (2011) Association between opioid prescribing patterns and opioid overdose-related deaths. JAMA 305(13):1315–1321

    Article  CAS  Google Scholar 

  26. Yu S, Szulc A, Walton S, Bosco J, Iorio R (2017) Pain control and functional milestones in total knee arthroplasty: liposomal bupivacaine versus femoral nerve block. Clin Orthop Relat Res 475(1):110–117

    Article  Google Scholar 

  27. Collis PN, Hunter AM, Vaughn MDD, Carreon LY, Huang J, Malkani AL (2016) Periarticular injection after total knee arthroplasty using liposomal bupivacaine vs a modified Ranawat suspension: a prospective, randomized study. J Arthroplast 31(3):633–636

    Article  Google Scholar 

  28. Uquillas CA, Capogna BM, Rossy WH, Mahure SA, Rokito AS (2016) Postoperative pain control after arthroscopic rotator cuff repair. J Shoulder Elbow Surg 25(7):1204–1213

    Article  Google Scholar 

  29. Schwarzkopf R, Drexler M, Ma MW et al (2016) Is there a benefit for liposomal bupivacaine compared to a traditional periarticular injection in total knee arthroplasty patients with a history of chronic opioid use? J Arthroplast 31(8):1702–1705. https://doi.org/10.1016/j.arth.2016.01.037

    Article  Google Scholar 

  30. Wu L, Li M, Zeng Y, Si H, Liu Y, Yang P, Shen B (2020) Prevalence and risk factors for prolonged opioid use after total joint arthroplasty: a systematic review, meta-analysis, and meta-regression. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-020-03486-4

    Article  PubMed  Google Scholar 

  31. Padilla JA et al (2019) A novel opioid-sparing pain management protocol following total hip arthroplasty: effects on opioid consumption, pain severity, and patient-reported outcomes. J Arthroplast 34(11):2669–2675

    Article  Google Scholar 

  32. Yu S, Eftekhary N, Wiznia D, Schwarzkopf R, Long WJ, Bosco JA, Iorio R (2020) Evolution of an opioid sparse pain management program for total knee arthroplasty with the addition of intravenous acetaminophen. J Arthroplasty 35(1):89–94

    Article  Google Scholar 

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Authors and Affiliations

  1. New York University Langone Orthopaedic Hospital, 301 East 17 St, Manhattan, New York, NY, 10003, USA

    David N. Kugelman, Siddharth A. Mahure, James E. Feng, Joshua C. Rozell, Ran Schwarzkopf & William J. Long

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  1. David N. Kugelman
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  2. Siddharth A. Mahure
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  3. James E. Feng
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  4. Joshua C. Rozell
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  5. Ran Schwarzkopf
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  6. William J. Long
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Correspondence to William J. Long.

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Kugelman, D.N., Mahure, S.A., Feng, J.E. et al. Total knee arthroplasty is associated with greater immediate post-surgical pain and opioid use than total hip arthroplasty. Arch Orthop Trauma Surg 142, 3575–3580 (2022). https://doi.org/10.1007/s00402-021-03951-8

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  • DOI: https://doi.org/10.1007/s00402-021-03951-8

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