J Orthopaedic Experience & Innovation Stevenson, Maryann, and Andrew Wickline. 2020. “23-Hour TKA in 10 Opioid Pills or Less through 90 Days: A Non-Selected Prospective Consecutive One Year Cohort.” Journal of Orthopaedic Experience & Innovation, July.
Background Modern treatment protocols for pain management following total knee arthroplasty (TKA) rely heavily on opioid medications. The growing concerns over the opioid epidemic and complications from their use remain problematic. The primary purpose of this study was to enhance multimodal perioperative pain control to reduce opioid consumption after TKA.
Methods 386 prospective and consecutive patients who consented for unilateral TKA were enrolled in a 4 month long multi-modal protocol including a robust education and optimization program with home-based physical therapy. Patients also received a continuous adductor canal block (CACB) with ropivacaine. Opioid consumption, Numeric Rating Scale (NRS) Pain scores, KOOS Jr, and ROM was recorded at baseline and postoperative days 1,2,3 and 3 weeks, 6 weeks, and 12 week.
Results Though 12 weeks, 86.3% of patients undergoing TKA required 10 pills or less and 18.9% required no opioid pills. 50.5% took only tramadol rather than stronger opioids. Additionally, 85.4% of patients required no formal physical therapy (PT) through 12 weeks. 63.2% of patients were discharged the day of surgery, and 91.2% were discharged by the first postoperative day. 311 of 386 (80.6%) patients completed all KOOS Jr. evaluations. The mean KOOS Jr score increased from 53.1 at baseline to 71.8 at 6 weeks and 90.0 at 12 weeks. Mean flexion was 109.2 deg at 3 weeks and 115.8deg at 6 weeks. The 90 day readmission rate was 1.2%.
Conclusion A novel multimodal protocol combining consistent and patient specific preoperative education, CACB, and self-directed and unsupervised postoperative rehabilitation dramatically reduces narcotic needs, formal physical therapy needs, and decreases length of stay following TKA.
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