Abstract
Background
Total knee arthroplasty (TKA) is associated with increased risk of prolonged narcotic
requirement compared to total hip arthroplasty (THA). This study aims to compare acute
postoperative narcotic consumption between the 2 procedures and quantify amount of
narcotics used by opioid prescribed.
Methods
From October 2017 to August 2019, patients were surveyed at 4-week follow-up to determine
amount and duration of opioids used and whether they continued to require narcotics.
Among 1332 patients who self-identified as opioid naïve, 670 underwent THA and 662
underwent TKA. Descriptive analysis was performed based on data type.
Results
The total morphine equivalent dose (MED) used in the postoperative period was lower
in THA than in TKA (143 ± 160 vs 259 ± 250 MED, P < .001). The duration of use was shorter, total amount of pills consumed was lower,
and refill rates were less in THA compared to TKA regardless of which opioid was prescribed.
A smaller proportion of patients required narcotics at 4-week follow-up in THA compared
to TKA. A postoperative prescription of 45 pills of any one type of narcotic was sufficient
for nearly 90% of THA patients, and 60 pills of any one type of narcotic was appropriate
for over 75% of TKA patients.
Conclusion
THA is associated with less total narcotic consumption, shorter duration of use, less
refills, and lower likelihood of requiring narcotics at 4-week follow-up. Percentiles
of total narcotics consumed are provided to promote judicious postoperative prescribing
patterns, and one could consider further reducing narcotics when utilizing our protocol,
particularly for THA patients.
Level of Evidence
This is a level III retrospective cohort study reviewing narcotic use in over 900
consecutive opioid-naïve patients undergoing total hip and knee arthroplasty.
Keywords
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Article info
Publication history
Published online: May 04, 2020
Accepted:
April 26,
2020
Received in revised form:
April 23,
2020
Received:
March 24,
2020
Footnotes
One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to https://doi.org/10.1016/j.arth.2020.04.089.
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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© 2020 Published by Elsevier Inc.
