Abstract
Increased exposure to opioids around total knee arthroplasty (TKA) can lead to a risk
of long-term dependence. We hypothesized that performing simultaneous bilateral total
knee arthroplasty (simBTKA) over staged surgery (staged bilateral total knee arthroplasty
[stgBTKA]) may decrease the total amount of opiates used. We retrospectively reviewed
29 patients who underwent simBTKAs performed between February 2015 and November 2020
and identified 23 that did not use opioids ≤90 days prior to surgery. These were frequency
matched for gender and body mass index to 50 stgBTKAs completed within 6 months who
also were opioid-free ≤90 days prior to their first surgery. Using our state's prescription
database, we reviewed postsurgery opioid refills and morphine milligram equivalents
(MMEs) for the two groups and compared their initial MME prescription at discharge
and their total MME consumption 6 months postoperatively. Total MME consumption for
the stgBTKA group included all prescriptions following the first and 6 months after
the second surgery, whereas for the simBTKA group, total consumption included the
6 months after their two same-day surgeries. The simBTKA group had more MMEs prescribed
initially (median = 375) than did the stgBTKA group after second surgery (median = 300;
p < 0.007), larger postoperative-refill MMEs in the first 30 days (median = 300) than
stgBTKA (median = 0; p = 0.221) and increased total MME consumption 6 months after surgery (median = 675)
compared with stgBTKA after second surgery (median = 450; p = 0.077). However, both groups had similar monthly consumptions rates, with medians
I MMEs/month of 112 for simBTKA versus 96 for stgBTKA (p = 0.585). Our results suggest there is no significant difference in opioid consumption
between simBTKA and stgBTKA. In fact, we found that simBTKA patients received larger
opioid amounts in the immediate postoperative period as well as slightly larger amounts
at 30 days.
Keywords
opioid use - knee arthroplasty - bilateral TKA
