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J Knee Surg 2024; 37(06): 436-443
DOI: 10.1055/s-0043-1775872
Original Article

Postoperative Opioid Consumption is Greater after Simultaneous versus Staged Bilateral Total Knee Arthroplasty

Sara J. Sustich
1   Department of Orthopedic Surgery, University of Oklahoma, Oklahoma City, Oklahoma
,
Jeffrey B. Stambough 
2   Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
,
Ryan Hui
2   Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
,
Eric R. Siegel
3   Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
,
C. Lowry Barnes
2   Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
,
Simon C. Mears
2   Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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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


Publication History

Received: 06 September 2023

Accepted: 11 September 2023

Article published online:
18 October 2023

© 2023. Thieme. All rights reserved.

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