Postoperative Pain and Opiate Requirement is Increased Following Second-Side Surgery Among Patients Undergoing Staged Total Knee Arthroplasty
Background: Primary total knee arthroplasty (TKA) continues to grow exponentially, with a significant subset of patients requiring staged bilateral procedures. The optimal interval between staged procedures and effective strategies to minimize postoperative pain to enhance rehabilitation and mobilit...
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| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-02-01
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| Series: | Arthroplasty Today |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352344124002760 |
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| Summary: | Background: Primary total knee arthroplasty (TKA) continues to grow exponentially, with a significant subset of patients requiring staged bilateral procedures. The optimal interval between staged procedures and effective strategies to minimize postoperative pain to enhance rehabilitation and mobility remain poorly understood. Methods: 160 consecutive patients undergoing staged bilateral TKA between August 2017 and January-2021 was retrospectively reviewed. Patients with a history of chronic opioid dependency were excluded. Baseline demographics, primary outcome measures, including visual analog scale (VAS) pain scores, perioperative opioid utilization (MME/day), and surgical satisfaction were evaluated. All patients had a minimum follow-up of 1-year-postoperatively. All univariate and multivariate statistical analyses were performed with significance given by P < .05. Results: The mean interval between staged TKA was 8-weeks (standard deviation, 4.9-weeks). Preoperative VAS pain scores were significantly higher for the initial TKA, confirming that the more symptomatic knee was addressed first. Despite this, VAS pain scores were significantly increased following second-side TKA at 6-months postoperatively (P = .001). Multivariate analysis identified weekly interval duration between staged procedures as the single-most predictive factor of increased pain following second-side TKA (β = −0.106; P < .01). Female patients were increasingly susceptible to elevated pain levels following second-side TKA (β = 0.372; P = .057). Conclusions: Postoperative pain increases after second-side TKA in staged-bilateral procedures, despite the more symptomatic side being addressed first. Our study identified weekly interval between staged procedures as the single-most predictive factor of pain, and female patients being predisposed to heightened pain following second-side TKA; implicating nociceptive pathways require weeks to normalize, necessitating gender-specific pain management and extended intervals. |
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| ISSN: | 2352-3441 |